Gout undertreated and flares are common: community study

Gout flares are common, with almost a quarter of patients reporting two or more flares in the previous 12 months, according to first population-based study of gout in Australia.

The South Australian Health Omnibus Survey of 2,778 people over 25 years of age found gout prevalence was 6.5%.

Participants with gout were more likely to be male and older, with a higher BMI and lower socioeconomic status than those without gout. Co-morbidities including heart disease and diabetes were common.

Just over a third (37.1%) of people with gout reported taking allopurinol to manage urate levels but even more people (39.7%) had never used the drug while 23.2% had used but discontinued the drug.

Older people and females were more likely to have never used allopurinol. Females were also more likely to discontinue the drug.

A slim majority of patients (58%) reported no gout flares in the previous 12 months but 24.6% reported two or more flares.

Only half of people with gout and reporting two or more flares per year (51%) were taking allopurinol.

“Despite the established role of ULT [urate-lowering therapy] in reducing flares, participants on ULT were more likely to experience frequent gout flares, suggesting suboptimal use,” said the study authors from the University of Adelaide.

“Furthermore, the ULT discontinuation rate was nearly 40%. Collectively, these results are consistent with suboptimal management of gout, as has been identified in previous studies.”

The study authors, including Professor Catherine Hill, of the Rheumatology Unit at The Queen Elizabeth Hospital, noted there were known difficulties in optimising treatment for gout such as flares with an initial sudden decrease in serum urate levels.

“Subsequently, patients may perceive therapy to be ineffective and continuation rates can be poor. A lack of education for both medical practitioners and patients has been identified as a key barrier for success in establishing and maintaining ULT,” they concluded.

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