Behavioral Characteristics of Gout Patients and Their Impact on the Results of Urate Lowering Therapy

Background. Gout is frequently accompanied by hypertension, obesity, and/or impaired glucose tolerance, which are often complicated with heavy smoking and dietary violations, especially in male patients.

Objective. To determine the behavioral characteristics of gout patients that could impact the results of urate lowering therapy.

Subjects and methods. The relationship between behavioral characteristics and results of urate lowering therapy were investigated in 74 male gout patients of Chengdu Rheumatism Hospital. The results of treatment were evaluated using serum uric acid contents before and after treatment, VAS pain score before and after treatment. Behavioral characteristics for the last ten years (smoking status, daily volume of drinking water, etc.) were accessed by means of retrospective survey.

Results. In gout patients with poor treatment response, serum uric acid at the beginning of the treatment was already significantly lower (365.76 ± 163.06 μmol/L); this trend was also noted in a “slow progress” group, while patients with higher serum uric acid before treatment had notably better response to urate lowering therapy. During further analysis age negatively correlated with serum uric acid (r = –0.328; p = 0.002) and uric acid clearance ratio (r = –0.299; p = 0.002).

In patients with uric acid clearance ratio above 40 % the prevalence of kidney diseases (stones or dysfunction) was significantly lower compared to other groups. There was no significant influence of hypertension, diabetes mellitus, fatty liver or hyperlipidaemia on uric acid clearance ratio (p > 0.05).

Amount of drinking water also influenced the serum uric acid clearance ratio. Bigger amount of patients in the “fast progress” group (40.0 % compared to 30.44 and 25.0 %) tended to drink more water.

Conclusion. In most gout patients, serum uric acid levels before treatment acted as the reliable predictor of good response to urate lowering therapy. Treatment response (serum uric acid clearance ratio) correlated positively with the hyperuricemia and drinking sufficient amounts of water, negatively – with prolonged smoking (more than 10 years) and age.

1. Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: Prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol. 2020; 16(7): 380-390. doi: 10.1038/s41584020-0441-1

2. Mattiuzzi C, Lippi G. Recent updates on worldwide gout epidemiology. Clin Rheumatol. 2020; 39(4): 1061-1063. doi: 10.1007/ s10067-019-04868-9

3. Mu Z, Wang W, Wang J, Lv W, Chen Y, Wang F, et al. Predictors of poor response to urate-lowering therapy in patients with gout and hyperuricemia: A post-hoc analysis of a multicenter randomized trial. Clin Rheumatol. 2019; 38(12): 3511-3519. doi: 10.1007/s10067-019-04737-5

4. Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifi tions for gout. Arthritis Res Ther. 2006; 8(Suppl 1): S2. doi: 10.1186/ar1907

5. Graham GG, Stocker SL, Kannangara DR, Day RO. Predicting response or non-response to urate-lowering therapy in patients with gout. Curr Rheumatol Rep. 2018; 20(8): 47. doi: 10.1007/ s11926-018-0760-2

6. Sánchez-Lozada LG. The pathophysiology of uric acid on renal diseases. Contrib Nephrol. 2018; 192: 17-24. doi: 10.1159/000484274

7. Wright DF, Duffull SB, Merriman TR, Dalbeth N, Barclay ML, Stamp LK. Predicting allopurinol response in patients with gout. Br J Clin Pharmacol. 2016; 81(2): 277-289. doi: 10.1111/bcp.12799

8. Goldfarb DS. Review: Thiazide, citrate, or allopurinol reduces recurrence after ≥ 2 kidney stone episodes. Ann Intern Med. 2013; 159(2): JC12. doi: 10.7326/0003-4819-159-2-201307160-02012

9. Becker MA, Schumacher HR, Espinoza LR, Wells AF, MacDonald P, Lloyd E, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: The CONFIRMS trial. Arthritis Res Ther. 2010; 12(2): R63. doi: 10.1186/ar2978

10. Wang W, Krishnan E. Cigarette smoking is associated with a reduction in the risk of incident gout: Results from the Framingham Heart Study original cohort. Rheumatology. 2015; 54(1): 91-95. doi: 10.1093/rheumatology/keu304

11. Teng GG, Pan A, Yuan JM, Koh WP. Cigarette smoking and the risk of incident gout in a prospective cohort study. Arthritis Care Res. 2016; 68(8): 1135-1142. doi: 10.1002/acr.22821

12. Fanning N, Merriman TR, Dalbeth N, Stamp LK. An association of smoking with serum urate and gout: A health paradox. Semin Arthritis Rheum. 2018; 47(6): 825-842. doi: 10.1016/j.semarthrit.2017.11.004

13. Hisatome I, Ohtahara A, Hamada T, Ogino K. Development of Guideline for the management of hyperuricemia and gout in Japan 3rd edition. Gout and Nucleic Acid Metabolism. 2018; 42(2): 147-156. doi: 10.6032/gnam.42.147