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Palpable tophi and more comorbidities associated with adherence to urate-lowering medical therapy in a Chinese gout cohort.
Joint Bone Spine. 2022 11; 89(6):105435.JB

Abstract

OBJECTIVE

Urate-lowering therapy (ULT) nonadherence is common and problematic in gout. Since, sociocultural factors affect adherence, we analyzed a Chinese cohort.

METHODS

We studied 903 Chinese gout patients aged 46.4±14.7 years (mean±SD), uniquely extending to assay of 2-year medication possession ratio (MPR) ≥80% defined as high adherence. Multivariable logistic regression analyses evaluated factors linked with adherence and ULT target attainment.

RESULTS

Characterization of ULT outcomes in this cohort revealed that after 2 years ULT, MPR ≥80% patients had better target serum urate (SU) achievement (from 23.3% to 71.0%, P <0.001), lower flare frequency and palpable tophi compared to MPR <80%. However, only 44.7% of cohort subjects had MPR ≥80%. Male sex (OR 3.68), gout onset age >60 years (OR 3.51), disease duration >5 years (OR 1.70), more comorbidities (OR 1.74), baseline palpable tophi (OR 1.53), SU <6mg/dL (360μmol/L) (OR 1.92) and more frequent follow-up visits (OR 1.98) were significantly associated with high adherence. Nevertheless, significant independent risk factors for failed SU target achievement included male sex (OR 0.36) and more comorbidities (OR 0.85).

CONCLUSION

Despite adherence to ULT linked to better outcomes for flares and tophi, the more adherent Chinese male patients and those with more comorbidities had decreased target SU attainment. Differences in adherence of Chinese gout patients compared to several primarily Western studies emphasize the importance of not stereotyping gout patients for projected nonadherence. Results underline the dual importance of identifying gout patients more likely to be ULT-adherent and leveraging adherence to drive treatment to SU target.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Hu S
Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China.
Terkeltaub R
VA San Diego VA Healthcare Center, University of California San Diego, 92093 San Diego, USA.
Sun M
Department of Rheumatology, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China.
Ji X
Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China.
Li Z
Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China.
Ran Z
Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China.
Li Y
Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China.
Zhang H
Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China.
Sun W
Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China.
Li C
Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China.
Lu J
Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China. Electronic address: 13127006046@163.com.

MeSH

HumansMaleUric AcidGout SuppressantsGoutCohort StudiesChina

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35777552

Citation

Hu, Shuhui, et al. "Palpable Tophi and More Comorbidities Associated With Adherence to Urate-lowering Medical Therapy in a Chinese Gout Cohort." Joint Bone Spine, vol. 89, no. 6, 2022, p. 105435.
Hu S, Terkeltaub R, Sun M, et al. Palpable tophi and more comorbidities associated with adherence to urate-lowering medical therapy in a Chinese gout cohort. Joint Bone Spine. 2022;89(6):105435.
Hu, S., Terkeltaub, R., Sun, M., Ji, X., Li, Z., Ran, Z., Li, Y., Zhang, H., Sun, W., Li, C., & Lu, J. (2022). Palpable tophi and more comorbidities associated with adherence to urate-lowering medical therapy in a Chinese gout cohort. Joint Bone Spine, 89(6), 105435. https://doi.org/10.1016/j.jbspin.2022.105435
Hu S, et al. Palpable Tophi and More Comorbidities Associated With Adherence to Urate-lowering Medical Therapy in a Chinese Gout Cohort. Joint Bone Spine. 2022;89(6):105435. PubMed PMID: 35777552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Palpable tophi and more comorbidities associated with adherence to urate-lowering medical therapy in a Chinese gout cohort. AU - Hu,Shuhui, AU - Terkeltaub,Robert, AU - Sun,Mingshu, AU - Ji,Xiaopeng, AU - Li,Zhiyuan, AU - Ran,Zijing, AU - Li,Yushuang, AU - Zhang,Hui, AU - Sun,Wenyan, AU - Li,Changgui, AU - Lu,Jie, Y1 - 2022/06/28/ PY - 2022/02/04/received PY - 2022/06/13/revised PY - 2022/06/15/accepted PY - 2022/7/2/pubmed PY - 2022/11/24/medline PY - 2022/7/1/entrez KW - Adherence KW - Gout KW - Gout flare KW - Tophi KW - Urate-lowering therapy SP - 105435 EP - 105435 JF - Joint bone spine JO - Joint Bone Spine VL - 89 IS - 6 N2 - OBJECTIVE: Urate-lowering therapy (ULT) nonadherence is common and problematic in gout. Since, sociocultural factors affect adherence, we analyzed a Chinese cohort. METHODS: We studied 903 Chinese gout patients aged 46.4±14.7 years (mean±SD), uniquely extending to assay of 2-year medication possession ratio (MPR) ≥80% defined as high adherence. Multivariable logistic regression analyses evaluated factors linked with adherence and ULT target attainment. RESULTS: Characterization of ULT outcomes in this cohort revealed that after 2 years ULT, MPR ≥80% patients had better target serum urate (SU) achievement (from 23.3% to 71.0%, P <0.001), lower flare frequency and palpable tophi compared to MPR <80%. However, only 44.7% of cohort subjects had MPR ≥80%. Male sex (OR 3.68), gout onset age >60 years (OR 3.51), disease duration >5 years (OR 1.70), more comorbidities (OR 1.74), baseline palpable tophi (OR 1.53), SU <6mg/dL (360μmol/L) (OR 1.92) and more frequent follow-up visits (OR 1.98) were significantly associated with high adherence. Nevertheless, significant independent risk factors for failed SU target achievement included male sex (OR 0.36) and more comorbidities (OR 0.85). CONCLUSION: Despite adherence to ULT linked to better outcomes for flares and tophi, the more adherent Chinese male patients and those with more comorbidities had decreased target SU attainment. Differences in adherence of Chinese gout patients compared to several primarily Western studies emphasize the importance of not stereotyping gout patients for projected nonadherence. Results underline the dual importance of identifying gout patients more likely to be ULT-adherent and leveraging adherence to drive treatment to SU target. SN - 1778-7254 UR - https://www.unboundmedicine.com/medline/citation/35777552/Palpable_tophi_and_more_comorbidities_associated_with_adherence_to_urate_lowering_medical_therapy_in_a_Chinese_gout_cohort_ DB - PRIME DP - Unbound Medicine ER -