When uric acid lowering therapy is indicated in patients with gout, medication adherence is deemed essential to prevent attacks. A recent study published in Rheumatology looked at how well gout patients over 40y old in the UK stick to taking the anti-gout medication Allopurinol (Rheumatology (Oxford). 2018 Sep 1;57(9):1641-1650). Only 39% of patients were considered to adhere to medication through the entire observation period. The results also indicated that adhering to your gout medication is especially poor if you are female or a smoker. Medication adherence remains low in those patients who restart Allopurinol after a medication gap as well. Further research is needed to find out why adherence is poor. The authors postulate that personalised care is important to improve medication adherence, and I would add that “treating to target” to achieve a an optimal serum uric acid level and addressing co-morbidities is vital.
At the American College Of Rheumatology Annual meeting in Chicago this month new data from a prospective cohort study was presented indicating that patients with gout who fail to achieve optimal levels of serum uric acid are at increased risk for dying prematurely, the risk being double in those with the highest levels of uric acid (American College of Rheumatology (ACR) 2018 Annual Meeting: Abstract 869 Presented October 22, 2018).
Using a treat to target approach, which aims to lower serum uric acid to target levels, is really similar to what we do in hypertension, hyperlipidaemia and diabetes management, and for sometime this has been gaining favour. These data support the need for renewed vigour by doctors to ensure their gout patients achieve the recommended serum uric acid target.
Written by Dr Simon Paul
Consultant Rheumatologist