Jeyaruban Andrew, Soden Muriel, Larkins Sarah
College of Medicine, Dentistry James Cook University, Townsville, Australia.
Royal Brisbane and Women's Hospital, Herston, Australia.
Rheumatol Int. 2016 Dec;36(12):1753-1758. doi: 10.1007/s00296-016-3580-6. Epub 2016 Oct 21.
To examine the management of gout in general practice in Townsville, Australia, and to explore comorbid conditions in patients with gout. Study will also explore how closely guidelines are being followed in managing gout. Retrospective chart review was conducted from May to November 2014 in three general practices in Townsville. Registers for patients were established by searching "gout" and "gouty arthritis". Three hundred and twenty-one patients were included in the study after excluding inactive patients, patients below age of 18 and patients with cancer. Main outcome measures were prevalence of comorbidities in gout patients, gout medications and adequate serum urate control (≤0.36 mmol/l). Multivariate logistic regression was used to study the relationship between serum urate level, comorbid conditions and lifestyle factors. Hypertension was the most common comorbid condition with 60.8 % of patients followed by obesity and dyslipidaemia. In terms of medication, 46.7 % of patients were on allopurinol, 12.8 % on indomethacin and 13.4 % on diuretics. Eighty-six percentage of patients had serum urate level (sUA) recorded in the previous year. Of these, 32.2 % had a serum urate level below or equal to 0.36 mmol/l. Moreover, 17.4 % of patients had lifestyle advice documented in chart. Male gender was the most influential factor in having poor uric acid control (p < 0.01), followed by not being on allopurinol (p < 0.01) and patients older than 50 years (p = 0.02). Management of gout in this study sample was not entirely concordant with guidelines. The study also suggests a need for possible tighter monitoring and allopurinol dosing regime in older, male patients.
为研究澳大利亚汤斯维尔地区全科医疗中痛风的管理情况，并探究痛风患者的合并症。本研究还将探讨在痛风管理中遵循指南的程度。2014年5月至11月，在汤斯维尔的三家全科诊所进行了回顾性病历审查。通过搜索“痛风”和“痛风性关节炎”建立患者登记册。排除不活跃患者、18岁以下患者和癌症患者后，321名患者纳入研究。主要观察指标为痛风患者合并症的患病率、痛风药物使用情况以及血清尿酸的充分控制（≤0.36 mmol/L）。采用多因素逻辑回归研究血清尿酸水平、合并症与生活方式因素之间的关系。高血压是最常见的合并症，60.8%的患者患有高血压，其次是肥胖和血脂异常。在药物治疗方面，46.7%的患者使用别嘌醇，12.8%的患者使用吲哚美辛，13.4%的患者使用利尿剂。86%的患者上一年记录了血清尿酸水平（sUA）。其中，32.2%的患者血清尿酸水平低于或等于0.36 mmol/L。此外，17.4%的患者病历中有生活方式建议记录。男性是尿酸控制不佳的最有影响因素（p < 0.01），其次是未使用别嘌醇（p < 0.01）和年龄大于50岁的患者（p = 0.02）。本研究样本中痛风的管理与指南并不完全一致。该研究还表明，可能需要对老年男性患者进行更严格的监测和调整别嘌醇给药方案。
