Article Figures & Data
Tables
Allopurinol Prescribed n=3,283 Allopurinol Not Prescribed n=4,859 Male, %, (No.) 70.9 (2,327) 67.9 (3,300) Mean age at diagnosis of gout, ya 65.4 (SD 10.2) 66.9 (SD 11.1) Eligible for allopurinol, %, (n) At baseline 34.7 (1,139) 27.1 (1,320) Ever 25.4 (835) 34.7 (1,684) Criteria by which eligible for allopurinol, %, (No.)b Not eligible 39.4 (1,294) 37.7 (1,832) CKD 2.8 (92) 4.1 (197) Diuretic therapy 40.7 (1,336) 47.5 (2,310) ≥2 gout attacks in 12 months 14.2 (466) 7.8 (381) Tophi 1.3 (41) 0.9 (43) Urolithiasis 1.6 (54) 2.0 (96) Exposure to alcohol, %, (No.)c Never exposed to alcohol 11.9 (392) 13.2 (641) Exposed to alcohol 76.3 (2,506) 71.6 (3,479) Not recorded 11.7 (385) 15.2 (739) BMI, %, (n) BMI ≤25kg/mb 19.1 (626) 24.1 (1,173) BMI >25kg/mb 64.9 (2,129) 56.1 (2,724) Not recorded 16.1 (528) 19.8 (962) Charlson comorbidity score at gout diagnosis, mean 1.7 (SD 1.9) 0.8 (1.2) Consultation for gout during follow-up, median No. (IQR) 2 (1–11) 1 (1–10) Consultation for any reason during follow-up, median No. (IQR) 42 (4–279) 88 (8–440) ACR = American College of Rheumatology; BMI = body mass index; CKD = chronic kidney disease; EULAR = European League Against Rheumatism; IQR = interquartile range; SD = standard deviation.
↵a Cohort older than 50 years.
↵b Eligibility according to the EULAR and ACR guidelines.5,6
↵c Exposure to alcohol measured as ever exposed/never exposed or not recorded closest to the date of diagnosis of gout.
Hazard Ratio 95% CI Eligible for allopurinol (ever) Not eligible 1 [referent] 1 [referent] CKD 3.48 2.31–5.26 Diuretic therapy 2.49 2.10–2.94 ≥2 Consultations for gout in 12 months 3.88 3.22–4.68 Tophi 2.10 1.10–4.00 Urolithiasis 2.33 1.44–3.78 Age at diagnosis of gouta 1.00 0.99–1.01 Male 0.59 0.51–0.69 Overweight (BMI >25kg/mb) Not overweight (BMI ≤25kg/mb) 1 [reference] 1 [reference] Overweight 1.14 1.02–1.27 Not recorded 0.88 0.74–1.04 Exposure to alcohol Never exposed 1 [reference] 1 [reference] Ever exposed to alcohol 1.07 0.93–1.24 Not recorded 0.80 0.65–0.99 Charlson comorbidity scorea 0.84 0.81–0.88 Number of consultations for gouta (during entire follow-up) 1.05 1.02–1.08 Number of consultations for any reason (during entire follow-up) Quartile 1 (0–34) 1 [reference] 1 [reference] Quartile 2 (34–64) 0.44 0.37–0.61 Quartile 3 (65–119) 0.20 0.16–0.24 Quartile 4 (≥120) 0.07 0.05–0.09 Time-varying covariatesc Male 1.007 1.004–1.011 Number of consultations for gouta (during entire follow-up) 1.002 1.001–1.002 Number of consultations for any reason (during entire follow-up) Quartile 1 (0–34) 1 [reference] 1 [reference] Quartile 2 (34–64) 1.005 1.001–1.009 Quartile 3 (65–119) 1.009 1.005–1.037 Quartile 4 (≥120) 1.015 1.012–1.020 Eligible for allopurinol (ever) Not eligible 1 [referent] 1 [referent] CKD 0.990 0.982–0.999 Diuretic therapy 0.991 0.988–0.994 ≥2 consultations for gout in 12 mo 0.985 0.980–0.989 Tophi 0.994 0.979–1.008 Urolithiasis 0.990 0.982–0.999 ACR = American College of Rheumatology; BMI = body mass index; CKD = chronic kidney disease; EULAR = European League Against Rheumatism.
Note: Model is adjusted for all listed variables and clustering by practice.
↵a Denotes a continuous variable.
↵b Eligibility according to the EULAR and ACR guidelines.5,6
Additional Files
The Article in Brief
Factors Influencing Allopurinol Initiation in Primary Care
Lorna E. Clarson , and colleagues
Background Although medication to reduce uric acid, such as allopurinol, can reduce the complications of gout, it is prescribed for only a minority of gout patients. This study investigates factors associated with time to initiation of allopurinol treatment.
What This Study Found Managing gout as a chronic, rather than an acute, condition could help prevent recurrences. A study of more than 8,000 medical records found a positive association between starting treatment with allopurinol and recurring doctor visits for the condition. Clinicians may therefore be more likely to offer allopurinol, or patients may be more likely to accept it, after multiple acute gout attacks.
Implications
- The authors suggest that more frequent chronic disease reviews to evaluate patients� preferences and eligibility for allopurinol could reduce barriers to successfully treating gout.
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