Elevated Serum CA72-4 May Predict Gout Flares During ULT Initiation

Gout flares can begin suddenly and last for weeks at a time. Flares are characterized by intense pain, swelling, redness, and heat in joints. Utilizing urate-lowering therapies (ULTs) can substantially reduce the risk of gout flares; however more than one-half of patients with gout at the time of ULT initiation. In addition, many gout patients have contraindications and/or experience negative side effects to frequently prescribed anti-inflammatory medications for flares.

A notable biomarker for gastrointestinal, pancreatic, ovary, and breast cancer is a glycoprotein known as CA72-4. Several observational studies have reported that serum CA72-4 was elevated in patients with gout, suggesting that CA72-4 may be a useful biomarker in the diagnosis and prognosis of gout. A lingering question that was raised following these studies was whether serum CA72-4 was an independent predictor for gout flare or if confounding variables were accountable for the association.

A 24-week prospective study, published in Rheumatology, was conducted to determine if indeed serum CA72-4 was an independent predictor for gout flares in a cohort of gout patients initiating ULT. Identifying 212 men with at least one gout flare in the past year and at least three serum CA72-4 measurements in the previous 6 months, participants began ULT treatment (fixed low-dose febuxostat) and attended in-person clinical visits every 4 weeks until the end of the study period. The incidence of gout flares was compared between those with high levels of CA72-4 and those with normal levels of CA72-4.

The overall incidence of at least one gout flare across both groups was 48.1%, 62.1% in the high CA72-4 group, and 38.4% in the normal CA72-4 group. The incidence of recurrent gout flares was 47.1% in the high CA72-4 group compared with 23.2% in the normal CA72-4 group.

Using logistic regression to identify risk factors associated with gout flares, researchers found that high CA72-4, duration of gout, intraarticular tophus size, high glucose levels, and high cholesterol were independent risk factors for gout flares.

“The reasons why serum CA72-4 is elevated in gout patients remain unclear,” the researchers wrote. “We speculate that increased CA72-4 in gout patients could be a consequence of urate priming or monosodium urate crystal-induced phagocyte or mucosal cell activation.”

The researchers concluded by noting that monitoring changes of CA72-4 in patients with gout may have potential to identify which patients may benefit from gout flare prophylaxis during ULT initiation.