Background In real life, urate levels are not maintained below the target of 6 mg/dL in a substantial proportion of gouty patients receiving urate-lowering therapy (ULT).
Objectives To search for factors associated with poor control of serum urate levels (sUA) in a large population of gouty patients receiving ULT.
Methods This is a cross-sectional multicentre study. Demographic, clinical data and recent (<1year) sUA levels were collected from 2444 gouty patients by 857 general practitioners and 92 rheumatologists from November 2010 to May 2011. Of these, 1689 patients were receiving ULT. Uni and multivariate logistic regression were used to search determinants for sUA level >6mg/dL.
Results 76% of the 1689 patients (mean age 64±12 years; men 85%) under ULT (xanthine oxidase inhibitors 96.6%) had urate levels above the recommended sUA target of 6mg/dL. Univariate analysis showed that patients with sUA levels above 6 mg/dl were older (p=0.003), consumed more sweetened soft drinks (>1 serving a day, p=0.02) and alcohol (≥30g/day, p=0.0001), had a higher waist circumference (p=0.02), and a shorter disease duration (p=0.01). These determinants persisted in multivariate logistic regression analysis after adjustment for potential confounders: sweetened soft drinks consumption (OR=1.55, 95%CI=0.99-2.43, p=0.05), alcohol consumption (OR=1.39, 95%CI=1.08-1.78, p=0.01), higher waist circumference (OR=1.38, 95%CI=1.01-1.88, p=0.04) and a shorter disease duration (less than 5 years) (OR=1.11, 95%CI=1.02-1.22, p=0.02).
Conclusions This study shows that a large proportion of gouty patients receiving ULT are not adequately treated. Sweetened soft drinks and alcohol consumption, waist circumference and short disease duration are associated with a poor urate levels control. Reinforcement of lifestyle interventions and dietary modifications may improve adequate control of sUA in patients suffering from chronic gout and receiving ULT.
Disclosure of Interest None Declared