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Simple Application and Adherence to Gout Guidelines Enables Disease Control: An Observational Study in French
Charlotte Jauffret1, Sébastien Ottaviani2, Augustin Latourte3
1Rheumatology Department, Saint-Philibert (GHICL), Lille Catholic University, 59160 Lille, France.
Insights
French gout guidelines are effective in clinical practice. A majority of patients achieved serum uric acid targets and reduced flares, demonstrating the feasibility and efficiency of these recommendations for gout management.
Area of Science:
- Rheumatology
- Clinical Practice Guidelines
- Gout Management
Background:
- Therapeutic inertia in gout management prompted the French Society of Rheumatology (SFR) to issue simple, concise guidelines in 2020.
- Gout management often faces challenges, including therapeutic inertia, necessitating clear and actionable recommendations.
Purpose of the Study:
- To profile patients referred to French gout-expert centers.
- To evaluate the outcomes of gout management based on SFR guidelines.
- To identify factors influencing treatment success in gout patients.
Main Methods:
- A multicenter observational study included 300 patients attending initial gout management visits.
- Data collected retrospectively at baseline (M0) and prospectively at 6 (M6), 12 (M12), and 24 (M24) months.
- Analysis focused on patient demographics, adherence to guidelines, serum uric acid (SU) levels, and clinical outcomes like flare reduction.
Main Results:
- Patients were predominantly male (81%) with a mean age of 62.2 years.
- 94.9% of patients received management aligned with French recommendations post-baseline.
- Serum uric acid (SU) levels < 6.0 mg/dL were achieved by 59.4% (M6), 67.9% (M12), and 78.6% (M24), correlating with decreased flares.
- Adequate dosage of urate-lowering therapy (ULT) was the sole predictor of achieving SU targets.
Conclusions:
- The straightforward implementation of gout management guidelines is practical and effective in real-world settings.
- Most patients successfully reached SU targets and experienced clinical improvement, including reduced gout flares.
- Sufficient ULT dosage is crucial for achieving therapeutic goals in gout management.
Abstract:
Background: In a context of therapeutic inertia, the French Society of Rheumatology (SFR) published its first recommendations on gout in 2020, which were deliberately simple and concise. The objectives of the study were to determine the profile of patients referred to French gout-expert centres, and to examine the results of their management and the factors leading to those results. Methods: Three hundred patients attending a first visit for gout management in three French referral centres were retrospectively and randomly included in this multicentre observational study. Visits were performed at baseline (M0) and scheduled for month 6 (M6), month 12 (M12), and month 24 (M24). Results: Patients were 81% male and had a mean age 62.2 ± 15.2 years. Management followed French recommendations after the baseline visit in 94.9% of cases. SU levels were below 6.0 mg/dL in 59.4% of patients at M6, 67.9% at M12, and 78.6% at M24, with increasing clinical improvement (i.e., flare decrease) over 2 years of follow-up. At M24, 50% of patients were treated with allopurinol (313 ± 105 mg/d), which exceeded renal restrictions of doses in 61.5% of them, and 48.2% received febuxostat (84 ± 36 mg/d). The need for a sufficient dosage of ULT was the only predictive factor found for successful achievement of SU levels < 6.0 mg/dL at a given visit. Conclusions: Simple application of gout-management guidelines is feasible in clinical practice and is efficient, with a majority of patients achieving SU targets and clinical improvement.
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