Tophus resolution with pegloticase: a prospective dual-energy CT study. Issue 1 (17th June 2015)

• Record Type: Journal Article
• Authors: Araujo, Elizabeth G; Bayat, Sara; Petsch, Christina; Englbrecht, Matthias; Faustini, Francesca; Kleyer, Arnd; Hueber, Axel J; Cavallaro, Alexander; Lell, Michael; Dalbeth, Nicola; Manger, Bernhard; Schett, Georg; Rech, Juergen
• Is Part Of: RMD open. Volume 1:Issue 1(2015)
• Publication Date: 2015-06-17
• Subjects: Gout -- Treatment -- Outcomes research; Musculoskeletal system -- Diseases -- Periodicals; Rheumatism -- Periodicals; 616.7005
• DOI: 10.1136/rmdopen-2015-000075
• Languages: English
• ISSNs: 2056-5933

Abstract

Abstract : Objective: To investigate the effect of intensive lowering of serum uric acid (SUA) levels by pegloticase on the resolution of tophi in patients with refractory gout. Methods: Descriptive study in patients with refractory gout receiving pegloticase treatment. SUA levels were measured before and after each infusion. Dual-energy CT (DECT) scans were taken from all patients before the first infusion and after the last infusion. Computerised tophus volumes were calculated for the baseline and follow-up assessments and compared with each other. Results: 10 patients with refractory gout and baseline mean SUA level of 8.1 mg/dL were enrolled. Patients were treated for a mean of 13.3 weeks. Pegloticase effectively reduced tophi in all patients showing a decrease in volume by 71.4%. Responders, showing reduction of SUA level below 6 mg/dL during at least 80% of the treatment time, were virtually cleared from tophi (−94.8%). Dependent on their anatomical localisation, resolution of tophi showed different dynamics, with articular tophi showing fast, and tendon tophi slow, resolution. Conclusions: Tophi are highly sensitive to pegloticase treatment, particularly when located at articular sites. Debulking of disease and a tophus-free state can be reached within a few months of pegloticase treatment. DECT allows for comprehensively assessing tophus burden and monitoring treatment responses.