Severity of gout does not determine previous prescription of urate-lowering treatment before rheumatology consultation

 

Fernando Perez-Ruiz (1), Ana M. Herrero-Beites (2), And Nerea Perez-Herrero (3)

 

Affiliation(s):

(1), Osi Eec, Cruces University Hospital, Rheumatology Division; (2) Osakidetza, Gorliz Hospital, Rehabilitation Division; (3) Medicine School, University Of Deusto

 

 

Objective: to evaluate the prescription of urate-lowering treatment (ULT) prescription before rheumatology consultation in patients with gout, as recommendations and guidelines suggest to prescribe ULT in patients with severe gout or presence of comorbid conditions.

Method: retrospective análisis of a nested prospective cohort of patients with gout. The database includes data on ULT prescription along with variables specifical for gout (tophi, polyarticular disease, time from onset). Comorbidity was evaluated with Kaiser-Permanente pyramid provided electronically by the county health department into the clinical files.

Results: 1  data from 1,800 patients were available for analysis (comorbidity in 1,050), 90% men, mean time from onset 6 years (median 4, IQ range 1-10).  Polyarticular involvement was present in 593/1800 (32.9%) and suncutaneous tophi in 565/1800 (31.4%). A previous prescription was retrieved in 800/1800 (44.4%) patients.

Bivariate análisis showed an association between severity of gout (polyarticular and tophaceous disease) nd time from onset (Table 1).

Stratified analysis showed that previous ULT prescription rate was only associated to increasing time from onset of gout as the rates for severe vs. non-severe disease variables did not differ from each other in the analysis of quartiles of time from onset of gout. (Figure 1).

Conclusions:

1.- Variables defining severity of gout are not independently associated to higher prescription rates of previous ULT.

2.- The rates of ULT prescription increase parallel to time from onset of the disease, what is known to associate with increasing severity.

3.- Nevertheless, even in patients with severe disease, overall ULT prescription is not present in close to half the patients after 5 years and close to one quarter after 10 years from onset of gout, independently of severity.

4.- Presence of significant clinical comorbidity is not associated  to increasing rates of ULT prescription.