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[Quality of treatment in gouty patients considering EULAR recommendations]
Marija Radak-Perović1, Mirjana Zlatković-Svenda
1School of Medicine, University of Belgrade, Belgrade, Serbia.
Insights
Gout treatment adherence is poor, with zero adherence for prophylaxis and monitoring. Many patients do not reach target serum uric acid levels, indicating significant gaps in gout care quality.
Area of Science:
- Rheumatology
- Clinical Pharmacology
- Evidence-Based Medicine
Context:
- Gout treatment guidelines exist, but their implementation in clinical practice is often suboptimal.
- Assessing adherence to established recommendations is crucial for improving patient outcomes.
Purpose:
- To evaluate the quality of gout therapy by analyzing patient adherence to four key treatment recommendations.
- Identify specific areas of non-adherence in gout management.
Summary:
- A retrospective study of 111 gout patients revealed significant deviations from treatment guidelines.
- Adherence was high for initiating allopurinol (76% for tophi) but zero for prophylaxis (R2) and monitoring (R4).
- Only 26% achieved target serum uric acid (SUc) levels (R3), with no difference between allopurinol users and non-users.
Impact:
- Current gout treatment practices show considerable deviation from best practices, ranging from 24% to 100%.
- Findings highlight critical deficiencies in prophylaxis, monitoring, and achievement of therapeutic goals in gout management.
- This underscores the need for improved adherence to gout treatment recommendations to enhance patient care and outcomes.
Introduction:
There are 12 recommendations for gout treatment, based on evidence and opinion of experts.
Objective:
To assess the quality of therapy in patients with gout analyzing adherence to four selected recommendations.
Methods:
Retrospective cross sectional study of 111 patients with gouty flare was conducted. Adherence to selected recommendation was defined as odds ratio between the number of patients whose therapy adhered to treatment recommendation and the number of patients eligible for the relevant recommendation. These recommendations refer to indications for allopurinol treatment (R1), prophylaxis of induced gouty flares in the first month of allopurinol treatment (R2), treatment goals (R3), and treatment monitoring regime (R4).
Results:
Out of 111 patients with gout, 25 with tophi, 87 with frequent gouty flares and 46 with CUA or X-ray erosions were indicated for allopurinol treatment. The adherence to R1 was 76% for tophi patients, 54% for patients with frequent gouty flares, and 63% for patients with CUA. None of the patients starting allopurinol was either recruited for gouty prophylaxis or monitored properly; adherence to R2 as well as to R4 was 0%. Target serum uric acid (SUc) rating below 360 micromol/L was achieved in 13/50 patients treated with allopurinol, while the adherence to R3 was 26%. Therapeutic monitoring in accordance with P4 was not done in any of the patients on allopurinol. There were no differences in mean levels of the SUc between allopurinol users and non-users: 471.3 +/- 164.4 vs. 460.0 +/- 103.5 micromol/L (p = 0.067). Therefore, almost every second patient with gouty flares was on allopurinol therapy (50/111).
Conclusion:
The degree of deviation in relation to the key principles of correct treatment in patients with gout ranged from a relatively high (24%) to that of absolute digression (100%).
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