Urate-lowering therapy for gout: Difficulties in goal achieving the and ways to overcome

Abstract

Introduction. The effectiveness of gout treatment is assured by achieving a serum uric acid target level, which is currently accepted by most national clinical guidelines and consensus as < 360 µmol/L. Achievement of therapy goals is ensured by modification of patients’ lifestyle and adequate prescription of urate-reducing therapy and often involves a number of difficultiesAim. To analyze the frequency of prescription and success of urate-reducing therapy in patients with gout over a five-year observation period in real clinical practice.Materials and methods. Retrospective evaluation of the management of 104 patients (72 men and 32 women) with gout diagnosed for the first time in 2018, followed up to and including 2023. We analyzed the adequacy of urate-reducing therapy prescription, frequency of arthritis exacerbations, and presence of comorbidities in subgroups achieving or not achieving uric acid target level < 360 µmol/L.Results. 26 people achieved uric acid target level, with a comparable ratio of men and female in subgroups of achieving or not achieving. The fact of achieving uric acid target level was recorded during the first year of observation and was maintained subsequently. Prescription of urate-reducing therapy was registered in 42% of the group, but in only 41% of them it was adequate. Even with adequate prescription of allopurinol, 1/3 of the patients did not achieve uric acid target level. The prescription of an alternative uricostatic agent, febuxostat, was noted in only 9% of patients.Conclusions. Achieving total control in gout in real clinical practice noted in 25%, and urate-reducing therapy was prescribed in 42% of patients. Urate-lowering therapy was prescribed adequate in less than 1/2 of patients. Alternative uricostatic to allopurinol febuxostat was prescribed in less than 1/10 of patients. Opportunity achievement of the urate-reducing therapy goal was determined within the first year from diagnosis gout. If the uric acid target level is not reached within a given period of time, it is necessary analyze the reasons for failure and prescribe or intensify urate-reducing therapy.