Predictors of Success in Gout Treatment

In this issue of The Journal , Singh, et al , from the University of Alabama, asked the key question regarding outcomes for people with gout: what are the factors associated with achieving and maintaining target serum urate (SU) concentrations with allopurinol1? To examine this, they have accessed a large, longitudinal cohort of patients with gout in the US Veterans Administration (VA) system from 2002 to 2012. To be included in the study, a patient needed a diagnostic code of gout for ≥ 1 inpatient episode or ≥ 2 outpatient visits, a new prescription for allopurinol, and a record in the VA system for at least 12 months. A successful outcome was achieving a target SU concentration of < 6 mg/dl (0.36 mmol/l) 14 days or more after the index allopurinol treatment. Successful maintenance was defined as those whose SU remained < 6 mg/dl at all subsequent measurements. There were 627,693 patients with gout in the VA system and 198,839 patients had a new prescription of allopurinol. However, only 41,153 had at least 1 SU result recorded and only 42% of these reached the target SU. This took a mean of 9 months to achieve. Only 17,402 incident allopurinol users had 2 or more SU results and of these, 42% achieved and maintained SU < 6 mg/dl for all blood samples tested over the period of observation. These findings are not surprising from what we know about outcomes for people with gout. However, they are depressing given that this form of arthritis can be controlled very well, if managed appropriately, in almost all … Address correspondence to Dr. R.O. Day, Department of Clinical Pharmacology and Toxicology, St. Vincent’s Hospital, Darlinghurst, Sydney 2010, Australia. E-mail: r.day{at}unsw.edu.au