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Swiss Med Wkly. 2019 Sep 2;149:w20121. doi: 10.4414/smw.2019.20121. eCollection 2019 Aug 26.

The target uric acid level in multimorbid patients with gout is difficult to achieve: data from a longitudinal Swiss single-centre cohort.

Author information

1
Department of Rheumatology, University Hospital Basel, Switzerland / Department of Rheumatology, Schmerzklinik Basel, Switzerland.
2
Medical Outpatient Clinic, University Hospital Basel, Switzerland / Department of Biomedicine, Translational Immunology Laboratory, University Hospital Basel, Switzerland.
3
Faculty of Medicine, University of Basel, Switzerland.
4
Department of Rheumatology, University Hospital Basel, Switzerland.
5
Service de Rhumatologie, Département de l'appareil locomoteur, CHUV, Lausanne, Switzerland.

Abstract

OBJECTIVE:

To characterise adherence and treat-to-target (T2T) strategy in gout patients within a Swiss tertiary hospital.

METHODS:

Consecutive presenting patients with proven gout were prospectively included in this cohort. Symptoms, comorbidities, medication and laboratory values were assessed (during hospitalisation and at planned 3- and 12-month follow-up assessments).

RESULTS:

116 patients (98 men) with a mean age of 67 (range 23–94 years) were included, 74% of whom had active arthritis. Comorbidities were frequent: hypertension, renal impairment, and obesity were present in 72, 55 and 35% of patients, respectively. Thirty-five percent of patients received urate-lowering treatment at inclusion. Only 62 and 50% attended the 3- and 12-month follow-up. The target serum uric acid level of <360 μmol/l was achieved in 22 and 57% of patients by the 3- and 12-month follow-up visits, respectively. Patients followed up by rheumatologists reached the target serum uric acid at follow-up more often than those that were not (p = 0.033). Median daily allopurinol dose at 12-month follow-up was 300 mg in those achieving T2T and 100 mg in the others (p = 0.033). Flares occurred during the first 3 months in 52% and during the subsequent 9 months in 47% of patients.

CONCLUSION:

Only half of patients attended the planned follow-up visits, indicating low awareness for gout. Of those attending follow-up, only approximately 50% had achieved the serum urate target at 12 months. Although new treatments are available, care for gout patients remains insufficient, notably in difficult-to-treat multimorbid patient subsets as described in this cohort.

PMID:
31476243
DOI:
10.4414/smw.2019.20121
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