Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK.
BMC Prim Care. 2023 Nov 22;24(1):246. doi: 10.1186/s12875-023-02201-7.
Gout is the most common inflammatory arthritis and is almost exclusively managed in primary care, however the course and severity of the condition is variable and poorly characterised. This research aims improve understanding about the frequency of, and factors associated with, gout flares in the UK and characterise the factors associated with the initiation of ULT.
Using the Clinical Practice Research Database, patients with a coded incident gout diagnosis without a prior prescription for urate-lowering therapy (ULT) were identified. Gout flares post diagnosis and ULT initiation were identified through prescribing and coded data. Patient characteristics, co-morbidities and co-prescribing were co-variants. Factors associated with gout flares and ULT initiation were analysed using cox-proportional hazard model and logistic regression.
Fifty-one thousand seven hundred eighty-four patients were identified: 18,605 (35.9%, 95%CI 35.5-36.3%) had experienced ≥ 1 recurrent flare, 17.4% (95%CI 17.1-17.8%) within 12 months of diagnosis. Male sex, black ethnicity, higher BMI, heart failure, CKD, CVD and diuretic use were associated with flares, with the highest HR seen with high serum urate levels (≥ 540 µmol/L HR 4.63, 95%CI 4.03-5.31). ULT initiation was associated with similar variables, although higher alcohol intake and older age were associated with lower odds of ULT initiation but were not associated with flares. ULT was initiated in 27.7% (95%CI 27.3-28.0%): 5.7% (95%CI 5.5-5.9%) within 12 months of diagnosis. ULT initiation rates were higher in patients with recurrent flares.
Approximately one in six people with incident gout had a second flare within 12 months. Factors associated with flare recurrence and ULT initiation were similar, but ULT initiation occurred later after diagnosis than previously thought.
痛风是最常见的炎症性关节炎，几乎完全在初级保健中进行管理，然而，病情的进程和严重程度是可变的，且特征描述较差。本研究旨在提高对英国痛风发作频率和相关因素的认识，并描述与开始使用降尿酸治疗（ULT）相关的因素。
使用临床实践研究数据库，确定了有编码的痛风初诊病例但无先前 ULT 处方的患者。通过处方和编码数据确定诊断后和开始 ULT 后的痛风发作。患者特征、合并症和共处方为协变量。使用 Cox 比例风险模型和逻辑回归分析与痛风发作和 ULT 开始相关的因素。
共确定了 51784 例患者：18605 例（35.9%，95%CI 35.5-36.3%）经历了≥1 次复发性发作，17.4%（95%CI 17.1-17.8%）在诊断后 12 个月内。男性、黑人种族、较高的 BMI、心力衰竭、CKD、CVD 和利尿剂使用与发作相关，而血清尿酸水平较高（≥540µmol/L HR 4.63，95%CI 4.03-5.31）与最高的 HR 相关。ULT 的开始与类似的变量相关，尽管较高的酒精摄入量和年龄较大与较低的 ULT 开始几率相关，但与发作无关。ULT 的起始率为 27.7%（95%CI 27.3-28.0%）：5.7%（95%CI 5.5-5.9%）在诊断后 12 个月内。有复发性发作的患者 ULT 起始率较高。
大约六分之一的新发痛风患者在 12 个月内有第二次发作。与发作复发和 ULT 开始相关的因素相似，但与之前的想法相比，ULT 的开始时间更晚。
