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SAT0368 Role of joint ultrasonography in patients with gout starting treatment with febuxostat

Background Gout is the most prevalent arthritis globally, it is due to monosodium urate (MSU) crystals deposit on tissues, mainly in joints and periarticular structures. Although the main clinical pattern in gout is monoarticular, many patients suffer from oligo/polyarticular disease. Due to the information obtained through imaging tests such as ultrasonography (US), we know that the extent of MSU deposits are greater than we expected in many occasions, affecting clinically silent joints. Musculoskeletal US is a key tool due to its accessibility and safety, it determines accurately the current extent of deposits and joint involvement in gout, which may condition therapeutic changes. Objectives To evaluate the influence of articular US for clinical practice in Rheumatology when initiating treatment with febuxostat in patients with gout, determining the degree of crystalline deposit and articular ultrasonographic involvement. Methods Observational cross-sectional study of 129 patients diagnosed with gout (ACR criteria), treated with febuxostat (14 due to renal disease, adverse reaction/intolerance to allopurinol, and 115 due to non-response to allopurinol). One month after the onset of treatment, US examination was performed following the protocol proposed by Peiteado et al1, determining the number of joints with signs of gout (double contour, hyperechoic aggregates) and acute inflammatory activity (Doppler). Other variables were analysed: age, sex, hypertension, diabetes, dyslipidemia, chronic kidney disease, time of disease evolution and clinical pattern of joint involvement. Results 115 patients with febuxostat (112 men and 3 women), with a mean age of 57±13 years and mean of disease evolution 14±10 years. 59 patients had monoarticular clinical pattern, 46 oligoarticular and 10 polyarticular. US involvement: we observed acute inflammatory activity by Doppler in 47 patients (40.86%), microcrystalline aggregates in 90 patients (78.26%) and double contour sign in 53 patients (42.08%). The mean uricemia at the time of the joint ultrasound examination was 7.4±1.8 g/dl. Of the 94 patients with uric acid levels>6 mg/dl, 72 presented extensive US involvement (76.59%), whereas of the 21 patients with levels<6 mg/dl, US involvement was observed in 18 (85,71%). From the observed variables, none was a risk predictor for joint involvement in binomial logistic regression model. Uricemia presented OR=0.83 CI (0.6–1.1) Conclusions US quantification of MSU deposits can significantly condition the intensity of uricemia-reducing treatment regardless of serum uric acid levels. In this study, patients with non-target uricemia did not present a greater joint affection evaluated by US, however, those with <6 mg/dl, did present more affectation than might be expected. US examination of joints allows a more precise individualization of the treatment in gout and should be incorporated to the periodic evaluation of these patients to optimise their prognosis Reference [1] Peiteado D, et al. Value of a short four-joint ultrasound test for gout diagnosis: a pilot study. Clin Exp Rheumatol2012;30:830–7. Disclosure of Interest None declared