Abstract
Objective
Streamlining the initiation of allopurinol could result in a cost benefit for a common
medical problem and obviate the perception that no treatment is required once acute
attacks have resolved. Our objective was to test the hypothesis that there is no difference
in patient daily pain or subsequent attacks with early versus delayed initiation of
allopurinol for an acute gout attack.
Methods
A total of 57 men with crystal-proven gout were randomized to allopurinol 300 mg daily
or matching placebo for 10 days. All subjects received indomethacin 50 mg 3 times
per day for 10 days, a prophylactic dose of colchicine 0.6 mg 2 times per day for
90 days, and open-label allopurinol starting at day 11. Primary outcome measures were
pain on visual analogue scale (VAS) for the primary joint on days 1 to 10 and self-reported
flares in any joint through day 30.
Results
On the basis of 51 evaluable subjects (allopurinol in 26, placebo in 25), mean daily
VAS pain scores did not differ significantly between study groups at any point between
days 1 and 10. Initial VAS pain scores for allopurinol and placebo arms were 6.72
versus 6.28 (P=.37), declining to 0.18 versus 0.27 (P=.54) at day 10, with neither group consistently having more daily pain. Subsequent
flares occurred in 2 subjects taking allopurinol and 3 subjects taking placebo (P=.60). Although urate levels decreased rapidly in the allopurinol group (from 7.8 mg/dL
at baseline to 5.9 mg/dL at day 3), sedimentation rates and C-reactive protein levels
did not differ between groups at any point.
Conclusions
Allopurinol initiation during an acute gout attack caused no significant difference
in daily pain, recurrent flares, or inflammatory markers.
Keywords
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Article Info
Footnotes
Funding: none.
Conflict of Interest: None. The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the US Government.
Authorship: All authors had access to the data and played a role in writing this manuscript. Reproducible Research Statement: Research study protocol, STATA statistical code, and data set, without personal identifiers, available from Thomas H. Taylor (e-mail: [email protected] ). This study was reviewed by the Veterans Affairs Research and Development Committee and received approval from the Dartmouth Medical School Institutional Review Board.
ClinicalTrials.gov registration number: NCT01310673.
Identification
Copyright
Published by Elsevier Inc.
