Editorial board comment
It is clear to all of us that the most common cause of not controlling serum urate levels in patients with gout is that no urate-lowering medication is prescribed.
This paper comes with the question of what factors may influence reaching therapeutic targets in clinical practice while on treatment. The first numerical impact of the paper is to ascertain that less than one in four patients who are prescribed medications do reach the minimal recommended target. The authors identify several independent variables associated with poor control, depicting a young, obese, hyperlipidemic, alcoholic and soft drink-consuming male, close to the classical paradigm of an overindulgent gout patient, in whom modification of lifestyle factors could be of relevant therapeutic utility. Other investigators have associated lower age, lower number of comorbid conditions, and alcohol intake to lower adherence to treatment, which may be a plausible cause of poor control.
Independently of the discussion about whether the metabolic syndrome or other factors not included, such as as adherence or dosing, are more or less influencing the results, what is clear to me after decades of clinical practice and hundreds of patients visited is that patients who gather these characteristics are more prone to be less adherent to follow-up and prescription. Therefore, we as clinicians – and especially primary care providers – should make additional efforts to closely monitor patients who, for any reason, are at higher risk of failing disease control, and especially those who are also at risk of preventable future cardiovascular events among other health problems.