Tophus resolution with pegloticase: a prospective dual-energy CT study

Language
en
Document Type
Article
Issue Date
2017-01-26
Issue Year
2015
Authors
Araujo, Elizabeth G.
Bayat, Sara
Petsch, Christina
Englbrecht, Matthias
Faustini, Francesca
Kleyer, Arnd
Hueber, Axel J.
Cavallaro, Alexander
Lell, Michael
Dalbeth, Nicola
Editor
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.

Journal Title
RMD Open
Volume
1
Issue
1
Citation
RMD Open 1.1 (2015) . <http://rmdopen.bmj.com/content/1/1/e000075>