Simple application of gout guidelines enables disease control: an observational study in French referral centres

Background: Recent studies have shown a lack of implementation of gout recommendations in primary care. In this context of therapeutic inertia, the French Society of Rheumatology (SFR) published its first recommendations on gout in 2020, which were deliberately simple and concise. Objectives: The objectives were to determine the profile of patients referred to French gout expert centres, and to examine the results of their management and the factors leading to those results. Methods: Three hundred patients attending a first visit for gout management in three French referral centres were retrospectively and randomly included in this multicentre observational study.Visits were performed at baseline (M0) and scheduled for month 6 (M6), month 12 (M12), and month 24 (M24). Data collected included: patient profile; disease activity and treatments; serum urate (SU) level; estimated glomerular filtration rate (eGFR). Results: Patients were 81% male and mean age 62.2 ± 15.2 years. Only 15,3% of them had difficult-to-treat gout at baseline. Management followed French recommendations after the baseline visit in 94.9% of cases. SU levels were below 6.0mg/dL in 59.4% of patients at M6, 67.9% at M12, and 78.6% at M24, with increasing clinical improvement (i.e. flare decrease) over 2 years of follow-up. At M24, 50% of patients were treated with allopurinol (313 ± 105 mg/d), which exceeded renal restrictions of doses in 61.5% of them, and 48.2% received febuxostat (84 ± 36mg/d). The need for a sufficient dosage of ULT was the only predictive factor found for successful reach SU levels <6.0mg/dL at a given visit. Overall, 50 patients (16.7%) received off-label anakinra for flare treatment or flare prophylaxis. Conclusion: Simple application of gout management guidelines is feasible in clinical practice, and is efficient with a majority of patients achieving SU targets and clinical improvement.