Gout management in Swiss primary care – a retrospective observational study
Gout is the most common form of inflammatory arthritis worldwide and its prevalence is rising. In Switzerland, there are no data available on the characteristics and treatment of gout patients. In this study, we aimed to describe numbers of patients affected by gout and hyperuricaemia and unveil approaches Swiss primary care physicians (PCPs) use for the management.
This was a retrospective observational study using electronic medical routine data provided from 242 Swiss PCPs. Included were all their patients receiving urate-lowering therapy (ULT), with a diagnostic code for gout or who had a serum uric acid (SUA) measurement. According to their disease status, patients were classified into four subgroups (normal urate, hyperuricaemia, untreated gout, treated gout). For treatment analysis, patients with SUA measurements before and after ULT initiation were included. Comorbidities and risk factors for secondary causes relevant in the context of gout were collected. Outcomes were prevalence of gout and hyperuricaemia, characteristics of patients according to subgroup, number of SUA measurements, levels of SUA and patients who reached the treatment goal of a SUA level <360 µmol/l.
We assessed 15,808 patients and classified them into the subgroups. This yielded a prevalence of 1.0% for gout and 1.2% for hyperuricaemia. 2642 patients were diagnosed with gout of whom 2420 (91.6%) received a ULT. Overall; 41.3% of patients with a gout treatment had at least one SUA measurement; 15.0% of patients with treated gout had a record of SUA measurements before and after ULT initiation; and 57.5% reached the treatment goal of <360 µmol/l after allopurinol treatment.
Swiss gout patients received comprehensive treatment, which is reflected in a high number of patients treated with ULT, laboratory tests per person and a high treatment success rate, although there is no systematic approach to the treatment of gout.
- Winnard D, Wright C, Taylor WJ, Jackson G, Te Karu L, Gow PJ, et al. National prevalence of gout derived from administrative health data in Aotearoa New Zealand. Rheumatology (Oxford). 2012;51(5):901–9. doi:.https://doi.org/10.1093/rheumatology/ker361
- Wijnands JM, Viechtbauer W, Thevissen K, Arts IC, Dagnelie PC, Stehouwer CD, et al. Determinants of the prevalence of gout in the general population: a systematic review and meta-regression. Eur J Epidemiol. 2015;30(1):19–33. doi:.https://doi.org/10.1007/s10654-014-9927-y
- Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis. 2008;67(7):960–6. doi:.https://doi.org/10.1136/ard.2007.076232
- Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41. doi:.https://doi.org/10.1002/art.30520
- Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol. 2015;11(11):649–62. doi:.https://doi.org/10.1038/nrrheum.2015.91
- Ting K, Gill TK, Keen H, Tucker GR, Hill CL. Prevalence and associations of gout and hyperuricaemia: results from an Australian population-based study. Intern Med J. 2016;46(5):566–73. doi:.https://doi.org/10.1111/imj.13006
- Pascart T, Lioté F. Gout: state of the art after a decade of developments. Rheumatology (Oxford). 2019;58(1):27–44.
- Kim Y, Kang J, Kim G-TJCR. Prevalence of hyperuricemia and its associated factors in the general Korean population: an analysis of a population-based nationally representative sample. Clin Rheumatol. 2018;37(9):2529–38. doi:.https://doi.org/10.1007/s10067-018-4130-2
- Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Curr Opin Rheumatol. 2014;26(2):186–91. doi:.https://doi.org/10.1097/BOR.0000000000000028
- Shiozawa A, Szabo SM, Bolzani A, Cheung A, Choi HK. Serum Uric Acid and the Risk of Incident and Recurrent Gout: A Systematic Review. J Rheumatol. 2017;44(3):388–96. doi:.https://doi.org/10.3899/jrheum.160452
- Richette P, Bardin T. Gout. Lancet. 2010;375(9711):318–28. doi:.https://doi.org/10.1016/S0140-6736(09)60883-7
- Robinson PC, Taylor WJ, Dalbeth N. An Observational Study of Gout Prevalence and Quality of Care in a National Australian General Practice Population. J Rheumatol. 2015;42(9):1702–7. doi:.https://doi.org/10.3899/jrheum.150310
- Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015;74(4):661–7. doi:.https://doi.org/10.1136/annrheumdis-2013-204463
- Maravic M, Hincapie N, Pilet S, Flipo R-M, Lioté F. Persistent clinical inertia in gout in 2014: An observational French longitudinal patient database study. Joint Bone Spine. 2018;85(3):311–5. doi:.https://doi.org/10.1016/j.jbspin.2017.03.013
- Cottrell E, Crabtree V, Edwards JJ, Roddy E. Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice. BMC Fam Pract. 2013;14(1):170. doi:.https://doi.org/10.1186/1471-2296-14-170
- Jeyaruban A, Larkins S, Soden M. Management of gout in general practice--a systematic review. Clin Rheumatol. 2015;34(1):9–16. doi:.https://doi.org/10.1007/s10067-014-2783-z
- Sarawate CA, Patel PA, Schumacher HR, Yang W, Brewer KK, Bakst AW. Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol. 2006;12(2):61–5. doi:.https://doi.org/10.1097/01.rhu.0000209882.50228.9f
- Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al.; American College of Rheumatology. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431–46. doi:.https://doi.org/10.1002/acr.21772
- Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29–42. doi:.https://doi.org/10.1136/annrheumdis-2016-209707
- Kiltz U, Alten R, Fleck M, Krüger K, Manger B, Müller-Ladner U, et al. Langfassung zur S2e-Leitlinie Gichtarthritis (fachärztlich) [Full version of the S2e guidelines on gouty arthritis : Evidence-based guidelines of the German Society of Rheumatology (DGRh)]. Z Rheumatol. 2016;75(S2, Suppl 2):11–60. German. doi:.https://doi.org/10.1007/s00393-016-0147-6
- Wüthrich H, Alromaih F, So A. Guidelines for the treatment of gout: a Swiss perspective. Swiss Med Wkly. 2016;146:w14341. doi:.https://doi.org/10.4414/smw.2016.14341
- Chmiel C, Bhend H, Senn O, Zoller M, Rosemann T ; FIRE study-group. The FIRE project: a milestone for research in primary care in Switzerland. Swiss Med Wkly. 2011;140:w13142.
- Hostettler S, Kraft E. FMH-Ärztestatistik 2017 – aktuelle Zahlen. Schweiz Arzteztg. 2018;99(13–14):408–13. doi:https://doi.org/10.4414/saez.2018.06573
- WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment, 21st edition. Oslo, Norway: WHO Collaborating Centre for Drug Statistics Methodology; 2012.
- World Organization of Family Doctors’ International Classification Committee. International Classification of Primary Care - ICPC-2. Oxford, UK: Oxford University Press; 2003.
- Federal Act on Research involving Human Beings 2014 [cited 2019] Available from: https://www.admin.ch/opc/en/classified-compilation/20061313/index.html.
- Raumgliederungen: Federal Statistical Office; [cited 2019] Available from: https://www.bfs.admin.ch/bfs/de/home/grundlagen/raumgliederungen.html.
- Forster A, Krebs A. Die Gicht – lästig, aber behandelbar. Swiss Medical Forum ‒ Schweizerisches Medizin-Forum. 2013;13(15):285–9.
- Ben Salem C, Slim R, Fathallah N, Hmouda H. Drug-induced hyperuricaemia and gout. Rheumatology (Oxford). 2017;56(5):679–88.
- Lamers LM, van Vliet RC. The Pharmacy-based Cost Group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation. Health Policy. 2004;68(1):113–21. doi:.https://doi.org/10.1016/j.healthpol.2003.09.001
- O’Halloran J, Miller GC, Britt H. Defining chronic conditions for primary care with ICPC-2. Fam Pract. 2004;21(4):381–6. doi:.https://doi.org/10.1093/fampra/cmh407
- R Development Core Team. (2008). R: A language and environment for statistical computing. R Foundation for Statistical Computing V, Austria. ISBN 3-900051-07-0, URL http://www.R-project.org.
- Kumar A U A, Browne LD, Li X, Adeeb F, Perez-Ruiz F, Fraser AD, et al. Temporal trends in hyperuricaemia in the Irish health system from 2006-2014: A cohort study. PLoS One. 2018;13(5):e0198197. doi:.https://doi.org/10.1371/journal.pone.0198197
- Stamp L, Dalbeth N. Screening for hyperuricaemia and gout: a perspective and research agenda. Nat Rev Rheumatol. 2014;10(12):752–6. doi:.https://doi.org/10.1038/nrrheum.2014.139
- Chales G. How should we manage asymptomatic hyperuricemia? Joint Bone Spine. 2019;86(4):437–43. doi:.https://doi.org/10.1016/j.jbspin.2018.10.004
- Goossens J, Lancrenon S, Lanz S, Ea HK, Lambert C, Guggenbuhl P, et al. GOSPEL 3: Management of gout by primary-care physicians and office-based rheumatologists in France in the early 21st century - comparison with 2006 EULAR Recommendations. Joint Bone Spine. 2017;84(4):447–53. doi:.https://doi.org/10.1016/j.jbspin.2017.04.002
- Harrold LR, Yood RA, Mikuls TR, Andrade SE, Davis J, Fuller J, et al. Sex differences in gout epidemiology: evaluation and treatment. Ann Rheum Dis. 2006;65(10):1368–72. doi:.https://doi.org/10.1136/ard.2006.051649
- Rai SK, Choi HK, Choi SHJ, Townsend AF, Shojania K, De Vera MA. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies. Rheumatology (Oxford). 2018;57(7):1282–92. doi:.https://doi.org/10.1093/rheumatology/kex530