Gout Outcomes May Improve With Strict Targeting of Serum Uric Acid

Gout treatment strategies that involved a strict serum uric acid (sUA) target were associated with a greater reduction in flares compared with strategies that targeted patient satisfaction, according to study data published in Arthritis Care & Research.

Investigators compared patient outcomes at 2 gout clinics that implemented different treatment methods. One gout clinic used a strict sUA target (≤0.30 mmol/L) with early addition of a uricosuric agent and a xanthine oxidase inhibitor (UA-strategy); the other used a patient-centered strategy that incorporated sUA targets and patient satisfaction (PC-strategy).

Patients at each clinic with newly diagnosed gout were enrolled and followed for 9 to 15 months. Primary outcomes included the proportion of patients reaching an sUA ≤0.36 mmol/L and the proportion of patients free of flares. Secondary outcomes were the proportion of patients requiring treatment intensification and the number of adverse events. Logistic regression analyses were performed to identify the differential effects of each treatment strategy on patient outcomes.

A total of 126 and 86 patients were recruited from the UA-strategy and PC-strategy clinics, respectively. The mean (standard deviation) follow-up period was 11.3±1.8 months at the UA-strategy clinic and 11.1±1.9 months at the PC-strategy clinic. A greater proportion of patients in the UA-strategy (83%) achieved sUA ≤0.36 mmol/L than patients in the PC-strategy (74%), although the result was only nominally significant (P =.10). A greater number of UA-strategy patients (46%) were free of flares compared with PC-strategy patients (36%; P =.15). In the UA-strategy clinic, 60% of patients were receiving allopurinol monotherapy compared with 73% in the PC-strategy (P =.05). Despite increased use of treatment intensification, patients in the UA-strategy clinic did not experience a greater number of adverse events than those in the PC-strategy clinic (P =.55).

A strict sUA target resulted in a greater proportion of patients without flares and patients reaching sUA ≤0.36 mmol/L, although these results were not statistically significant. Clinics with stricter sUA targets implemented significantly more therapy intensification, although risk for adverse events did not increase. Further research with greater sample sizes is necessary to confirm these preliminary findings.

Reference

te Kampe R, van Durme C, Janssen M, van Eijk-Hustings Y, Boonen A, Jansen TL. A comparative study of real-life management strategies in gout: data from two protocolized gout clinics [published online May 31, 2019]. Arthritis Care Res. doi:10.1002/acr.23995