Background Inadequate control of hyperuricaemia in gout patients can lead to more arthritis, activity limitations and higher gout-related treatment costs. General Practitioners can use well tolerated urate-lowering drugs, but some patients are inadequately controlled. European League against Rheumatism (EULAR) has published new guidelines1 in 2016 with similar serum Uric Acid (sUA) goals.
Objectives To evaluate sUA control in patients diagnosed with gout who were attended in primary care and to compare them to EULAR 2016 guidelines1.
Methods Retrospective analysis, carried out in 2 primary care health centres (8 family doctors) in Spain. We selected patients that have consulted in the last year diagnosed with gout at any time. Demographic variables, gout-related drugs and last sUA level were collected. Adequate control was defined as sUA level <6 mg/dL.
Limitations: We used only one isolated sUA value. No drug doses were analyzed. We did not distinguish severe from mild gout.
Ethical-legal aspects: We did not identify the patients. There was no intervention.
Results We analyzed 231 patients diagnosed with gout, mean 70.1 years-old (Confidence Interval CI95% 68.3–72.0), 189 (81.8%) were men. The mean sUA was 6.55 mg/dL (CI95% 6.31–6.79 mg/dL).
39% were adequately controlled according to EULAR (sUA <6 mg/dL), 25.5% were close to the objective (6–7mg/dL) and clearly inadequate (>7mg/dL) in 35.5%. 10% had really bad control (sUA >9 mg/dL).
There was no difference between control in male 6.58 mg/dL (IC95% 6.33–6.83) and female 6.40 mg/dL (CI95% 5.73–7.07). Control improves in elder people: <60 years 7.01 mg/dL (CI95% 6.60–7.42) vs.>70 years 6.30 mg/dL (CI95% 6.00–6.60)
The only 14 patients receiving febuxostat achieved similar control using allopurinol (6.5 versus 6.7 mg/dL).
Conclusions The degree of control of sUA in primary care patients in our area is mostly between optimal and acceptable, but it can be optimized in more than half of the cases. In a few patients the control is lousy. The worst-controlled patients were the youngest.
Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, Coyfish M, Guillo S, Jansen TL, Janssens H, Lioté F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell T, So A, Tausche AK, Uhlig T, Zavada J, Zhang W, Tubach F, Bardin T. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017 Jan;76(1):29–42. http://ard.bmj.com/content/76/1/29.abstract.
Disclosure of Interest None declared