- •Patients with gout have multiple comorbid conditions.
- •Patients with gout frequently have contraindications to acute and chronic gout medications.
- •Therapeutic decisions should be based on individualized risks and benefits.
- •Potential adverse effects may be averted with heightened clinician and patient education.
Materials and Methods
- Bailie G.R.
- Johnson C.A.
- Mason N.A.
- St Peter W.L.
|Disease||Mild-to-Moderate or Controlled||Moderate-to-Severe or Uncontrolled|
|Hypertension||Controlled prescribed anti-HTN medications with SBP<140 mm Hg or DBP<90 mm Hg||Uncontrolled with or without prescribed anti-HTN medications and SBP≥140 mm Hg or DBP≥90 mm Hg|
|Hyperlipidemia||Documentation of HL controlled with medical therapy (TC≤240 mg/dL, TG≤150 mg/dL, LDL≤150 mg/dL)||Documentation of HL uncontrolled with or without medical therapy (TC≥240 mg/dL, TG≥150 mg/dL, LDL≥150 mg/dL)|
|Chronic kidney disease|
|Creatinine>1.2 mg/dL and eGFR≥60 mL/min/1.73 m2||eGFR<60 mL/min/1.73 m2|
|Chronic hepatitis||Serologically proven chronic hepatitis with normal LFTs: AST<42, ALT<40; and no detectable viral load (hepatitis B and C)||Serologically proven chronic hepatitis with abnormal LFTs or detectable viral load (hepatitis B and C)|
|Diabetes mellitus||HbA1c≤7.0 mg/dL with or without medical therapy||HbA1c>7.0 mg/dL with or without treatment, or history of DKA/hyperosmolar hyperglycemic state|
|astroesophageal diseases||GERD with prescribed histamine2 receptor antagonist blocker or proton pump inhibitor||Documented PUD or history of upper GI bleed regardless of prescribed histamine2 receptor antagonist blocker or proton pump inhibitor|
|Coronary artery disease||Documentation of angina, ischemia, positive stress test, or myocardial infarction|
|Documentation by DEXA (T-score≤−2.5) on medical therapy or osteopenia (T-scores between −2.0 and −2.5) documented by DEXA not on therapy|
|Chronic infection||Documented presence of untreated or partially treated osteomyelitis or tuberculosis|
- •to nonsteroidal anti-inflammatory drugs—hypertension, cardiovascular disease, chronic kidney disease, gastroesophageal disease;
- •to glucocorticoids—hypertension, diabetes mellitus, cardiovascular disease, hyperlipidemia, gastroesophageal disease, osteoporosis;
- •to colchicine—chronic kidney disease, chronic hepatitis;
- •to allopurinol—chronic kidney disease, chronic hepatitis, allopurinol hypersensitivity;
- •to probenecid—chronic kidney disease, severe gastroesophageal disease.
|Characteristics||Mean±SD (95% CI)|
|Cohort 1 (N=575)||Cohort 2 (N=478)||Cohort 3 (N=41)|
|Serum uric acid level, mg/dL||7.67±2.06 (7.49-7.86)||7.72±2.16 (7.51-7.93)||7.91±2.33 (7.16-8.65)|
|Body mass index, kg/m2||28.97±5.45 (28.52-29.42)||29.11±5.60 (28.60-29.61)||28.78±4.93 (27.22-30.34)|
|Systolic BP, mm Hg||127.47±17.73 (126.01-128.92)||127.26±17.70 (125.67-128.86)||125.75±20.16 (119.39-132.12)|
|Diastolic BP, mm Hg||71.25±12.68 (70.21-72.29)||71.06±12.81 (69.91-72.22)||69±15.27 (64.17-73.82)|
|Creatinine, mg/dL||1.45±0.93 (1.37-1.53)||1.45±0.94 (1.37-1.54)||1.55±0.62 (1.35-1.74)|
|eGFR, mL/min/1.73 m2||66.64±27.40 (64.32-68.95)||66.43±27.48 (63.91-68.95)||58.79±20.57 (52.12-65.46)|
|HgA1C, mg/dL||6.44±3.94 (6.04-6.83)||6.33±1.73 (6.14-6.52)||6.43±1.35 (5.96-6.90)|
|Total cholesterol, mg/dL||169.29±47.67 (165.30-173.27)||168.57±41.57 (164.79-172.35)||158.75±30.63 (149.08-168.42)|
|Triglycerides, mg/dL||154.73±179.68 (139.71-169.75)||158.35±191.91 (140.89-175.80)||142.68±66.59 (121.66-163.70)|
|Allopurinol dose, mg||192.18±99.79 (179.90-204.47)||192.18±99.79 (179.90-204.47)||202.63±97.85 (155.46-249.79)|
|Age, y||71.75±11.64 (70.79-72.70)||71.74±11.78 (70.67-72.79)||71.73±9.96 (68.58-74.87)|
|South East Asian||2.1||2.1||7.3|
Prevalence of Contraindications to Gout Medications
Prescription of Gout Medications Despite Contraindications
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Funding: Drs Keenan and Fisher were supported by National Institutes of Health T32 Training Grant 5T32AR007176 . Dr Fisher also was the recipient of Fellowship Training Award from the Arthritis Foundation New York Chapter. No other external funding was used.
Conflict of Interest: Dr Goldfarb is a consultant for Takeda. None of the other authors have any conflict of interest regarding this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.