Gout is the most common inflammatory arthritis and its incidence and prevalence have increased in recent years. Current guidelines recommend a urate-lowering treatment for patients with more severe gout and those with accompanying conditions.
Eliminating the causes of gout
This type of treatment lowers uric acid levels sufficiently to eliminate the crystals that cause gout. However, after the first diagnosis, it remains unclear when such “curative” treatment is appropriate.
Dr Chang-Fu Kuo and his colleagues from The University of Nottingham investigated the timing of eligibility for, and prescription of urate-lowering treatment in people following their first diagnosis of gout in a large UK primary care database (the Clinical Practice Research Data-link).
Of 52,164 patients with gout, the average time to first treatment (such as multiple attacks, chronic kidney disease, diuretic use, presence of subcutaneous tophi), was five months and the increasing probability of fulfilling any indication was 44 per cent at the first time of presentation and 61 per cent at one year, 87 per cent at five years, and 94 per cent at 10 years following diagnosis. The cumulative probabilities for prescription at the same time points were 0 per cent, 17 per cent, 30 per cent, and 41 per cent.
The average prescription rate for urate-lowering treatment among practices was 32.5 percent. Examined patient and practice-level factors accounted for only one-fifth of the variance in prescriptions.
Dr Chang-Fu Kuo from The University of Nottingham said: “Our study aimed to estimate the proportion of patients fulfilling eligibility criteria for urate-lowering treatment since the diagnosis of the disease. We found that 44 per cent of patients were already eligible at diagnosis and 61 per cent at one year, 87 per cent at five years, and 94 per cent at 10 years after diagnosis. Therefore the majority of patients are eligible at or shortly following diagnosis. However, only one-third of eligible patients received such potentially curative treatment.
“This suboptimal treatment occurs for many reasons, including insufficient knowledge of the disease and its management, and misconceptions concerning its causes and its impact on patients quality of life and well-being. Our recommendation is to give full information to patients early in their clinical course at the time that they are first being informed about gout, its causes and the treatments that are available.
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Notes to editors: The University of Nottingham has 43,000 students and is ‘the nearest Britain has to a truly global university, with campuses in China and Malaysia modelled on a headquarters that is among the most attractive in Britain’ (Times Good University Guide 2014). It is also the most popular university in the UK among graduate employers, in the top 10 for student experience according to the Times Higher Education and winner of ‘Research Project of the Year’ at the THE Awards 2014. It is ranked in the world’s top one per cent of universities by the QS World University Rankings.
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