Lifestyle modification might improve ULT response in gout patients
medwireNews: Dyslipidemia, abdominal obesity, and alcohol consumption are associated with a poor response to urate-lowering therapy (ULT) among patients with gout, researchers report.
These “modifiable risk factors […] are strongly influenced by lifestyle, and might be related to dietary indiscretion,” say the study authors, adding that their findings could “help physicians identify patients with a need for a lifestyle change and educational intervention or a tighter follow-up to adapt ULT dosage, to achieve the treatment target.”
In a cross-sectional study, Pascal Richette (Hôpital Lariboisière, Paris, France) and colleagues found that only 22.3% of 1995 gout patients who were receiving ULT achieved the target serum urate level of 6.0 mg/dL or lower. Most participants (83.8%) were male, and the majority of patients were prescribed allopurinol (71.7%), with the remainder taking febuxostat, probenecid, or benzbromarone.
The 1550 patients with serum urate levels above 6.0 mg/dL had significantly higher total cholesterol levels, and significantly lower high-density lipoprotein (HDL) cholesterol levels, than the 445 reaching target levels, with corresponding measurements of 210 versus 199 mg/dL and 52 versus 54 mg/dL.
After multivariate analysis adjusting for factors including age, duration of gout, comorbidities, and concomitant treatments, patients with high total cholesterol levels were 83% more likely to have poor control of urate levels than patients with lower cholesterol levels, whereas those with high versus low HDL cholesterol levels were 50% less likely to have hyperuricemia.
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.
Patients who did not reach target urate levels were also significantly more likely to drink alcohol excessively, defined as the consumption of more than two glasses a day, and have abdominal obesity (waist circumference ≥ 94 cm for men and ≥ 80 cm for women) compared with those reaching target levels, at 49.4% versus 39.6% and 81.5% versus 75.3%, respectively.
And in the multivariate analysis, excessive alcohol consumption and abdominal obesity were associated with a corresponding 52% and 55% increased likelihood of poor urate control.
Dyslipidemia, alcohol consumption, and abdominal obesity may “reflect behavioral features associated with poor-adherence to treatment and could thus partly explain the association” between these factors and failure to reach target urate levels, write the researchers in Arthritis Care & Research.
However, they note that their study was unable prove causality and that “further prospective studies are warranted.”
“Despite this unclear relationship, each of these modifiable factors should be tightly controlled in gout management to improve the chances of reaching the treatment target,” conclude Richette and colleagues.
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