Francis-Sedlak Megan, LaMoreaux Brian, Padnick-Silver Lissa, Holt Robert J, Bello Alfonso E
Horizon Therapeutics plc, 150 South Saunders Road, Lake Forest, IL, 60045, USA.
Illinois Bone and Joint Institute, 2401 Ravine Way, Glenview, IL, 60025, USA.
Rheumatol Ther. 2021 Mar;8(1):183-197. doi: 10.1007/s40744-020-00260-1. Epub 2020 Dec 7.
Gout is a common, progressive, systemic inflammatory arthritis caused by hyperuricemia. Current guidelines recommend that serum uric acid (sUA) levels be maintained below 6.0 mg/dl to minimize acute gout attacks, tophi development, and long-term joint and organ damage. This study examined the influence of uncontrolled gout on post-diagnosis comorbidities and medication use.
The Humana Research Database (2007-2016, commercial insurance and Medicare) was searched (PearlDiver tool) for patients who had a gout diagnosis code, claims data for at least 6 months before and after diagnosis, and at least 90 days of continuous urate-lowering therapy within 1 year of diagnosis. Patients with controlled (all sUA measurements < 6.0 mg/dl) and uncontrolled (all sUA measurements ≥ 8.0 mg/dl) gout were further examined and compared to better understand the influence of uncontrolled gout on post-diagnosis comorbidities, medication use, and reasons for seeking medical care.
A total of 5473 and 1358 patients met inclusion and classification criteria for the controlled and uncontrolled groups, respectively. Identified comorbidities in both groups included hypertension, hyperlipidemia, diabetes, cardiovascular disease, and chronic kidney disease (CKD). However, the uncontrolled group was more likely to have diabetes, CKD, and cardiovascular disease (including heart failure and atrial fibrillation). Additionally, CKD tended to be more advanced in the uncontrolled gout population (Stage 4-5: 34.6 vs. 22.2%). Overall opioid use was higher in uncontrolled patients.
The current study identified differences between controlled and uncontrolled gout patients, including usage of medication, severity of CKD, and prevalence of CKD, diabetes, and heart disease.
痛风是一种由高尿酸血症引起的常见、进行性、全身性炎症性关节炎。当前指南建议将血清尿酸（sUA）水平维持在6.0毫克/分升以下，以尽量减少急性痛风发作、痛风石形成以及长期的关节和器官损害。本研究探讨了未控制的痛风对诊断后合并症和药物使用的影响。
利用PearlDiver工具在Humana研究数据库（2007 - 2016年，商业保险和医疗保险）中搜索有痛风诊断代码的患者，以及诊断前后至少6个月的索赔数据，且在诊断后1年内有至少90天的持续降尿酸治疗。对痛风得到控制（所有sUA测量值＜6.0毫克/分升）和未得到控制（所有sUA测量值≥8.0毫克/分升）的患者进行进一步检查和比较，以更好地了解未控制的痛风对诊断后合并症、药物使用及就医原因的影响。
分别有5473例和1358例患者符合控制组和未控制组的纳入及分类标准。两组中确定的合并症包括高血压、高脂血症、糖尿病、心血管疾病和慢性肾脏病（CKD）。然而，未控制组更易患糖尿病、CKD和心血管疾病（包括心力衰竭和心房颤动）。此外，CKD在未控制的痛风人群中往往更为严重（4 - 5期：34.6%对22.2%）。未控制组患者总体阿片类药物使用量更高。
本研究确定了痛风得到控制和未得到控制的患者之间的差异，包括药物使用情况、CKD的严重程度以及CKD、糖尿病和心脏病的患病率。
