Prescription and dosing of urate-lowering therapy, rather than patient behaviours, are the key modifiable factors associated with targeting serum urate in gout
Long term serum urate (SU) lowering to a target of <0.36 mmol/l (6 mg/dl) is recommended for effective gout management. However, many studies have reported low achievement of SU targets. The aim of this cross-sectional study was to examine the clinical and psychological factors associated with SU targets in patients with gout.
Patients with gout for <10 years were recruited from primary and secondary care settings. SU target was defined as SU concentration <0.36 mmol/L at the time of the study visit. Both clinical and psychological factors associated with SU target were analysed. The relationship between SU target and measures of gout activity such as flare frequency, tophi, work absences, and Health Assessment Questionnaire-II was also analysed.
Of the 273 patients enrolled into the study, 89 (32.6%) had SU concentration <0.36 mmol/L. Urate-lowering therapy (ULT) use was strongly associated with SU target (p < 0.001). In those patients prescribed ULT (n = 181), allopurinol dose, patient confidence to keep SU under control, female sex, and ethnicity were independently associated with SU target. Other patient psychological measures and health-related behaviours, including adherence scores, were not independently associated with SU target in those taking ULT. Creatinine clearance, diuretic use, age, and body mass index were not associated with SU target. Patients at SU target reported lower gout flare frequency, compared with those not at target (p = 0.03).
ULT prescription and dosing are key modifiable factors associated with achieving SU target. These data support interventions focusing on improved use of ULT to optimise outcomes in patients with gout.
- Perez-Ruiz, F (2009) Treating to target: a strategy to cure gout. Rheumatology (Oxford) 48: pp. 9-14 CrossRef
- Li-Yu, J, Clayburne, G, Sieck, M, Beutler, A, Rull, M, Eisner, E, Schumacher, HR (2001) Treatment of chronic gout. Can we determine when urate stores are depleted enough to prevent attacks of gout?. J Rheumatol 28: pp. 577-580
- Shoji, A, Yamanaka, H, Kamatani, N (2004) A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 51: pp. 321-325 CrossRef
- Perez-Ruiz, F, Calabozo, M, Pijoan, JI, Herrero-Beites, AM, Ruibal, A (2002) Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum 47: pp. 356-360 CrossRef
- Perez-Ruiz, F, Martin, I, Canteli, B (2007) Ultrasonographic measurement of tophi as an outcome measure for chronic gout. J Rheumatol 34: pp. 1888-1893
- Jordan, KM, Cameron, JS, Snaith, M, Zhang, W, Doherty, M, Seckl, J, Hingorani, A, Jaques, R, Nuki, G (2007) British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford) 46: pp. 1372-1374 CrossRef
- Zhang, W, Doherty, M, Bardin, T, Pascual, E, Barskova, V, Conaghan, P, Gerster, J, Jacobs, J, Leeb, B, Liote, F, McCarthy, G, Netter, P, Nuki, G, Perez-Ruiz, F, Pignone, A, Pimentao, J, Punzi, L, Roddy, E, Uhlig, T, Zimmermann-Gorska, I (2006) EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 65: pp. 1312-1324 CrossRef
- Dalbeth, N, Kumar, S, Stamp, L, Gow, P (2006) Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout. J Rheumatol 33: pp. 1646-1650
- Roddy, E, Zhang, W, Doherty, M (2007) Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations. Ann Rheum Dis 66: pp. 1311-1315 CrossRef
- Harrold, LR, Andrade, SE, Briesacher, BA, Raebel, MA, Fouayzi, H, Yood, RA, Ockene, IS (2009) Adherence with urate-lowering therapies for the treatment of gout. Arthritis Res Ther 11: pp. R46 CrossRef
- Mikuls, TR, Farrar, JT, Bilker, WB, Fernandes, S, Saag, KG (2005) Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD). Rheumatology (Oxford) 44: pp. 1038-1042 CrossRef
- Edwards, NL (2010) Why is Management Suboptimal and What Can Be Done About It?. Curr Rheumatol Rep, Curr Rheumatol Rep
- Harrold, LR, Mazor, KM, Velten, S, Ockene, IS, Yood, RA (2010) Patients and providers view gout differently: a qualitative study. Chronic Illn 6: pp. 263-271 CrossRef
- Solomon, DH, Avorn, J, Levin, R, Brookhart, MA (2008) Uric acid lowering therapy: prescribing patterns in a large cohort of older adults. Ann Rheum Dis 67: pp. 609-613 CrossRef
- Suppiah, R, Dissanayake, A, Dalbeth, N (2008) High prevalence of gout in patients with Type 2 diabetes: male sex, renal impairment, and diuretic use are major risk factors. N Z Med J 121: pp. 43-50
- Wallace, SL, Robinson, H, Masi, AT, Decker, JL, McCarty, DJ, Yu, TF (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20: pp. 895-900 CrossRef
- Dalbeth, N, Petrie, KJ, House, M, Chong, J, Leung, W, Chegudi, R, Horne, A, Gamble, G, McQueen, FM, Taylor, WJ (2011) Illness perceptions in patients with gout and the relationship with progression of musculoskeletal disability. Arthritis Care Res (Hoboken) 63: pp. 1605-1612 CrossRef
- Talbot, F, Nouwen, A, Gingras, J, Gosselin, M, Audet, J (1997) The assessment of diabetes-related cognitive and social factors: the Multidimensional Diabetes Questionnaire. J Behav Med 20: pp. 291-312 CrossRef
- Stamp, LK, O'Donnell, JL, Zhang, M, James, J, Frampton, C, Barclay, ML, Chapman, PT (2011) Using allopurinol above the dose based on creatinine clearance is effective and safe in patients with chronic gout, including those with renal impairment. Arthritis Rheum 63: pp. 412-421 CrossRef
- Spencer, K, Carr, A, Doherty, M (2012) Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis.
- Rees, F, Jenkins, W, Doherty, M (2012) Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis.
- Chandratre, P, Roddy, E, Mallen, C (2012) Patient related factors are also important in treating gout. BMJ 344: pp. e191 CrossRef
- Dalbeth, N, Lindsay, K (2012) The patient's experience of gout: new insights to optimize management. Curr Rheumatol Rep 14: pp. 173-178 CrossRef
- Reach, G (2011) Treatment adherence in patients with gout. Joint Bone Spine 78: pp. 456-459 CrossRef
- Zhu, Y, Pandya, BJ, Choi, HK (2011) Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum 63: pp. 3136-3141 CrossRef
- Prior, IA, Rose, BS, Harvey, HP, Davidson, F (1966) Hyperuricaemia, gout, and diabetic abnormality in Polynesian people. Lancet 1: pp. 333-338 CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/13/174/prepub
- Prescription and dosing of urate-lowering therapy, rather than patient behaviours, are the key modifiable factors associated with targeting serum urate in gout
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BMC Musculoskeletal Disorders
- Online Date
- September 2012
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- BioMed Central
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- 1. Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
- 2. Department of Psychological Medicine, University of Auckland, Auckland, 1023, New Zealand
- 3. Department of Molecular Medicine, University of Auckland, Auckland, 1023, New Zealand
- 4. Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, 6242, New Zealand