Background Gout is the most prevalent form of inflammatory arthritis and its prevalence is increasing. A EULAR task force has recently set the biochemical target of serum uric acid (sUA) at <6.0 mg/dL, similar to ACR1. Recent studies show that over 50% of gout patients do not reach the biochemical target with limited options of ULT, and lack of tight control and treat to target strategy2,3,4.
Objectives The aim of this study is to evaluate the remission rate and ULT used to reach remission in our cohort of gout patients.
Methods For this retrospective descriptive study we analysed 110 randomly selected gout patients diagnosed and treated in our hospital between 2009 and 2013. Patients were treated in daily clinical care targeting a sUA <6mg/dL (<0.36mmol/L). According to the Dutch health legislations during the study period, which allowed a free availability of allopurinol and benzbromaron, but no health insurance coverage for febuxostat. Combination therapy of allopurinol and benzbromaron was allowed when necessary to reach sUA target. The inclusion criterion was microscopical proof of monosodium urate (MSU) crystals in synovial fluid or tophus aspirate. Exclusion criteria were missing essential data (baseline serum uric acid and index date) and a follow up of less than 9 months. Index date was defined as the date of diagnosis. Remission was defined according the EULAR biochemical criterion as a sUA <6mg/dL (<0.36mmol/L) plus an attack free period of at least 3 months.
Results Of 110 patients, 12 did not meet the inclusion criterion. Nine were excluded because of lack of data and 11 patients were excluded because they had a follow up of less than 9 months. Among the 78 patients included in our analysis most were men (86%) and the mean age was 62 years (range 35-85, SD 12,36). Within a one year period 45 patients (58%) achieved remission. Eventually 65 patients (83,3%) achieved remission. Of the patients achieving remission 45 (69,2%) were treated with allopurinol monotherapy, 11 patients (16,9%) with a combination of allopurinol and benzbromaron, 6 patients (9,2%) with benzbromaron monotherapy and 3 patients (4,6%) were treated with febuxostat. There were no significant differences between the remission and no-remission group regarding age, creatinine clearance or sUA at baseline.
Conclusions Over 80% of gout patients in our cohort achieved remission with first-line medication consisting of allopurinol and/or benzbromaron. This remission rate is high when compared with other cohorts due to sUA level targeted therapy and if necessary combining two modes of action. We think that even higher remission percentages are feasible when patients will be treated by tight control treatment protocols that also allow the use of novel pharmaceutical preparations.
Richette P, Doherty M, Pascual E, et al. Updated EULAR evidence-based recommendations for gout. Part II: management. EULAR ARD 2014.
Doherty M, Jansen TL, Nuki G, et al. Gout: why is this curable disease so seldom cured? ARD 2012; 10.1136/ard-2012-201687.
Singh J et al. EULAR 2012. poster FRI0383.
Disclosure of Interest A. Wennemers: None declared, I. Meek: None declared, R. Bakker: None declared, T. Janssen Grant/research support from: Novartis, Sobi, Consultant for: Astra, Menarini