July 02, 2019
2 min read

Despite guidelines, only half of patients with frequent gout flares receive allopurinol

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Just 51% of patients who reported frequent gout flares also said they were currently receiving first-line urate-lowering therapy, according to Australia-based survey findings published in Arthritis Research & Therapy.

“There is a paucity of community-based data regarding gout flares,” Catherine L. Hill, MBBS, MD, MSc, FRACP, of Queen Elizabeth Hospital, South Australia, and colleagues wrote. “One internet-based case-crossover U.S.-based study found that 53% of enrolled participants did not consult a health care physician during an acute gout flare, suggesting most gout flares are self-managed in the community and that the ‘treatment gap’ may be under-estimated.”

To analyze the prevalence of self-reported gout and associated flares, as well as the use of allopurinol, the first-line urate-lowering therapy in Australia, Hill and colleagues examined data from the 2017 South Australian Health Omnibus Survey (HOS). According to the researchers, the HOS is an annual population survey, conducted through face-to-face interviews with approximately 3,000 residents aged 15 years and older. For their own study, the researchers included 2,778 participants aged 25 years and older in the final analysis.

Just 51% of patients who reported frequent gout flares receive first-line urate-lowering therapy, according to findings.
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Data collected in the survey included self-reported medically diagnosed gout, treatment with allopurinol and flares in the last 12 months. The survey also noted sociodemographic variables and health-related quality of life (HRQoL, SF-12). The researchers weighed this data against information in the Australian Bureau of Statistics 2016 census to better reflect the population of South Australia.

According to the researchers, the overall prevalence of self-reported gout was 6.5% (95% CI, 5.5-7.5). Among those participants with gout, 37.1% (95% CI, 29.6-45.3) reported currently allopurinol use, and 23.2% (95% CI, 16.9-21.) reported prior use, for a discontinuation rate of 38%. A quarter of participants with gout reported frequent flares — defined as at leasttwo in the last year. Such frequent flares were more likely reported in patients with younger age, higher BMI and current allopurinol use (P <.05). In addition, the flare frequency was associated with a lower physical HRQoL (P=0.012). Just 51% of patients with frequent flares reported current allopurinol use.

“This is the first community-based study of gout flare, which utilized rigorous sampling methodology to ensure that the data was representative of the general population,” Hill and colleagues wrote. “We conclude that gout continues to be a prevalent and poorly managed disease, despite readily available treatment. A quarter of participants with gout reported frequent flares that were associated with reduced physical HRQoL. Current allopurinol use was reported by only 51% of participants with frequent gout flares, suggesting undertreated disease and suboptimal use of [urate-lowering therapy].” – by Jason Laday

Disclosure: Hill reports no relevant financial disclosures. Please see the full study for additional researchers’ disclosures.