Université Paris-Diderot, Sorbonne Paris-Cité, 75205 Paris, France.
Joint Bone Spine. 2012 Oct;79(5):464-70. doi: 10.1016/j.jbspin.2011.12.006. Epub 2012 Jan 26.
To assess diagnoses and management of acute and chronic gout in primary care and rheumatology settings relative to 2006 European League Against Rheumatism (EULAR) gout recommendations. Secondary objectives were to describe patient demographics, clinical features, lifestyle modifications, and short- and mid-term outcomes.
Prospective, cross-sectional, descriptive survey of patients with chronic gout, acute gout, or suspected gout, included by randomly selected general practitioners (GPs, n = 398) and rheumatologists (n = 109) between October 2008 and September 2009, in France. At the first visit, a structured questionnaire was completed. Each patient completed self-questionnaires at the first visit and 3 to 6 months later.
We included 1003 patients, including 879 (87.6%) males (mean age, 61.6 ± 11.4 years; 28.1% obese) and 124 (12.4%) females (70.2 ± 11.9 years; 33.1% obese). Mean disease duration was 8.0 ± 8.3 years and mean time since hyperuricemia diagnosis 8.2 ± 8.4 years. Mean annual number of flares was 1.9 ± 1.5. ACR criteria for gout were met in 855 pts. Gout was acute in 487 (48.6%) patients and chronic in 241 (24.4%). Tophi (19.4% of patients) were associated with disease duration but not gender or chronic kidney disease (CKD). The main co-morbidities were hypertension (53.8%), dyslipidemia (47.2%), and hyperglycemia/diabetes mellitus (15.0%). CKD 3-5 was present in 43% of patients but was identified by physicians in only 5.2%. CKD severity was significantly associated with age, gender, hypertension, and diuretic use.
This cohort will prove valuable for addressing the concordance with EULAR recommendations and for future studies of gout in everyday practice, most notably regarding metabolic syndrome, other co-morbidities, and identification of difficult-to-treat patients.
评估初级保健和风湿病学环境中急性和慢性痛风的诊断和管理情况，以符合 2006 年欧洲抗风湿病联盟（EULAR）痛风建议。次要目标是描述患者的人口统计学特征、临床特征、生活方式改变以及短期和中期结果。
2008 年 10 月至 2009 年 9 月，在法国通过随机选择的全科医生（GP，n=398）和风湿病学家（n=109）对慢性痛风、急性痛风或疑似痛风患者进行前瞻性、横断面、描述性调查。在第一次就诊时，完成了一份结构化问卷。每位患者在第一次就诊时和 3 至 6 个月后完成了自我问卷。
我们纳入了 1003 名患者，包括 879 名（87.6%）男性（平均年龄 61.6±11.4 岁；28.1%肥胖）和 124 名（12.4%）女性（70.2±11.9 岁；33.1%肥胖）。平均疾病持续时间为 8.0±8.3 年，平均血尿酸诊断后时间为 8.2±8.4 年。平均每年发作次数为 1.9±1.5 次。855 例患者符合 ACR 痛风标准。487 例（48.6%）患者为急性痛风，241 例（24.4%）为慢性痛风。痛风石（19.4%的患者）与疾病持续时间相关，但与性别或慢性肾脏病（CKD）无关。主要合并症为高血压（53.8%）、血脂异常（47.2%）和高血糖/糖尿病（15.0%）。43%的患者存在 CKD 3-5 期，但只有 5.2%的医生发现。CKD 严重程度与年龄、性别、高血压和利尿剂使用显著相关。
该队列将有助于解决与 EULAR 建议的一致性问题，并为未来日常实践中痛风的研究提供信息，尤其是关于代谢综合征、其他合并症和难治性患者的识别。
