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| ID | Type | Description | Link |
|---|---|---|---|
| 2024-A00937-40 | Other Identifier | IDRCB |
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| Name | Class |
|---|---|
| Institut National de la Santé Et de la Recherche Médicale, France | OTHER_GOV |
| ART VIGGO Association for Research | UNKNOWN |
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Gout is characterized by episodes of acute arthritis of the lower limbs due to intermittent activation of innate immunity in the joints where urate crystals have formed. These crystals occur when serum urate (SUA) levels have been above 70 mg/L for many years. They can be dissolved by lowering SUA levels to at least 60 mg/L (treat-to-target - T2T - strategy). Once the crystals are dissolved, patients are no longer symptomatic and are considered to be in remission (treat-to-dissolve - T2D - strategy).
The presence of crystals and their dissolution during treatment can be monitored by repeated ultrasound (US) scans of the feet and knees.
The time required for complete dissolution varies from patient to patient. ReViGore40 is a cohort designed to i) determine the time to complete dissolution of urate deposits in joints when SUA levels are maintained below 40 mg/L, ii) determine the factors (clinical, biological, genetic) associated with the time required for complete dissolution of urate deposits within joints.
Patients with newly diagnosed gout according to the 2015 ACR/Eular criteria, not treated with urate-lowering therapy and with US evidence of urate deposition (feet, knees; ultrasound score ≥ 2/24) will be enrolled in the ReViGore40 cohort.
In all patients, SUA levels will be lowered with allopurinol or febuxostat (XOI) depending on renal function (eGFR greater or less than 30 ml/mn/m2) or uricosurics, by starting medications at a low dose and subsequent titration. The target SUA levels is less than 40 mg/L in all patients.
Patients will then be monitored by US every 6 months until complete urate crystals dissolution. An ultrasound score (min 0- max 24; 0 meaning no urate deposits and 24 the highest value for quantifying the extent of deposits) will be calculated for each US scan. Dissolution is considered to have been achieved when a score of 0/24 is reached on two successive US scans performed 6 months apart.
The Predictive Factors (clinical, biological, genetic) associated with the complete dissolution of urate deposits will be determined.
DECT (feet) will be performed only in tophaceous patients at M0 and M24. Each patient will receive a capillary urate point of care device for self-urate measurement. Patients will be contacted monthly by nurses for the first 6 months to ensure treatment compliance and SUA target attainment.
Blood samples will be collected at M0, M6, M24 and M36 for omic and epigenetic studies. Clinical data will be collected at M0, M6, M12, M24, M36 and M48. Change in Protein, Epigenetic and omic profils will be determined.
DNA for genetic studies will be collected at M0. Co-morbidities, particularly cardiovascular and hepatic, will be assessed at M6: coronary artery calcium (CAC) scoring and liver fibroscan.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Gout patients treated according to a Treat-to-Dissolve strategy | Patients initiated with ULT (urate target less than 40 mg/L), and followed every 6 months with Ultrasound until complete urate dissolution |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard X-Rays | Diagnostic Test | - Standard X-Rays: feet (Month 0) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Time required for complete dissolution of urate deposits | For each patient, urate deposit dissolution will be monitored by repeated US scans. The US features which will be recorded according to the Outcome Measures in Rheumatology (OMERACT) scoring system:
| Change between baseline (month 0) and up to 48 months after initiation of ULT |
| Measure | Description | Time Frame |
|---|---|---|
| Number of flares | Flares is defined when 3 of the following 4 criteria are present:
| At Month 0, Month 6, Month 12, Month 18, Month 24, Month 30, Month 36, Month 48 |
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Inclusion Criteria:
Exclusion Criteria:
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Gout patient managed according to a T2T (treat to target) strategy
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Pascal RICHETTE, PR | Contact | 0149956314 | pascal.richette@aphp.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| APHP, Lariboisière Hospital, Rheumatology departement | Recruiting | Paris | 75010 | France |
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| ID | Term |
|---|---|
| D006073 | Gout |
| ID | Term |
|---|---|
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D000070657 | Crystal Arthropathies |
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| ID | Term |
|---|---|
| D014463 | Ultrasonography |
| ID | Term |
|---|---|
| D003952 | Diagnostic Imaging |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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Lariboisière Center:
Month 6, Month 12 and Month 36: 1 EDTA tube 10 ml; 1 Paxgen 2 ml Month 24: 1 EDTA tube 10 ml; 1 EDTA tube 5 ml and 1 Paxgen 2 ml
For Lille and Rouen centers:
Month 6, Month 12; Month 24 and Month 36: 1 EDTA tube 10 ml; 1 Paxgen 2 ml
| Ultrasound | Diagnostic Test | - Ultrasound (score 0-24): assessment for DC (Double Contour) sign (0-3), aggregates (0-3), tophi (0-3) at MTP1s (first metatarsophalangeal joints) and DC sign (0-3) at both knees, according to the OMERACT, every 6 months until complete dissolution of urate deposits. |
|
| DECT of feet | Diagnostic Test | DECT of feet: in tophaceous patients only (Month 0, Month 24) |
|
| DNA sample | Biological | DNA will be collected at Month 0 |
|
| Serum collection | Biological | - Serum will be collected at Month 0, Month 6, Month 12, Month 18, Month 24 , Month 36 and Month 48. For OMICs and epigenetic studies: Month 0, Month 6, Month 24 and Month 36. |
|
| Health status as assessed by the EQ-5D-3L questionnaire |
Health status as assessed by the EQ-5D-3L descriptive system comprising the following five dimensions:
|
| At Month 0, Month 6, Month 12, Month 24, Month 36, Month 48 |
| Patient self-rated health on a vertical visual analogue scale (EQ VAS) | The EQ VAS records the patient's self-rated health on a vertical visual analogue scale from 0 to 100, with 100 being the best health and 0 corresponding to the worst health. | At Month 0, Month 6, Month 12, Month 24, Month 36, Month 48 |
| Health status as assessed by the HAQ-ID questionnaire | The questionnaire includes 8 sections: dressing, arising, eating, walking, hygiene, reach, grip, and activities, with 4 questions for each section. Scoring within each section is from 0 (without any difficulty) to 3 (unable to do). For each section the score given to that section is the worst score within the section. The 8 scores of the 8 sections are summed and divided by 8. The score obtained ranges from 0 to 3. The higher the score, the worse the state of health. | At Month 0, Month 6, Month 12, Month 24, Month 36, Month 48 |
| Proteins profils | Change in plasma Proteins concentrations | Month 0, Month 6, Month 24, Month 36 |
| D012216 |
| Rheumatic Diseases |
| D011686 | Purine-Pyrimidine Metabolism, Inborn Errors |
| D008661 | Metabolism, Inborn Errors |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |