Factors associated with initiation and persistence of urate-lowering therapy
Factors associated with initiation and persistence of urate-lowering therapy
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DOI：
10.1186/s13075-016-1211-y
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发表时间：
2017-01-17
影响因子：
4.9
通讯作者：
Jacobsson, Lennart T. H.
中科院分区：
文献类型：
--
作者：
Dehlin, Mats;Ekstrom, Emin Hoxha;Jacobsson, Lennart T. H.
背景：痛风是最常见的炎症性关节炎疾病，由持续性高尿酸血症继发的晶体沉积引起。自 20 世纪 50 年代以来，降尿酸疗法 (ULT) 的病因治疗就已出现，但之前的研究表明治疗效果欠佳。近年来，我们看到了在病程早期进行 ULT 的建议，但反映当前情况的当代报告很少。因此，我们着手调查痛风诊断后接受并坚持 ULT 的比例及其预测因素。方法：使用区域和国家人口登记册进行的基于人群的队列研究。来自瑞典西部的 2011 年至 2013 年发生痛风的患者队列（n = 7709），年龄为 18 岁及以上。痛风发生病例的定义是在过去 5 年内被诊断为痛风（ICD-10 M10、M14.0-14.1），之前没有进行过痛风诊断或进行 ULT。主要结局指标是痛风 ULT 的累积发生率以及 ULT 开始和持续的预测因素。结果：在首次痛风诊断后的第一年内，32% 的患者接受了 ULT。男性、存在糖尿病或心血管合并症、肾功能下降但未诊断为“终末期肾衰竭”会增加接受 ULT 的可能性。在开始 ULT 的患者中，大多数 (75%) 在最初 2 年内没有坚持接受 ULT 治疗。年龄 < 50 岁、无合并症以及“肾功能正常”或“终末期肾衰竭”与不坚持 ULT 相关。结论：只有少数患者接受了 ULT，其中大多数患者在接下来的 2 年内没有坚持治疗。然而，患有肾功能损害和合并症的老年患者（可能患有更严重的痛风病）更有可能接受并坚持治疗。因此，痛风 ULT 的治疗仍有相当大的改进空间。
Background: Gout is the most common inflammatory arthritic disease and is caused by crystal deposition secondary to persistent hyperuricemia. Etiological treatment with urate-lowering therapy (ULT) has been available since the 1950s but previous studies have demonstrated suboptimal degree of treatment. In recent years we have seen recommendations for ULT earlier in the course of the disease, but there are few contemporary reports reflecting the current situation. Therefore we set out to investigate proportion receiving and persisting with ULT after gout diagnosis and predictors thereof.Method: A population-based cohort study using regional and national population-based registers. Cohort of patients (n = 7709) from western Sweden with incident gout aged 18 years and above from 2011 to 2013. An incident case of gout was defined as having been given a diagnosis of gout (ICD-10 M10, M14.0-14.1) not preceded by a gout diagnosis or a dispensation of ULT during the previous 5 years. Main outcome measures were cumulative incidence and predictors for start of, and persistence with, ULT in gout.Results: Within the first year after first gout diagnosis, 32% received ULT. Male sex, presence of diabetes or cardiovascular comorbidity, reduced kidney function but not diagnosed "end-stage kidney failure"increased the likelihood of receiving ULT. Of those starting ULT a majority (75%) did not persist with ULT treatment within the first 2 years. Age < 50 years, lack of comorbidities, and "normal kidney function"or "end-stage kidney failure"were associated with non-persistence with ULT.Conclusions: Only a minority of patients received ULT and a majority of these did not persist with treatment over the next 2 years. However, the older patients with renal impairment and comorbidities, possibly suffering from a more severe gout disease, were more likely to receive and persist with treatment. There is thus still room for considerable improvement with regards to management of ULT in gout.