Background Despite a significant progress in treatment (ttt) of gout, urate-lowering ttt (ULT) remains problematic, in our country too, partly because the patients with gout are often observed by non-rheumatologists (n-rhs).
Objectives To assess some aspects of ULT in gout, to evaluate its regularity and effectiveness by rheumatologists (rhs) and interviewed patients.
Methods 360 patients with gout (2010-2014) were chosen for the interviewing, the diagnosis was based on the ACR criteria (1977). 83.6% of patients were males, the mean age was 56.4±11.3 years, the average disease duration was 11.8±7.4 years. Patients admitted to the Rheumatology Unit were questioned by rhs on lifestyle, diet, previous and current ULT. We focused our questions on the regularity and effectiveness of ULT as viewed by both rhs and patients. In addition, it was of an interest what doctor (n-rh or rh) had administered and controlled this ttt.
Results According to patients, 59.7% (n=215) of them were taking ULT regularly, while the rhs specified that ULT was prescribed to 16.9% (n=61) of patients between gouty attacks and to 22.5% (n=81) of patients during the attacks of gout (more frequently at the beginning of attacks). In both groups, ULT course lasted not more than 1-2 months. Only 20.3% (n=73) received regular ULT daily, administered correctly by the rhs (duration>2-24 months). 14.2% (n=51) of patients had an experience of ULT, but at the time of the interview, 45 subjects were not taking it because of comorbid conditions (allergies, gastric and duodenal ulcers, hepatitis and cirrhoses, chronic renal failure).
26.1% (n=94) of patients with gout duration of 2-12 years never tried ULT due to various causes (self-treatment, another diagnosis, rare attacks, comorbidities, refusal, polypragmasia). In total, 18.3% (n=66) of patients had indications for ULT in the absence of contra-indications. 32.2% (n=87) of patients receiving ULT now or earlier appreciated its effectiveness. A significant number of patients - 152 (67.8%) - considered ULT to be low- or non-effective. Patients with gouty arthritis considered the ULT to be effective if gouty attacks repeated not more than once per year (OR-2.66, 95% CI 1.92 to 3.69; p=0.0023), and the ULT was controlled by rhs (OR-3.54, 95% CI 2.61 – 4.82; p<0.0001).
The rhs stated a very small number of patients under regular ULT - 5,5% (n=4), achieving the effectiveness of it (absence of gout activity, ACR, 2012)
Conclusions The ULT administered by non-rheumatologists is often not optimal. In our series, 18.3% of patients do not receive this treatment despite the indications; among the patients under ULT, only 20.3% took it regularly. Certain scepticism of patients with gout towards ULT is due to the lack of improvement of their condition, non-rational current or previous ULT and follow-up by non-rheumatologists.
Khanna D., J. Fitzgerald, P. Khanna and all. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care and Res. 2012; 10: 1447-1461.
Disclosure of Interest None declared