Latourte A1,2, Bardin T1,2, Clerson P3, Ea HK1,2, Flipo RM4, Richette P1,2.
In real life, in a substantial proportion of gouty patients receiving urate-lowering therapy (ULT), urate levels are not maintained below the target of 6 mg/dL. We aimed to search for factors associated with poor control of serum urate levels (sUA) in a large population of gouty patients receiving ULT.
This cross-sectional study involved adults with gout in primary care who were receiving ULT. Demographics, gout history, comorbidities, lifestyle, clinical factors, concomitant treatments and laboratory data were compared in well-controlled gout (sUA ≤ 6 mg/dL) versus poorly-controlled gout (sUA > 6 mg/dL) on univariate and multivariate analyses.
Among the 1995 patients receiving ULT, only 445 (22.3%) had reached the target of 6 mg/dL sUA. Such patients had a lower rate of gout flares within the previous year than patients without the target (1.7±1.4 vs. 2.1±1.4, p < 0.0001). The main factors associated with poor sUA level control in multivariate analysis were low high-density lipoprotein-cholesterol level (adjusted odds ratio 0.5, 95% confidence interval 0.26 to 0.96; p=0.04), high total cholesterol level (1.83, 1.29 to 2.60; p=0.0007), increased waist circumference (1.55, 1.11 to 2.13; p=0.008) and alcohol consumption (1.52, 1.15 to 2.00; p=0.003).
Dyslipidaemia, abdominal obesity and alcohol consumption are the main factors associated with a poor response to ULT. Knowledge of these factors might help physicians identify cases of gout that may be less likely to achieve target urate level.