Charlotte Jauffret, Sebastien Ottaviani, Augustin Latourte, Hang Korng Ea, Sahara Graf, Frederic Lioté, Thomas Bardin, Pascal Richette, Tristan Pascart
Affiliation(s):
Groupement Des Hôpitaux De L'institut Catholique De Lille - Saint Philibert, Lille
Background: Recent studies have shown a lack of implementation of gout recommendations in primary care. In this context of therapeutic inertia, the french society of rheumatology (SFR) published its first recommendations on gout (RECO) in 2020 [1,2], which were deliberately simple and concise.
Objectives: To determine the profile of patients referred to french gout expert centres, and to examine the results of their management.
Methods: Three hundred patients attending a first visit for gout management in three french referral centres were retrospectively included. Visits were performed at baseline (m0) and scheduled for month 6 (m6), month 12 (m12), and month 24 (m24). Data collected included: patient profile; disease activity and treatments; serum urate (SU) level; estimated glomerular filtration rate (EGFR).
Results: Patients were 81% male, mean age 62.2 ± 15.2 years, 42.7% prevalence of EGFR <60ml/min/1.73m2, 28.1% diabetes mellitus, and 25.4% had a history of major cardiovascular event. Management followed french recommendations after the baseline visit in 94.9% of cases. Overall, 50 patients (16.7%) received off-label anakinra for flare treatment or flare prophylaxis. SU levels were below 6.0mg/dl in 59.4% of patients at m6, 67.9% at m12, and 78.6% at m24. 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 ± 36mg/d). At inclusion, 94% of patients had experienced at least one flare in the previous six months, versus 23.6% at m12, and 13.1% at m24 (of which 8/12 (66.7%) had SU>6.0mg/dl).
Conclusion: 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. A minority of patients in referral centres have ‘difficult-to-treat’ gout requiring specific management.
References: [1] Latourte A, et al. 2020 Recommendations from the French Society of Rheumatology for the management of gout: management of acute flares. Joint Bone Spine 2020;87:387-93. [2] Pascart T, et al. 2020 Recommendations from the French Society of Rheumatology for the management of gout: urate-lowering therapy. Joint Bone Spine 2020;87:395- 404.