Management and long-term serum urate control in gout: a population-based primary care cohort study.

Abstract (English)

BACKGROUND: Gout is a prevalent chronic inflammatory disease associated with a substantial clinical and cardiovascular burden. Despite the availability of effective urate-lowering therapies (ULTs), gout management remains suboptimal. AIM: To describe clinical characteristics and treatment patterns, and to identify factors associated with long-term serum urate (SU) control in gout. DESIGN AND SETTING: Retrospective population-based cohort study using the primary care research database 'Sistema d'Informaci&#xf3; per al Desenvolupament de la Investigaci&#xf3; en Atenci&#xf3; Prim&#xe0;ria' (SIDIAP), covering >75% of the Catalan population within a universal healthcare system. METHOD: Individuals with incident gout diagnosed between 2012 and 2023 were included. Demographic, clinical, and ULT data were collected. Good SU control was defined as SU levels <6 mg/dL for ≥80% of follow-up time. Factors associated with SU control were analysed. RESULTS: A total of 94 759 patients were included (mean age 66.25 [standard deviation 14.64] years; 79.58% male [75 412/94 759]; median follow-up 5.44 [interquartile range 2.54-8.24] years). In the 94 759 patients, hypertension (65.15%, <i>n</i> = 61 732), dyslipidaemia (50.58%, <i>n</i> = 47 932), diabetes (24.19%, <i>n</i> = 22 919), and chronic kidney disease (32.80%, 27 013/82 270 ) were common. Of the patients, 88.95% (<i>n</i> = 84 288) had ≥1 SU measurement. In total, 37.30% (35 343/94 759) had never received ULT. Allopurinol was the initial therapy in 96.09% of treated patients. Only 12.40% (10 453/84 288) achieved good SU control, with no improvement over time. Short ULT duration (≤25 days) occurred in 15.92% (9459/59 416) of patients. Good control was associated with longer treatment duration, higher allopurinol doses, febuxostat use, and better adherence, whereas delayed ULT initiation, male sex, obesity, chronic kidney disease, dyslipidaemia, and hypertension were associated with poor control. CONCLUSION: Long-term SU control in gout remains poor in primary care. Early initiation of ULT, appropriate dose optimisation, and improved adherence represent key modifiable targets to improve gout management.