Abstract

Introduction

The objective of the study was to evaluate changes regarding main European League Against Rheumatism (EULAR) recommendations on diagnosis and treatment of gout compared to a previous assessment.

Methods

The GEMA-2 (Gout Evaluation and MAnagement) is a transversal assessment of practice for gout by rheumatologists. Main outcome variables were improvement of the previous GEMA assessment regarding the rate of crystal-proven diagnosis and that reaching therapeutic serum urate target below 6 mg/dl at last visit. Other management variables (prophylaxis, treatment of flares, lifestyle change advice) were also evaluated along with general characteristics. The sample was powered to include at least 483 patients for up to 50% change.

Results

Data on management of 506 patients were retrieved from 38 out of 41 rheumatology units that participated in the previous GEMA audit. Crystal-proved diagnosis rate increased from 26% to 32% (31% improvement) and was higher in gout-dedicated practices; ultrasonography contributed to diagnosis in less than 1% of cases. Therapeutic serum urate at last visit improved from 41% to 64% of all patients (66% of patients on urate-lowering medications), in any case over 50% improvement from the previous assessment. The use of any urate-lowering medication available was not prescribed as per label dosing in patients who failed to achieve target serum urate. Clinical inertia to increase doses of either allopurinol or febuxostat was still present in clinical practice.

Conclusion

Over 50% improvement in targeting therapeutic serum urate has been observed, but clinical inertia is still present. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive.

Funding

Menarini España.

Details

Title
Improvement in Diagnosis and Treat-to-Target Management of Hyperuricemia in Gout: Results from the GEMA-2 Transversal Study on Practice
Author
Perez Ruiz, Fernando 1   VIAFID ORCID Logo  ; Sanchez-Piedra, Carlos A. 2 ; Sanchez-Costa, Jesus T. 2 ; Andrés, Mariano 3 ; Diaz-Torne, Cesar 4 ; Jimenez-Palop, Mercedes 5 ; De Miguel, Eugenio 6 ; Moragues, Carmen 7 ; Sivera, Francisca 8 

 Hospital Universitario Cruces e Instituto de Investigación Biomédica Biocruces, Vizcaya, Spain; Universidad del País Vasco, Vizcaya, Spain (GRID:grid.11480.3c) (ISNI:0000000121671098) 
 Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain (GRID:grid.419354.e) (ISNI:0000 0000 9147 2636) 
 Hospital General Universitario de Alicante, Alicante, Spain (GRID:grid.411086.a) (ISNI:0000 0000 8875 8879); Universidad Miguel Hernández, Alicante, Spain (GRID:grid.26811.3c) (ISNI:0000 0001 0586 4893) 
 Hospital de la Santa Cruz y San Pablo, Barcelona, Spain (GRID:grid.413396.a) (ISNI:0000 0004 1768 8905) 
 Hospital Universitario Puerta de Hierro, Madrid, Spain (GRID:grid.73221.35) (ISNI:0000 0004 1767 8416) 
 Hospital Universitario La Paz, Madrid, Spain (GRID:grid.81821.32) (ISNI:0000 0000 8970 9163) 
 Hospital Universitario Bellvitge, Barcelona, Spain (GRID:grid.411129.e) (ISNI:0000 0000 8836 0780) 
 Hospital Universitario de Elda, Alicante, Spain (GRID:grid.414736.3) (ISNI:0000 0004 1771 1327) 
Pages
243-253
Publication year
2018
Publication date
Jun 2018
Publisher
Springer Nature B.V.
ISSN
21986576
e-ISSN
21986584
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2867139594
Copyright
© The Author(s) 2017. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.