Monday, 20 May 2019

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Ideal Outcomes are Seldom Achieved in Gout

Studies from a cohort of gout patients in Mexico shows that long-term goals of a target serum urate (sUA) < 6 mg/dL and remission are rare, especially for those with severe gout. 

The GRESGO (gout) cohort of 500 patients compared outcomes in 221 with severe gout (44%) and 279 with non-severe gout (56%). Patients were followed at 6-month intervals. 

Ssevere gout patients were younger, with lower educational and socioeconomic status, longer disease duration, more absenteeism, more hypertension and chronic renal failure, more affected joints and tophi, and more activity limitations. Predictors of severe gout were disease duration (p=0.008) and gout flares (p=0.055).

While there were no significant differences between these groups in achieving an sUA U 6 mg/dL or 5 mg/dL (non-severe and severe gout, respectively), target urate < 6 mg/dL was achieved in 50-70% of the patients followed for 3-5 years and less than 50% of patients achieved TU < 5mg/dL during 5 years of follow-up.

Remission (no flares, SUA < 6.0, Pain < 2.0; no tophi) was achieved less often: 9.1% at year 1; 30% at year 2; 28% at year 3 and 28% after 5 years. None of the patients with severe gout achieved remission.

Patients with severe gout were unlikely to achieve both target sUA and remission. Hence, there exists many obstacles to achieving a target sUA and remission in gout. include poor medication adherence, persistent tophi and loss to follow-up.

These findings are in line with multiple studies showing that the target sUA is only achieved in 30-40% of gout patients.  However, many recent gout management studies have shown far better (80-80%) rates of remission and target sUA < 6.0 when patients are managed by nurses or pharmacists using a treat to target protocol, usually at more frequent intervals (every1-2 mos.).

The author has no conflicts of interest to disclose related to this subject

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