Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 11-12, Pages: 717-721
https://doi.org/10.2298/SARH1212717R
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Quality of treatment in gouty patients considering EULAR recommendations
Radak-Perović Marija (Medicinski fakultet, Beograd + Institut za reumatologiju, Beograd)
Zlatković-Švenda Mirjana (Institut za reumatologiju, Beograd)
Introduction. There are 12 recommendations for gout treatment, based on
evidence and opinion of experts. Objective. To assess the quality of therapy
in patients with gout analyzing adherence to four selected recommendations.
Methods. Retrospective cross sectional study of 111 patients with gouty flare
was conducted. Adherence to selected recommendation was defined as odds ratio
between the number of patients whose therapy adhered to treatment
recommendation and the number of patients eligible for the relevant
recommendation. These recommendations refer to indications for allopurinol
treatment (R1), prophylaxis of induced gouty flares in the first month of
allopurinol treatment (R2), treatment goals (R3), and treatment monitoring
regime (R4). Results. Out of 111 patients with gout, 25 with tophi, 87 with
frequent gouty flares and 46 with CUA or X-ray erosions were indicated for
allopurinol treatment. The adherence to R1 was 76% for tophi patients, 54%
for patients with frequent gouty flares, and 63% for patients with CUA. None
of the patients starting allopurinol was either recruited for gouty
prophylaxis or monitored properly; adherence to R2 as well as to R4 was 0%.
Target serum uric acid (SUc) rating below 360 µmol/L was achieved in 13/50
patients treated with allopurinol, while the adherence to R3 was 26%.
Therapeutic monitoring in accordance with P4 was not done in any of the
patients on allopurinol. There were no differences in mean levels of the SUc
between allopurinol users and non-users: 471.3±164.4 vs. 460.0±103.5 µmol/L
(p=0.067). Therefore, almost every second patient with gouty flares was on
allopurinol therapy (50/111). Conclusion. The degree of deviation in relation
to the key principles of correct treatment in patients with gout ranged from
a relatively high (24%) to that of absolute digression (100%).
Keywords: gout, treatment recommendations, quality of therapy, allopurinol