AB0918 FACTORS ASSOCIATED WITH ACHIEVEMENT OF TARGET SERUM URIC ACID IN PATIENTS WITH NON-TOPHACEOUS GOUT ATTENDING PRIMARY CARE CLINICS.

Abstract

Background:Gout is characterised by deposition of monosodium urate crystal in the synovial fluid of joint and other tissues, in the presence of elevated serum uric acid (SUA). Dose-escalation strategy with allopurinol as first-line urate lowering therapy (ULT) was shown to be cost effective and a target SUA of less than 360µmol/L was recommended in non-tophaceous gout.1Some of the barriers to treatment effectiveness were related to physician and patient-related factors.2,3Objectives:To investigate the factors associated with achievement of target SUA in patients with non-tophaceous gout attending primary care clinics.Methods:A cross-sectional study was conducted over four months on patients with gout attending 21 primary care clinics in Selangor, an urbanised state in Malaysia. The demographic and clinical data, including the most recent SUA within six months of study participation, were obtained from patients’ interview and medical records. Obesity was defined as body mass index (BMI) of >27.5kg/m2. Data was analysed for patients with non-tophaceous gout. Comparison between patients who achieved and did not achieve target SUA, defined as <360µmol/L, was performed using chi-square and student t-test for categorical and continuous data, respectively.Results:Four hundred and twenty-six patients with gout participated in this study and 343 (80.5%) patients had non-tophaceous gout. Their mean age was 57.7 (±12.9) years. Majority were men (280 patients), Malay (260 patients) and had at least a secondary education (223 patients). There were high prevalence of cardiovascular co-morbidities; hypertension in 279 (81.3%), dyslipidaemia in 235 (68.5%), diabetes mellitus in 154 (44.9%) and obesity in 167 of 265 (63%). There were 280 patients diagnosed with gout for more than six months and 201 (71.8%) had recent SUA; 44 (21.9%) achieved target SUA and 157 (78.1%) did not achieve target SUA. The factors found to be significantly different between the two groups were age, ethnicity, education level, BMI and SUA level before ULT initiation. (Table 1) The mean allopurinol dose were similar between patients who achieved and did not achieve target SUA (191.3±80.8mg vs 197.1±72.5mg, p=0.56) despite significant difference in the mean SUA (301.5±70.3µmol/L vs 488.3±93.1µmol/L, p<0.01).Table 1.Comparison between patients who achieved and did not achieve target sUA level.FactorsTarget sUA achieved, mean (±SD)Target sUA not achieved, mean (±SD)p-valueAge, years63.9 (8.9)58.1 (12.5)<0.01Gender*0.92 • Male35 (21.7)126 (78.3) • Female9 (22.5)31 (77.5)Ethnic*0.03 • Malay30 (19.1)127 (80.9) • Others14 (35)26 (65)Education*, n=1810.14 • Primary17 (35.4)31 (64.6) • Secondary and beyond24 (18.0)109 (82.0)Disease duration, years94.5 (99.9)96.39 (94.8)0.91BMI, kg/m228.3 (4.3)31.1 (7.8)<0.01SUA before ULT, µmol/L553.2 (109.2)603.2 (98.5)0.03Recent SUA, µmol/L301.5 (70.3)488.3 (93.1)<0.01Allopurinol dose, mg191.3 (80.8)197.1 (72.5)0.67*no of patientsConclusion:There was a low percentage of patients who achieved target SUA in primary care clinics. Older age, ethnicity other than Malay, lower BMI and lower SUA level before ULT initiation were significantly associated with achievement of target SUA. Higher education was significantly associated with failure to achieve target SUA and in these patients, allopurinol was not titrated according to SUA level.References:[1]Richette P, Dorthy M, Pascual E,et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017 Jan;76(1):29-42.[2]Perez-Ruiz F, Desideri G. Improving adherence to gout therapy: an expert review. Ther Clin Risk Manag. 2018 May 3;14:793-802.[3]Rogenmoser S, Arnold MH. Chronic gout: Barriers to effective management. Aust J Gen Pract. 2018 Jun;47(6):351-356.Acknowledgments:We wish to acknowledge the contribution made by the primary care physicians and their team members who conducted the study in their centres.Disclosure of Interests:Hazlyna Baharuddin Speakers bureau: Sanofi, J&J, Syang Pyng Gan: None declared, Shereen Suyin Ch’ng Speakers bureau: Novartis, Pfizer, GSK, Mollyza Mohd Zain: None declared