Maastricht University Medical Centre, Maastricht, The Netherlands.
VieCuri Medical Centre, Venlo, The Netherlands.
Arthritis Care Res (Hoboken). 2020 Aug;72(8):1169-1176. doi: 10.1002/acr.23995. Epub 2020 Jun 11.
To compare outcomes of 2 gout clinics that implemented different treatment strategies.
Patients newly diagnosed with gout and a follow-up of 9-15 months were included. Co-primary outcomes were the proportion of patients reaching a serum uric acid (UA) ≤0.36 mmoles/liter and free of flares. Secondary outcomes were the proportion of patients requiring treatment intensification and experiencing adverse events. One clinic adopted a strict serum UA (≤0.30 mmoles/liter target) strategy, with early addition of a uricosuric to allopurinol, and the other clinic adopted a patient-centered (PC) strategy emphasizing a shared decision based on serum UA and patient satisfaction with gout control. Independent t-tests or chi-square tests were used to test differences in outcomes, and logistic regressions were used to adjust the effect of the treatment center on outcomes for confounders.
In total, 126 and 86 patients had a follow-up mean ± SD of 11.3 ± 1.8 versus 11.1 ± 1.9 months. In the UA strategy, 105 of 126 patients (83%) compared to 63 of 86 (74%) in the PC strategy (P = 0.10) reached the threshold of ≤0.36 mmoles/liter; and 58 of 126 (46%) versus 31 of 86 (36%) were free of flares (P = 0.15). In the UA strategy, 76 of 126 patients (60%) were on allopurinol monotherapy compared to 63 of 86 (73%) in the PC strategy (P = 0.05), yet the number of adverse events was not different (n = 25 [20%] versus n = 20 [23%]; P = 0.55). Adjusting for confounders did not substantially change these associations.
A strict UA strategy resulted in a nonsignificantly higher proportion of patients reaching a serum UA ≤0.36 mmoles/liter and being free of flares. This result was accomplished with significantly more therapy intensification. The small sample size plays a role in the significance of results.
比较两种不同治疗策略下的痛风诊所的治疗效果。
纳入新诊断为痛风且随访时间为 9-15 个月的患者。主要转归指标为血清尿酸（UA）≤0.36mmol/L 且无痛风发作的患者比例。次要转归指标为需要强化治疗的患者比例和发生不良反应的患者比例。一家诊所采用严格的血清 UA（≤0.30mmol/L 目标）策略，所有患者均早期加用别嘌醇和促尿酸排泄药；另一家诊所采用以患者为中心（PC）的策略，强调基于血清 UA 和患者对痛风控制的满意度做出共同决策。采用独立样本 t 检验或卡方检验比较转归的差异，采用逻辑回归调整治疗中心对转归的影响，以校正混杂因素。
共纳入 126 例和 86 例患者，随访时间的平均值±标准差分别为 11.3±1.8 个月和 11.1±1.9 个月。在 UA 策略中，126 例患者中有 105 例（83%）达到≤0.36mmol/L，而 86 例患者中有 63 例（74%）（P=0.10）；126 例患者中有 58 例（46%）无痛风发作，而 86 例患者中有 31 例（36%）（P=0.15）。在 UA 策略中，126 例患者中有 76 例（60%）接受别嘌醇单药治疗，而 86 例患者中有 63 例（73%）（P=0.05），但不良反应的数量没有差异（25 例[20%]与 20 例[23%]；P=0.55）。调整混杂因素后，这些关联没有明显变化。
严格的 UA 策略可使更多患者的血清 UA 达到≤0.36mmol/L，且无痛风发作，但需要更多的强化治疗。小样本量影响了结果的显著性。
