medigraphic.com
ISSN 0016-3813 (Print)

2012, Number 5

<< Back Next >>

Gac Med Mex 2012; 148 (5)

Study of patients with gout: clinical features in the last 2 years of monitoring

Sicras-Mainar A, Viana ÁR, Galera LJ, Granell VM, Navarro-Artieda R

Language: Spanish
References: 30
Page: 448-456
PDF size: 96.46 Kb.


ABSTRACT

Objective: to analyze the clinical characteristics of gout patients with ‹ 3 attacks and ≥ 3 acute attacks per year. Methods: retrospective observational study carried out at 6-primary care (AP) and 2 hospitals. We included patient’s ≥ 18 years during the years 2003-2007 inclusive. The study groups were: patients with 1-2 and ≥ 3 attacks/acute recurrences. The main variables: demographic, metabolic syndrome (MS), clinical features and treatment. Statistical analysis: logistic regression model, p ‹ 0.05. Results: 3,130 patients were included. The mean age was 55.8 years and 81.1% were male: 31.6% have ≥ 3 attacks per year. The prevalence of MS was 28.8% (CI: 27.2-30.4%) in patients with 1-2 attacks. Subjects with ≥ 3 acute attacks were associated with: MS (OR: 6.2; CI: 4.6-8.3; 65.8 vs. 11.8%), obesity (OR: 2.1; CI: 1.7-2.5; 63.5 vs. 33.8%) and hypertension (OR: 1.6; CI: 1.3-1.9; 58.3 vs. 36.9%), p ‹ 0.001; 58.4% continued to take allopurinol(50.3 vs. 62.2%; p ‹ 0.001). Conclusions: patients with ≥ 3 attacks per year have a more severe disease with acute poly-articular, tophi and higher number of co-morbidities. It is important to control uric acid to reduce the recurrence of attacks in these patients.


REFERENCES

  1. Wortmann RL, Kelley WN. Gout and hyperuricemia. In: Ruddy S, ed. Kelley’s textbook of rheumatology. Philadelphia: WB Saunders; 2000.

  2. Lai SW, Liu CS, Lin T, Lin CC, Lai HC, Liao KEF. Prevalence of gout and hyperuricemia in Taiwan: a hospital-based, cross-sectional study. South Med J. 2009;102(7):772-3.

  3. Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II. Management. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2006;65:1312-24.

  4. Janssens HJ, Janssen M, Van de Lisdonk EH, Fransen J, Van Riel PL, Van Weel C. Limited validity of the American College of Rheumatology criteria for classifying patients with gout in primary care. Ann Rheum Dis. 2010;69:1255-6.

  5. Malik A, Schumacher HR, Dinnella JE, Clayburne GM. Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. J Clin Rheumatol. 2009;15:22-4.

  6. Thissen CA, Frank J, Lucker GP. Tophi as first clinical sign of gout. Int J Dermatol. 2008;47 Suppl 1:49-51.

  7. Gaffo AL, Saag KG. Management of hyperuricemia and gout in CKD. Am J Kidney Dis. 2008;52:994-1009.

  8. Roddy E, Zhang W, Doherty M. Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations. Ann Rheum Dis. 2007;66:1311-5.

  9. Pérez-Ruiz F, Pascual E, Carmona L, et al. Diagnosis of gout in the rheumatology, hospital-based setting lies far from that recommended: results from the GEMA (Gout Evaluation of Management) Study. Arthritis Rheum. 2007;56(Suppl):639.

  10. Pérez Ruiz F. Tratamiento de la gota: reflexiones desde el estudio GEMA. Reumatol Clin. 2008;4 Suppl 3:41-4.

  11. Reinders MK, Van Roon EN, Houtman PM, Brouwers JR, Jansen TL. Biochemical effectiveness of allopurinol and allopurinol-probenecid in previously benzbromarone-treated gout patients. Clin Rheumatol. 2007;26:1459-65.

  12. Hu M, Tomlinson B. Febuxostat in the management of hyperuricemia and chronic gout: a review. Ther Clin Risk Manag. 2008;4:1209-20.

  13. Becker MA, Schumacher HR, MacDonald PA, Lloyd E, Lademacher C. Clinical efficacy and safety of successful longterm urate lowering with febuxostat or allopurinol in subjects with gout. J Rheumatol. 2009;36:1273-82.

  14. Terkeltaub RA, Furst DE, Bennett K, Kook KA, Crockett RS, Davis MW. High versus low dosing of oral colchicine for early acute gout flare: twenty-four-hour outcome of the first multicenter, randomized, doubleblind, placebo-controlled, parallel-group, dose-comparison colchicine study. Arthritis Rheum. 2010;62:1060-8.

  15. Keenan RT, O’Brien WR, Lee KH, et al. Prevalence of contraindications and prescription of pharmacologic therapies for gout. Am J Med. 2011;124:155-63.

  16. Martinon F. Update on biology: uric acid and the activation of immune and inflammatory cells. Curr Rheumatol Rep. 2010;12:135-41.

  17. Schumacher HR Jr, Edwards LN, Pérez-Ruiz F, et al. OMERACT 7 Special Interest Group. Outcome measures for acute and chronic gout. J Rheumatol. 2005;32:2452-5.

  18. García-Puig J, Martínez MA. Hyperuricemia, gout and the metabolic syndrome. Curr Opin Rheumatol. 2008;20:187-91.

  19. Hjortnaes J, Algra A, Olijhoek J, et al. Serum uric acid levels and risk for vascular diseases in patients with metabolic syndrome. J Rheumatol. 2007;34:1882-7.

  20. Choi HK, Ford ES, Li C, Curhan G. Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2007;57:109-15.

  21. National Cholesterol Education Program – Expert Panel on Detection, Evaluation, and Treatment on High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Adult Treatment Panel III final report. Circulation. 2002;106:3143-421.

  22. Shah A, Keenan RT. Gout, hyperuricemia, and the risk of cardiovascular disease: cause and effect? Curr Rheumatol Rep. 2010;12:118-24.

  23. Lamberts H, Wood M, Hofmans-Okkes IM, eds. The International Classification of Primary Care in the European Community. With a multilanguage layer. Oxford: Oxford University Press; 1993.

  24. Anónimo. Guidelines for ATC classification. Oslo: Nordic Collaborating Centre for Drug Statistics Methodology; 1991.

  25. Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-83.

  26. Weiner JP, Starfield BH, Steinwachs DM, Mumford LM. Development and application of a population-oriented measure of ambulatory care casemix. Med Care. 1991;29:452-72.

  27. Sattar N, Gaw A, Scherbakova O, et al. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation. 2003;108:414-9.

  28. Novak S, Melkonian AK, Patel PA, Kleinman NL, Joseph-Ridge N, Brook RA. Metabolic syndrome-related conditions among people with and without gout: prevalence and resource use. Curr Med Res Opin. 2007;23:623-30.

  29. Vázquez-Mellado J, Cruz J, Guzmán S, Casasola-Vargas J, Lino L, Burgos- Vargas R. Severe tophaceous gout. Characterization of low socioeconomic level patients from Mexico. Clin Exp Rheumatol. 2006;24:233-8.

  30. Riedel AA, Nelson M, Joseph-Ridge N, Wallace K, MacDonald PA, Becker M. Compliance with allopurinol therapy among managed care enrolees with gout: a retrospective analysis of administrative claims. J Rheumatol. 2006;31:1575-81.




2020     |     www.medigraphic.com