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Purpose: to test the EULAR recommendations for the treatment of gout, including that for the treatment both acute flares and for the control of hyperuricemia to achieve serum urate levels lower that 360 mmol/L (6 mg/dl), along with general measures to reduce hyperuricemia.
Methods: cross-sectional study based on the audit of data from clinical files. A probabilistic stratified two-stage method was used to select 50 hospital-based rheumatology settings as representative for the whole nation population aged over 50 years, according to the National Institute of Statistics population data. We draw a random sample of 20 files per site from the local patient registries. Selection criteria were patients with a diagnosis of gout according to ICD-9 codes who were attended from Oct 2005 to Oct 2006 in each setting. For treatment, data regarding to NSAIDs and colchicine prescriptions, urate-lowering drugs (ULDs) prescription, general measures implementation, and control of hyperuricemia were obtained, and a sensitivity analysis made.
Results: from 1,000 elegible patients, data were retrieved from 803 and 520 files for the treatment of hyperuricemia and acute flares respectively. Although up to 20 different NSAIDs were prescribed, indomethacin and diclofenac comprised for half the prescriptions. NSAID doses ranged widely, 5/20 NSAIDs were prescribed in doses over that registered. ULDs had been prescribed to 89% during an average time of 6-yr: (97% allopurinol (mean dose 250 mg/day), and 6% benzbromarone (mean dose 79 mg/dl). No patients with significant renal function impairment was prescribed allopurinol 300 mg/day or over. A step-up dosing schedule for ULMS was prescribed only to 50% of the patients. Serum urate levels were available in 87% of the patients in the last visit. Mean serum urate level was 6.8±2 mg/dl (405 mmol/L), and 57% of them showed serum urate levels > 6 mg/dl (360 mmol/L) whilst patients with no ULD showed mean serum urate level 7.5±2 mg/dl (450 mmol/L) and 80% were > 6 mg/dl). Treatment with benzbromarone was associated with lower serum urate levels, but swift to another ULD or combination of ULDs was infrequently prescribed despite poor control of serum urate levels with allopurinol.
Conclusions: in this audit of clinical practice of the management of gout, treatment of acute inflammation episodes is mostly adequate to EULAR recommendations. By contrary, treatment of hyperuricemia of gout deserves further improvement: half the patients were initially prescribed full-dose ULDs and over half the patients did not achieve proper serum urate level control. Interestingly, swift or combination of ULDs were very infrequently prescribed despite poor control of serum urate levels.
Methods: cross-sectional study based on the audit of data from clinical files. A probabilistic stratified two-stage method was used to select 50 hospital-based rheumatology settings as representative for the whole nation population aged over 50 years, according to the National Institute of Statistics population data. We draw a random sample of 20 files per site from the local patient registries. Selection criteria were patients with a diagnosis of gout according to ICD-9 codes who were attended from Oct 2005 to Oct 2006 in each setting. For treatment, data regarding to NSAIDs and colchicine prescriptions, urate-lowering drugs (ULDs) prescription, general measures implementation, and control of hyperuricemia were obtained, and a sensitivity analysis made.
Results: from 1,000 elegible patients, data were retrieved from 803 and 520 files for the treatment of hyperuricemia and acute flares respectively. Although up to 20 different NSAIDs were prescribed, indomethacin and diclofenac comprised for half the prescriptions. NSAID doses ranged widely, 5/20 NSAIDs were prescribed in doses over that registered. ULDs had been prescribed to 89% during an average time of 6-yr: (97% allopurinol (mean dose 250 mg/day), and 6% benzbromarone (mean dose 79 mg/dl). No patients with significant renal function impairment was prescribed allopurinol 300 mg/day or over. A step-up dosing schedule for ULMS was prescribed only to 50% of the patients. Serum urate levels were available in 87% of the patients in the last visit. Mean serum urate level was 6.8±2 mg/dl (405 mmol/L), and 57% of them showed serum urate levels > 6 mg/dl (360 mmol/L) whilst patients with no ULD showed mean serum urate level 7.5±2 mg/dl (450 mmol/L) and 80% were > 6 mg/dl). Treatment with benzbromarone was associated with lower serum urate levels, but swift to another ULD or combination of ULDs was infrequently prescribed despite poor control of serum urate levels with allopurinol.
Conclusions: in this audit of clinical practice of the management of gout, treatment of acute inflammation episodes is mostly adequate to EULAR recommendations. By contrary, treatment of hyperuricemia of gout deserves further improvement: half the patients were initially prescribed full-dose ULDs and over half the patients did not achieve proper serum urate level control. Interestingly, swift or combination of ULDs were very infrequently prescribed despite poor control of serum urate levels.
F. Perez Ruiz, Pfizer, 5; IPSEN, 5; Savient, 5; L. Carmona, None; E. Pascual, None; E. De Miguel, None; M.A. Gonzalez-Gay, None; I. Ureņa, None.