[ACR22] Metabolic and Crystal Arthropathies

Author: Diego Benavent

Botson et al (0001) assessed the efficacy and safety of pegloticase (PEGylated uricase) with methotrexate (MTX) vs placebo (PBO) as co-therapy, in the MIRROR RCT trial. Efficacy endpoints were proportion of responders, proportion with resolution of ≥1 tophus, and time to serum uric acid (sUA) monitoring discontinuation (2 consecutive pre-infusion sUA >6 mg/dL) at month 12. Response rate was 60.0% (60/100) vs 30.8% (16/52) in the MTX vs PBO group (difference: 29.1% , 95% CI 13.2-44.9, p< 0.001), while 22.9% (22/96) of the MTX and 63.3% (31/49) of the PBO group met sUA discontinuation criteria. 53.8% (28/52) vs 31.0% (9/29) had complete resolution of ≥1 tophus at week 52 (difference: 22.8% , 95% CI 1.2-44.4, p = 0.048). Safety profile was similar between groups.

Parikh et al (1239) described the use of dual-energy computed tomography (DECT) in a cohort of patients throughout the years 2013-2022. A total of 280 DECT scans were performed, yielding a global sensitivity of DECT of 75% and specificity of 50% in diagnosing gout, using positive MSU crystals as the gold standard. When DECT was considered the standard of reference, joint aspiration showed a sensitivity of 33% and specificity of 86%.

Johnson et al (1580) investigated the associations of gout and gout treatment status with major adverse cardiovascular events (MACE), heart failure (HF) hospitalization, and cardiovascular disease (CVD)-related death in a national cohort of US Veterans. 559,243 gout patients were matched to 5,407,379 non-gout controls. Crude incidence rates of individual CVD events were higher in gout vs. non-gout (HR: 1.24, 95% CI 1.23, 1.25), as well as adjusted HF hospitalization (aHR 1.60, 95% CI 1.57-1.64). Gout patients were at higher risk of HF-related death (aHR 1.25, 95% CI 1.21-1.29), and MACE (aHR 1.22, 95% CI 1.21-1.23).

Pascart et al (1795) assessed treatment modalities used in European tertiary hospitals for the management of patients with chronic calcium pyrophosphate deposition (CPPD) disease. Among 129 patients, 194 treatments were initiated; the most frequent first-line therapy was colchicine (n= 83, 72.8%), followed by methotrexate (n= 36, 27.9%). Anakinra (n= 27, 20.9%) and tocilizumab (n= 25, 19.4%) were the most frequently used biological therapies.

McCormick et al (1805) evaluated whether intake of fruit juice and other fructose-rich beverages was associated with risk for gout flares. In this prospective case-crossover study, 862 people with gout were included, among who 126 had ≥ 1 gout flare during the study period and completed ≥ 1 non-flare questionnaire. Higher intake of fruit juice and other sugary beverages were each associated with increased risk for flare (OR 3.07, 95% CI 1.31-7.19, with ≥3 servings of either of them).

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