Can Doctors Treat Gout Well? Insight On Gout Management In Referral Centres
Charlotte Jauffret, Sebastien Ottaviani, Augustin Latourte, Hang Korng Ea, Sahara Graf, Frederic Lioté, Thomas Bardin, Pascal Richette, Tristan Pascart
Groupement Des Hôpitaux De L'institut Catholique De Lille - Saint Philibert, Lille
Background: Recent studies have shown a lack of implementation of gout recommendations in primary care. In this context of therapeutic inertia, the french society of rheumatology (SFR) published its first recommendations on gout (RECO) in 2020 [1,2], which were deliberately simple and concise.
Objectives: To determine the profile of patients referred to french gout expert centres, and to examine the results of their management.
Methods: Three hundred patients attending a first visit for gout management in three french referral centres were retrospectively included. Visits were performed at baseline (m0) and scheduled for month 6 (m6), month 12 (m12), and month 24 (m24). Data collected included: patient profile; disease activity and treatments; serum urate (SU) level; estimated glomerular filtration rate (EGFR).
Results: Patients were 81% male, mean age 62.2 ± 15.2 years, 42.7% prevalence of EGFR <60ml/min/1.73m2, 28.1% diabetes mellitus, and 25.4% had a history of major cardiovascular event. Management followed french recommendations after the baseline visit in 94.9% of cases. Overall, 50 patients (16.7%) received off-label anakinra for flare treatment or flare prophylaxis. SU levels were below 6.0mg/dl in 59.4% of patients at m6, 67.9% at m12, and 78.6% at m24. At m24, 50% of patients were treated with allopurinol (313 ± 105 mg/d), which exceeded renal restrictions of doses in 61.5% of them, and 48.2% received febuxostat (84 ± 36mg/d). At inclusion, 94% of patients had experienced at least one flare in the previous six months, versus 23.6% at m12, and 13.1% at m24 (of which 8/12 (66.7%) had SU>6.0mg/dl).
Conclusion: Simple application of gout management guidelines is feasible in clinical practice, and is efficient with a majority of patients achieving SU targets and clinical improvement. A minority of patients in referral centres have ‘difficult-to-treat’ gout requiring specific management.
References:  Latourte A, et al. 2020 Recommendations from the French Society of Rheumatology for the management of gout: management of acute flares. Joint Bone Spine 2020;87:387-93.  Pascart T, et al. 2020 Recommendations from the French Society of Rheumatology for the management of gout: urate-lowering therapy. Joint Bone Spine 2020;87:395- 404.