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Interventions for tophi in gout.

Melonie K Sriranganathan1, Ophir Vinik, Claire Bombardier

  • 1Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, UK, SO16 6YD.

The Cochrane Database of Systematic Reviews
|October 21, 2014
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Summary
This summary is machine-generated.

Pegloticase effectively reduces tophi in gout patients, but carries a high risk of infusion reactions. Further research is needed on other treatments, including surgery, for gout tophi management.

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Area of Science:

  • Rheumatology
  • Pharmacology
  • Clinical Trials

Background:

  • Tophi are a common complication of untreated or uncontrolled gout.
  • The presence of tophi can lead to severe and potentially fatal complications.
  • No systematic reviews have previously focused on the management of tophi in gout.

Purpose of the Study:

  • To assess the benefits and harms of non-surgical and surgical treatments for tophi management in gout.
  • To evaluate the efficacy of urate-lowering therapies and surgical interventions for tophi resolution.
  • To identify the risks and benefits associated with different treatment modalities for gout tophi.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) and controlled clinical trials.
  • Searched Cochrane CENTRAL, MEDLINE, and EMBASE databases, supplemented by hand-searched abstracts and reference lists.
  • Included studies examining interventions for tophi in adult gout patients, including pharmacological treatments and surgical removal.

Main Results:

  • One study, comprising two RCTs, met inclusion criteria, evaluating pegloticase versus placebo.
  • Moderate-quality evidence suggests biweekly pegloticase 8 mg infusion reduced tophi in 21/52 participants compared to 2/27 on placebo (NNTB=3).
  • Biweekly pegloticase increased withdrawals due to adverse events (NNTH=7), primarily infusion reactions, compared to placebo.

Conclusions:

  • Pegloticase likely benefits gout patients by resolving tophi but poses a significant risk of adverse infusion reactions.
  • Further RCT data are required to evaluate other interventions, including surgical tophi removal.
  • The current evidence base for gout tophi management is limited, necessitating more comprehensive research.