Gout in a rheumatology clinic: results of EULAR/ACR guidelines-compliant treatment

Abstract

Objective: Surveys of treatment results of gout in primary care have shown that less than 25% of patients reach the recommended treatment target (serum urate < 0.36 mmol/l). The aim of this study was to measure the results of a specialized European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) guidelines-based treatment of gout in a rheumatology clinic.

Method: Data from consecutive new crystal-proven gout patients were analysed in a prospective observational study.

Results: The study included 100 patients: 88 males aged 62.1 ± 13.1 years (mean ± sd) and 12 females aged 74.1 ± 6.9 years. Disease duration was 8.6 ± 6.9 years, and the disease pattern was monoarticular, oligoarticular, polyarticular, and tophaceous in 18, 37, 25, and 20 patients, respectively. Overall, 42% had tried urate-lowering treatment (ULT) ever and 15% were on ULT at entry. ULT was initiated or intensified in a treat-to-target (T2T) approach in 93 patients, with flare prophylactic colchicine treatment in 90 patients. T2T was successfully reached in 85 patients after 4.7 ± 3.9 months and 82 patients reached a state of well-controlled disease (T2T reached for 3 months and no flares or anti-inflammatory treatment for 1 month) after 10.4 ± 5.6 months. Ten patients did not reach T2T owing to low compliance and five patients did not reach T2T owing to adverse effects or nephropathy.

Conclusion: EULAR/ACR guidelines-compliant treatment in a rheumatology clinic with verified diagnosis, patient education, T2T with ULT, and flare prophylaxis led to successful treatment results in 85% of patients.