The ideal serum urate levels required for the clearance of monosodium urate tissue deposits in chronic gout patients are debatable. The connection between blood urate levels during medication and the rate of decrease of tophi in patients with chronic tophaceous gout is investigated in the observational, prospective study. Sixty-three patients with crystal-confirmed tophaceous gout were treated with allopurinol, benzbromarone, or a combination of the two drugs to lower serum uric acid levels below the threshold for tissue urate saturation. The tophi that were chosen for follow-up evaluation were the ones with the biggest diameter detected during physical examination. Patients who received benzbromarone alone or in combination with allopurinol and benzbromarone therapy had a faster rate of tophi reduction than those who received allopurinol alone. During therapy, the rate of tophi decrease was proportional to the mean serum urate level. The faster tophi are reduced, the lower the serum urate levels are. In patients with tophaceous gout, serum urate levels should be reduced enough to encourage urate deposit breakdown. When appropriate serum urate levels are achieved during medication, both allopurinol and benzbromarone are equally efficacious. Patients who do not exhibit enough reduction in serum urate levels with single-drug therapy may benefit from combined therapy.
Link:onlinelibrary.wiley.com/doi/full/10.1002/art.10511
