Target Serum Urate and Remission Difficult to Achieve in Severe Gout

Poor medication adherence and loss to follow up are 2 primary obstacles preventing patients with gout from achieving remission, according to research published in the Journal of Rheumatology.

Researchers evaluated 500 patients from the GRESGO (Gout Study Group) cohort at 6-month intervals, including serum urate, gout flares, tophus burden, health-related quality of life, activity limitations, and pain level. At baseline, patients received a dose of urate-lowering therapy (95% allopurinol and 1.4%-7.5% probenecid).

Patients were prescribed oral allopurinol 150 mg/d for 10 days, increasing their dose to 300 mg/d for 10 days followed by a second increase to 450 mg/d until their next clinic visit. Within the study group, 44% of patients had severe gout, and 56% had nonsevere gout.

Significant differences were noted between the 2 groups. Primarily, those in the severe gout group were younger at disease onset (mean age 31.3±11.0 vs 36.4±13.3 years) and experienced a longer duration of disease (mean 16.3±10.3 vs 10.5±10.1 years).

Additionally, those in the severe gout group had a lower educational and socioeconomic status and more labor absenteeism and were more likely to have hypertension and chronic renal failure. The severe gout group displayed a significantly higher number of affected joints, higher tophus burden, more limitations on activity, and a poorer health-related quality of life than those in the nonsevere gout group.

At 3 to 5 years of follow up, target urate <6 mg/dL was achieved in 50% to 70% of patients. During the course of 5 years of follow up, fewer than 50% of patients achieved target urate levels <5 mg/dL. No significant differences were noted in percentages of target urate between groups.

At 5 years, remission was observed in 28% of patients. However, due to the dynamic nature of the cohort, only 40 patients remained in the study at that point. No patients with severe gout achieved remission.

One important limitation of this study is the number of patients lost to follow up. The researchers noted that by the first year, a high proportion of patients had already been lost. Other limitations include limited generalizability due to the location of the study and the self-prescription of glucocorticoids by some patients.

The study researchers concluded, “Gout is considered a reversible crystal deposition disease, as long as timely diagnosis, adequate treatment, and appropriate referral to rheumatology departments are provided to affected individuals. In addition, effective gout patient education programs are critical to ensure treatment adherence, lifestyle changes, and continuity of medical care.”

Reference

Alvarado-de la Barrera C, López-López CO, Álvarez-Hernández E, et al. Are target urate and remission possible in severe gout? A five-year cohort study [published online May 1, 2019]. J Rheumatol. doi: 10.3899/jrheum.181214