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Background The evaluation of radiographic damage in inflammatory arthritis has been considered important, because structural damage of affected joints impairs the functional status of patients with various inflammatory rheumatic diseases and increases their economic problems and mortality [1, 2]. However, there has still been no relevant radiographic index for damage of affected joints in patients with chronic gouty arthritis. Modified SvdH scoring method has been proposed to be an alternative method [3], however, it seems to be so complex and also lack of relevance to use in clinical practice. Objectives The aim of this study was to develop and validate more a simple method to score radiographic damage measurement in patients with chronic gout. Methods Two independent observers read foot x-rays using the DAmagE index of GoUt score method (DAEGU score) and the modified Sharp/van der Heijde (SvdH) method. The 10 metatarsophalangeal (MTP) and 2 interphalangeal (IP) joints of the first toes of both feet from 15 patients with chronic gout were scored on plain radiography for erosion and joint space narrowing (JSN) (180 total joints). The intraobserver and interobserver reliability were analyzed by intraclass correlation coefficient (ICC) and minimal detectable change (MDC). The correlation between the DAEGU and SvdH methods was analyzed using Spearman9s correlation coefficients and Kappa coefficients. Results The intraobserver and interobserver ICCs for the DAEGU method were 0.945–0.987 and 0.993–0.996, respectively. The MDC at the 95% confidence interval (MDC95) showed 0.5–2.1 and 0.3–0.7 in the intra- and interobserver analyses, respectively. Strong positive correlations were represented between the DAEGU and SvdH methods for each radiological abnormality including erosion, JSN, and total score (correlation coefficients: r =0.870–0.985, p Conclusions This study demonstrated that the DAEGU score had a high reproducibility and strongly correlated with SvdH. The DAEGU method may provide a more easy assessment of structural damage in patients with chronic gout. References Kavanaugh A, et al. J Rheumatol 2004;31:849–55. Gladman DD, et al. Arthritis Rheum 1998;41:1103–10. Dalbeth N, et al. Arthritis Rheum 2007;57:1067-73. Disclosure of Interest None declared

Gout is an ancient disease that has caused pain and suffering over many centuries. The tragedy is that today we have excellent medication for the prevention of chronic gout, yet many people continue to be plagued by gout attacks and develop chronic arthritis. The incidence of gout is increasing worldwide. This is related to ageing and lifestyle changes. Gout is increased in people with the metabolic syndrome, obesity, use of diuretics and intake of beer and sugared drinks. This video and associated Powerpoint presentations should help anyone who manages patients with gout to understand how to elicit a good history, examine them and generate …

Objectives To compare functional limitations in patients with chronic gout and matched patients with rheumatoid arthritis (RA) as measured with the HAQ-DI and PF-10. Methods Consecutive patients with crystal deposition proven gout (n=102) or with RA (n=619) visiting the outpatient rheumatology clinic of the hospital in Enschede, the Netherlands completed the HAQ-DI and PF-10. Gout patients were matched to patients with RA on sex, age (± 5 years) and disease duration (±5 years). Ninety-three patients with gout could be successfully matched to 93 patients with RA. The HAQ-DI contains 20 items measuring physical disabilities over the past week in eight categories of daily living. Items are scored on a 4-point rating scale from 0 (without any difficulty) to 3 (unable to do). A total score is calculated by averaging the highest score in each category if at least six categories are completed. The PF-10 is the physical functioning scale of the multidimensional SF-36v2. It measures current limitations in a variety of physical activities using 10 items. Items are scored from 1 (yes, limited a lot) to 3 (no, not limited at all). Scores on the PF-10 items are summed and linearly transformed to range between 0 and 100, with higher scores indicating better functioning. Results In both disease groups mean age was 59 (± 12) years, mean disease duration was 7 (±9) years and 86% of patients were male. Median PF-10 scores did not significantly differ between patients with gout or with RA and ceiling effects (no limitations) were similar (6.7% versus 6.5%) (see table). However, patients with RA had significantly worse HAQ-DI total scores than patients with gout, and ceiling effects were significantly lower in RA than in gout. Analysis of HAQ-DI category scores showed that gout patients had less limitations in activities that involve the upper extremities such as Dressing, Eating, Hygiene and Grip than RA patients, while scores for activities mostly involving the lower extremities were similar. Image/graph: Conclusions Gout patients have less functional limitations than RA patients according to HAQ-DI total scores, while according to PF-10 scores gout patients and RA patients do not significantly differ in functional limitations. HAQ-DI seems to underestimate the functional limitations of gout patients compared to RA patients because of the inclusion of activities involving upper extremities, which may be less relevant for patients with gout. On the other hand PF-10 seems to underestimate the functional limitation of patients with RA because of the emphasis on activities involving lower extremities. Disclosure of Interest None Declared

Gout is a chronic metabolic and inflammatory disease whose sine qua non is hyperuricemia. The acute attacks seen in gout are merely the “tip of the iceberg” and represent the effector response to a set of conditions that lead to monosodium urate precipitation and deposition. Moreover, the chronic state of gout is accompanied by co-morbidities that are not resolved when the inflammatory attacks are treated. In consequence, gout must be thought of as a chronic rather than an intermittent condition, and gout treatment should be considered a long-term, and possibly lifelong endeavor. In this brief talk we will consider the chronic nature of gout, as well as current recommendations for chronic gout treatment (diet, lifestyle, and anti-inflammatory and urate-lowering pharmacotherapy), and for assessment of treatment outcomes, including the potential use of imaging. We will also discuss the possibility that good gout treatment initially results in easier gout treatment later on (“debulking”, or Perez-Ruiz’s “dirty dish” hypothesis), and the question of whether “tight control” of gout may have benefit not only for gout, but for gout’s co-morbidities as well. Disclosure of Interest M. Pillinger Grant/research support from: Savient Pharmaceuticals, Takeda Pharmaceuticals

Background Gouty arthritis-causing uric acid is persistently in excess in the form of tophi. The ultimate therapeutic ideal should be to completely eliminate all tophi. So far, clinicians have relied on physical examination and plain radiographs to assess the locations and sizes of Gouty tophi. The dual energy computerized tomography (DECT), magnetic resonance imaging (MRI), 2-fluoro-deoxy-D-glucose (FDG) positron emission tomography (PET) each offers a different perspective of gouty tophi. None of the papers have used all four techniques concomitantly, no guidelines are available concerning their applications. Objectives To visualize in a gout patient,using four different imaging techniques,the locations, sizes, compactness of tophi. Methods The feet and knees were imaged by X-ray, MRI, DECT and PET. Results DECT uncovered deposits in unexpected locations. The combination of DECT, MRI and PET showed that tophi were much larger and more inflammatory than clinically suspected. Conclusions The locations and sizes of tophi in chronic gout patients can far exceed those accessible by physical examination and X-ray. These can be critical when making decisions concerning the initiation and aggressiveness of serum uric acid- lowering therapies. References Neogi T. Clinical practice. Gout. N Engl J Med. 2011 Feb 3;364(5):443-52. Dalbeth N, McQueen FM. Use of imaging to evaluate gout and other crystal deposition disorders. Curr Opin Rheumatol. 2009 Mar;21(2):124-31. Choi HK, Al-Arfaj AM, Eftekhari A, Munk PL, Shojania K, Reid G, et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis. 2009 Oct;68(10):1609-12. Nicolaou S, Yong-Hing CJ, Galea-Soler S, Hou DJ, Louis L, Munk P. Dual-energy CT as a potential new diagnostic tool in the management of gout in the acute setting. AJR Am J Roentgenol. 2010 Apr;194(4):1072-8. Ko KH, Hsu YC, Lee HS, Lee CH, Huang GS. Tophaceous gout of the knee: revisiting MRI patterns in 30 patients. J Clin Rheumatol. 2010 Aug;16(5):209-14. Disclosure of Interest None Declared

Background The Medical Outcomes Study Short-Form 36 (SF-36) has been endorsed as a valid instrument for measurement of health related quality of life (HRQoL) in gout at the International Consensus Conference on Outcome Measures in Rheumatology (OMERACT 9) [1] Objectives To compare HRQoL in patients with chronic gout and matched patients with rheumatoid arthritis (RA) as measured with the SF-36 version 2 (SF-36v2). Methods Consecutive patients with crystal deposition proven gout (n=102) or with RA (n=619) visiting the outpatient rheumatology clinic of the hospital in Enschede, the Netherlands completed the SF-36v2. Gout patients were matched to patients with RA on sex, age (± 5 years) and disease duration (±5 years). Ninety-three patients with gout could be successfully matched to 93 patients with RA. SF-36v2 measures eight aspects of HRQoL with a total of 36 items (Physical Functioning (PF), Role problems as a result of physical health (RP), Bodily Pain (BP), General health (GH), Vitality (VT), Social Functioning (SF), Mental Health (MH) and Role problems as a result of emotional problems (RE)), as well as two summary scores for physical health (Physical Component Summary, PCS) and mental health (Mental Component Summary, MCS). Differences in the eight aspects and two summary scores of HRQoL between patients with gout and RA were tested by t-tests. Results In both disease groups mean age was 59 (± 12) years, mean disease duration was 7 (±9) years and 86% of patients were male. HRQoL scores in matched groups of patients with gout and RA were highly similar (see table). Mean differences between patients with gout and RA were small and non-significant for all scales and both summary scores. Image/graph: Conclusions As measured with SF36, the impact of chronic gout is highly similar to the impact of RA on health related quality of life. References Grainger R, Taylor JW, Dalbeth N et al. Progress in Measurement Instruments for Acute and Chronic Gout Studies. J Rheumatol 2009; 36:2346–55 Disclosure of Interest None Declared

Background Urate-lowering therapy (uric acid Objectives To comparerecurrent gout attacks in chronic gout treated by US findings normalization strategy or ULT strategy. Methods We designed an open label, randomized controlled trial. We screened 74 chronic gout (uric acid>7.0 mg /ld., and double contour sign of US findings in any joint) for inclusion. 63 gout patients were randomly allocated either US strategy group (US group) or ULT group(C group). In both strategies febuxostat is used. US strategy is performed US by 4 weeks. Double contour sign or urate crystals were evaluated; febuxostat is intensified to dissolve it. ULT strategy is performed blood examination by 4 weeks. Febuxostat is intensified to target uric acid Results The characteristics of each group at baseline were not significantly different. There was no significant difference in the proportion of no recurrent attack within 52 weeks between the US strategy (87.6%) and ULT strategy (83.4%) groups. There was no significant difference in the occurrence of adverse events (AEs) between the US strategy and ULT strategy groups. Conclusions In chronic gout, if the patients were treated by febuxostat, US without blood examination might be equivalent to uric acid in blood. References A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia. Chowalloor PV, et al. Ann Rheum Dis. 2013 Jan 3. [Epub ahead of print]2. EULAR evidence based recommendations for gout . Part II:Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT). Zhang W, et al. Ann Rheum Dis. 2006 Oct;65(10):1312-24. Epub 2006 May 17.3. Efficacy and Tolerability of Febuxostat in Hyperuricemic Patients With or Without Gout : A Systematic Review and Meta-Analysis. Ye P, et al. Clin Ther. 2013 Jan 15. doi:pii: S0149-2918(12)00723-0. 10.1016/j.clinthera.2012.12.011. Disclosure of Interest : None Declared