Background Gout prevalence is increasing mainly due to an increase in the overall longevity and in the prevalence of risk factors such as obesity, alcohol, high intake of purines, hypertension, and renal disease1. Patients commonly experience ongoing clinical manifestations of the disease due to failure to reduce serum urate (sUr) below the therapeutic target, despite access to treatment, and therefore represent “treatment failure gout”2. Chronic refractory gout is the persistent of clinical manifestations despite implementation of treatments and procedures to optimally reduce sUr to target therapeutic levels3. These patients commonly show the highest prevalence of comorbid conditions.
Objectives Analyze the long term impact of autoinflammation of gout in the comorbidities.
Methods Observational, retrospective, multicenter and national study. Data were collected retrospectively in 34 centres for all patients aged ≥18 years, with diagnosis of gout (≥10 years previous). Comorbidities were assessed at diagnosis and at the last available data previous to inclusion, including renal function impairment, hypercholesterolemia, cerebrovascular diseases, ischemic heart disease, diabetes mellitus, hypertension, gastrointestinal disorders, hyperlipidaemia and other cardiovascular diseases. The number of hospitalizations and emergency room (ER) visits was also evaluated.
Results 394 patients were included, mean age (SD) of 63.6 (11.5), mostly men (90.6%). The mean age at diagnosis was 49.6 (13.3) years. Most patients had a diagnosis based on monosodium urate crystals (89.5%) and 33.5% showed subcutaneous tophi [5.3 (5.9)]. In the last year, the mean number of hospitalizations was 1.3 (0.8) [35.1% due to comorbilities, 18.9% to gout flares] and the mean number of ER visits was 1.8 (1.6) [53.1% due to gout attack and 23.9% to comorbidities]. Overweight and obesity were present in 45.7% and 39.6% respectively. After a mean period of 14 years the comorbidities rates increases were (diagnosis vs study): hyperlipidaemia (37.8% vs 58.8%), hypertension (18.3% vs 50.9%), hypercholesterolemia (13.2% vs 34.8%), diabetes mellitus (5.6% vs 14.3%), gastrointestinal disorders (3.1% vs 6.0%), cerebrovascular diseases (2.0% vs 4.9%) and renal impairment (6.4% vs 19.8%). The most common treatments in the last year were allopurinol (85.3%), colchicine (56.4%) and NSAIDs (41.4%), the first two most commonly used for maintenance therapy (86.9% and 61.7%) and NSAIDs for the acute treatment (68.7%).
Conclusions Results from this study display a substantial increase of comorbidities from the onset of gout in patients with longstanding gout. Comorbidities (one in three), but also gout (one in five) were common causes for hospital admission and ER visits.
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Wu EQ, Forsythe A, Guérin A, Yu AP, Latremouille-Viau D, Tsaneva M. Comorbidity burden, healthcare resource utilization, and costs in chronic gout patients refractory to conventional urate-lowering therapy. Am J Ther 2012; 19(6): e157-66.
Disclosure of Interest F. Pérez-Ruiz : None Declared, R. Viana Employee of: Novartis, J. Galera Employee of: Novartis