title: Factors associated with acute gout attacks in normouricaemic gout patients receiving allopurinol: a retrospective study.
abstract: OBJECTIVE
  To identify factors associated with acute gout attacks in normouricaemic gout patients receiving allopurinol.
  
  
  METHODS
  We reviewed the medical records of 860 patients with chronic gout who were treated with allopurinol at a single tertiary hospital between 2003 and 2009. Of these, 135 patients had serum urate concentrations ≤ 360 μmol/L (6 mg/dL). Patients whose serum urate concentrations exceeded 360 μmol/L (6 mg/dL) at least once during follow-up were excluded. Patients who experienced at least one acute attack during follow-up, despite normouricaemia [≤ 360 μmol/L (6 mg/dL)], were classified as the Attack group (n = 51). The others were classified as the Non-attack group (n = 84).
  
  
  RESULTS
  The gout disease duration was significantly longer in the Attack group than in the Non-attack group (p = 0.036). The presence of tophi and multiple joint involvement were associated with acute attacks in normouricaemic gout patients. Multivariate analysis showed that both the presence of tophi [odds ratio (OR) 4.16, 95% confidence interval (CI) 1.41-12.23, p = 0.010] and the number of involved joints (OR 1.51, 95% CI 1.05-2.17, p = 0.028) were independently associated with acute attacks in normouricaemic gout patients receiving allopurinol.
  
  
  CONCLUSIONS
  The presence of tophi and multiple joint involvement were associated with acute attacks in normouricaemic gout patients receiving allopurinol.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Korea.
authors.forename: M W
authors.initials: MW
authors.lastname: So
authors.forename: S G
authors.initials: SG
authors.lastname: Lee
authors.forename: Y-G
authors.initials: YG
authors.lastname: Kim
authors.forename: C-K
authors.initials: CK
authors.lastname: Lee
authors.forename: B
authors.initials: B
authors.lastname: Yoo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage*; D015210:Arthritis, Gouty / Q000150:complications; D006073:Gout / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006074:Gout Suppressants / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol