Does Starting XXXX Prolong Acute Treated Gout? A Randomized Clinical Trial.

@entity1 @entity697 @entity625 @entity1790 @entity158 @entity3812 @entity210 @entity208 @entity414
BACKGROUND: Traditionally, @entity208 is not initiated during an @entity697 to avoid prolonging the painful @entity625 . The 2012 American College of Rheumatology Guidelines for the Management of Gout suggest that urate-lowering therapy can be started during an acute attack, based on "consensus opinion of experts, case studies, or standard of care." OBJECTIVE: The aim of this study was to determine whether initiating @entity208 will adversely affect the resolution of acute, treated @entity210 . METHODS: We conducted a 28-day, placebo-controlled, double-blind study of @entity208 initiation in @entity1 with @entity697 . @entity1 with crystal-proven @entity210 by arthrocentesis were enrolled if they presented to the rheumatology clinic with an @entity697 within 72 hours from initial therapy. The @entity1 were also required to meet at least 1 additional criterion for urate-lowering therapy including (1) the presence of @entity697 per year, (3) a history of @entity1790 , or (4) urate overproduction (>1000 mg in 24-hour urine collection). @entity1 were excluded from the study if they had a glomerular filtration rate of less than 50 or liver function test of greater than 1.25 times the upper limit of normal. The treating physician determined therapy for the @entity697 . Standard prophylaxis, with @entity3812 or nonsteroidal anti-inflammatory drugs, was prescribed. @entity208 or placebo was initiated at 100 mg daily for the first 14 days and then increased to 200 mg daily for the next 14 days. The primary end point was protocol defined days to resolution of @entity697 , incorporating @entity1 -rated joint @entity158 and physician examination. Secondary measures included Physician Global Assessment, @entity1 -rated @entity158 , adverse effects of therapy, and serum @entity414 . RESULTS: Thirty-one @entity1 (17 on placebo, 14 on @entity208 ) completed the study. Both intent-to-treat and completer analyses showed only a statistically insignificant difference in days to resolution (15.4 days in the @entity208 group completers vs 13.4 days in the placebo group; P = 0.5). The secondary measures revealed that the acute phase of @entity158 rapidly improved in both groups. CONCLUSIONS: We initiated @entity208 at low doses during an @entity697 in @entity1 who met criteria for starting urate-lowering therapy and did not have abnormal kidney or liver function. In this cohort, @entity208 did not prolong the acute, treated attack.
