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Quality of Care in Patients with Gout: Why is Management Suboptimal and What Can Be Done About It?

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Abstract

Gout is a common inflammatory arthritis. We know a great deal about its etiopathogenesis and have relatively safe and effective therapies for it. Gout, however, remains a poorly managed disease with mistakes made in securing an accurate diagnosis and in using appropriate therapies for acute and chronic stages of the disease. Synovial fluid analysis with polarizing microscopy is the “gold standard” for confirming the diagnosis of gout but has been used in fewer than 10% of all patients diagnosed with gout. The newly adopted European clinical guidelines offer a practical alternative to synovial fluid analysis, but primary care physicians are not well-versed in their use. Other serious errors in the management of gout are related to the use of medications to treat acute and chronic gout. Frequently, the anti-inflammatory drugs used to treat acute symptoms and urate-lowering drugs used to prevent long-term destruction are improperly dosed, leading to dissatisfaction on the part of patients and physicians. Widespread education about evidence-based diagnostic and treatment guidelines is desperately needed.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Edwards NL. Crystal deposition diseases. In Cecil’s Textbook of Medicine. 24th Edition, 2010.

  2. Pascual E, Sivera F, Why is gout so poorly managed? Ann Rheum Disease 2007: 66;1269–1270.

    Article  Google Scholar 

  3. McCarty DJ, Hollander JL. Identification of urate crystals in gouty synovial fluid. Ann Intern Med 1961; 54:452–60.

    PubMed  CAS  Google Scholar 

  4. Schlesinger N, Baker DG, Schumacher HR Jr. How well have diagnostic tests and therapies for gout been evaluated? Curr Opin Rheumatol 1999; 11:441–5.

    Article  PubMed  CAS  Google Scholar 

  5. Zhang W, Doherty M, Pascual E et al.: EULAR evidence-based recommendations for gout. Part I. Diagnosis. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Disease 2006; 65:1301–11.

    Article  CAS  Google Scholar 

  6. Mikuls TR, Farrar JT, Bilker WB et al. Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricemia: results from the UK General Practice Research Database (GPRD). Rheumatology 2005: 44;1038–1042.

    Article  PubMed  CAS  Google Scholar 

  7. 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 Disease 2007: 66;1311–1315.

    Article  CAS  Google Scholar 

  8. Pal B, Foxall M, Dysart T, et al. How is gout managed in primary care? A review of current practice and proposed guidelines. Clin Rheumatol 2000: 19;21–25.

    Article  PubMed  CAS  Google Scholar 

  9. ••Terkeltaub R. Update on gout: new therapeutic strategies and options. Nat Rev Rheumatol 2010; 6:30–38. Evidence-based strategies for using established and inexpensive drugs are defined, and recommendations for the use of novel targeted approaches are outlined in this review.

    Article  PubMed  CAS  Google Scholar 

  10. Edwards NL. Management of Hyperuricemia. In, Arthritis and Allied Conditions 16th Edition (ed WJ Koopman) Williams and Wilkins (Baltimore), 2009.

    Google Scholar 

  11. •• Edwards NL. Treatment failure gout: a moving target. Arthritis Rheum 2008: 58;2587–2590. Established ULTs allopurinol and probenecid have historically been misunderstood and misused by physicians, leading to the belief that failures in treating gout were the fault of the medication and not of the prescribing habits.

    Article  PubMed  Google Scholar 

  12. Sarawate CDA, Brewer KK, Yang W et al. Gout medication treatment patterns and adherence to standards of care from managed care perspective. Mayo Clin Proc 2006: 81;925–934.

    Article  PubMed  Google Scholar 

  13. Perez-Ruiz F, Liote F. Lowering serum uric acid levels: what is the optimal target for improving clinical outcomes in gout? Arthritis Rheum 2007: 57;1324–1328.

    Article  PubMed  Google Scholar 

  14. Singh JA, Hodges JS, Toscano JP et al. Quality of care for gout in the U needs improvement. Arthritis Rheum 2007: 57;822–829.

    Article  PubMed  Google Scholar 

  15. Mikuls TR. Quality of care in gout: from measurement to improvement. Clin Exp Rheumatol 2007: 256(suppl 47); S114–S119.

    Google Scholar 

  16. Mikuls TR, MacLean CH, Olivieri J, et al. Quality of care indicators for gout management. Arthritis Rheum 2004: 50;937–943.

    Article  PubMed  Google Scholar 

  17. Neogi T, Hunter DJ, Chaisson CE, et al. Frequency and predictors of inappropriate management of recurrent gout attacks in a longitudinal study. J Rheumatol 2006:33; 104–109.

    PubMed  Google Scholar 

  18. Harrold LR, Yood RA, Mikuls TR et al. Sex differences in gout epidemiology: evaluation and treatment. Ann Rheum Disease 2006; 65:1368–72.

    Article  CAS  Google Scholar 

  19. Sarawate CA, Patel PA, Schumacher HR et al. Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol 2006; 12:61–5.

    Article  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  21. Stamp L, Gow P, Sharples K et al. The optimal use of allopurinol: an audit of allopurinol use in South Auckland. Aust N Z J Med 2000; 30:567–72.

    PubMed  CAS  Google Scholar 

  22. Perez-Ruiz F, Alonso-Ruiz A, Calabozo M, et al. Efficacy of allopurinol and benzbromarone for the control of hyperuricemia. A pathogenic approach to the treatment of primary chronic gout. Ann Rheum Disease 1998; 57:545–549.

    Article  CAS  Google Scholar 

  23. Hande K, Noone R, Stone W. Severe allopurinol toxicity: description and guidelines for prevention in patients with renal insufficiency. Am J Med 1984; 76:47–56.

    Article  PubMed  CAS  Google Scholar 

  24. Dalbeth N, Kumar S, Stamp L, et al. Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout. J Rheumatol 2006, 33: 1646–1650.

    PubMed  CAS  Google Scholar 

  25. Vazquez-Mellado J, Meono Morales E, Pacheo-Tena C, et al. Relationship between adverse events associated with allopurinol and renal function in patients with gout. Ann Rheum Disease 2001; 60:981–983.

    Article  CAS  Google Scholar 

  26. Becker M, Schumacher HJ, Wortmann R et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005; 353:2450–61.

    Article  PubMed  CAS  Google Scholar 

  27. •• Singh J, Strand V. Gout is associated with more comorbidity, poorer health-related quality of life and higher health care utilization in US veterans. Ann Rheum Disease 2008; 67:1310–1316. This population-based, health-related quality-of-life assessment in US veterans with gout showed greater health care use, functional disability, and 1-year unadjusted mortality rates compared with non-gouty veterans.

    Article  CAS  Google Scholar 

  28. Li-Yu J, Clayburne G, Sieck M, Beutler A, Rull M, Eisner E, et al. Treatment of chronic gout: can we determine when urate stores are depleted enough to prevent attacks of gout? J Rheumatol 2001; 28:577–80.

    PubMed  CAS  Google Scholar 

  29. Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004; 51:321–5.

    Article  PubMed  CAS  Google Scholar 

  30. Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Eustace D, Palo WA et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005; 353:2450–61.

    Article  PubMed  CAS  Google Scholar 

  31. Perez-Ruiz F, Calabozo M. Fernandez-Lopez MJ, Herrero-Beites A, Ruiz-Lucea E, Garcia-Erauskin G, et al. Treatment of chronic gout in patients with renal function impairment: an open, randomized, actively controlled study. J Clin Rheumatol 1999; 5:49–55.

    Article  PubMed  CAS  Google Scholar 

  32. Perez-Ruiz F, Calabrozo M, Herrero-Beites AM, Garcia-Erauskin G, Pijoan JI. Improvement of renal function in patients with chronic gout after proper control of hyperuricemia and gouty bouts. Nephron 2000; 86:287–91.

    Article  PubMed  CAS  Google Scholar 

  33. Siu Y-P, Leung KT, Tong MKH, et al. Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kid Disease. 2006; 47:51–59.

    Article  CAS  Google Scholar 

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Disclosure

Dr. Edwards has served as a consultant for Takeda Pharmaceuticals North America, Savient Pharmaceuticals, and Ardea Biosciences; has received honoraria from Takeda Pharmaceuticals North America; and has had travel/accommodations expenses covered or reimbursed by Takeda Pharmaceuticals North America and Ardea Biosciences.

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  1. Division of Rheumatology, University of Florida, 1600 Southwest Archer Road, Room 4102, Gainesville, FL, 32610-0277, USA

    N. Lawrence Edwards

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Edwards, N.L. Quality of Care in Patients with Gout: Why is Management Suboptimal and What Can Be Done About It?. Curr Rheumatol Rep 13, 154–159 (2011). https://doi.org/10.1007/s11926-010-0154-6

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  • DOI: https://doi.org/10.1007/s11926-010-0154-6

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