Rheumatology: elevated serum CA72-4 predicts gout attacks at the start of urate-lowering therapy, a prospective cohort study

Purpose: Gout attacks are common at the start of urate-lowering therapy (ULT), but the predictors of these episodes are unclear
.
The aim of the study was to determine whether serum CA72-4 is an independent predictor of gout attacks during ULT initiation.

Methods: A prospective cohort study
was conducted between March 2021 and January 2022.
Male patients with gout who had at least one gout attack in the past year and at least three serum CA72-4 measurements
in the past six months were included.
Participants were grouped
according to their highest recorded serum CA72-4 level (above or within the normal range).

All participants took febuxostat 20 mg daily without seizure prophylaxis and had face-to-face visits every four weeks until 24 weeks
.
The incidence
of gout attacks was compared between the two groups.
Inverse stepwise logistic regression analysis is used to determine risk factors
associated with episodes.
ROC curve analysis is used to evaluate the prediction effect
.

Results: A total of 193 people completed the study (79 with high CA72-4; 114 people with normal CA72-4).

The cumulative incidence of at least one gout attack was 48.
1% (62.
1% in the high CA72-4 group, 38.
4% in normal CA72-4, P = 0.
001), and the recurrence (≥ 2) gout attack rate was 33.
0% (47.
1% in the high CA72-4 group, 23.
2% in normal CA72-4, P <0.
001).

High CA72-4, duration of disease, intra-articular gout size, glucose, high-density lipoprotein cholesterol, and erythrocyte sedimentation rate are independent risk factors
for gout attacks.
Serum CA72-4 alone predicted recurrent episodes, with an AUC of 0.
63 (95% CI = 0.
54 to 0.
71) and an AUC of 0.
78 (95% CI = 0.
71 to 0.
85)
when combined with other independent variables.

Conclusion: High serum CA72-4 predicts the risk of gout attacks during ULT initiation.

Sources:

Hu S, Sun M, Li M, et al.
Elevated serum CA72-4 predicts gout flares during urate lowering therapy initiation: a prospective cohort study [published online ahead of print, 2022 Nov 21].
Rheumatology (Oxford).
2022; keac656.
doi:10.
1093/rheumatology/keac656.