title: Prescription and dosing of urate-lowering therapy, rather than patient behaviours, are the key modifiable factors associated with targeting serum urate in gout.
abstract: BACKGROUND
  Long term serum urate (SU) lowering to a target of <0.36 mmol/l (6 mg/dl) is recommended for effective gout management. However, many studies have reported low achievement of SU targets. The aim of this cross-sectional study was to examine the clinical and psychological factors associated with SU targets in patients with gout.
  
  
  METHODS
  Patients with gout for <10 years were recruited from primary and secondary care settings. SU target was defined as SU concentration <0.36 mmol/L at the time of the study visit. Both clinical and psychological factors associated with SU target were analysed. The relationship between SU target and measures of gout activity such as flare frequency, tophi, work absences, and Health Assessment Questionnaire-II was also analysed.
  
  
  RESULTS
  Of the 273 patients enrolled into the study, 89 (32.6%) had SU concentration <0.36 mmol/L. Urate-lowering therapy (ULT) use was strongly associated with SU target (p < 0.001). In those patients prescribed ULT (n = 181), allopurinol dose, patient confidence to keep SU under control, female sex, and ethnicity were independently associated with SU target. Other patient psychological measures and health-related behaviours, including adherence scores, were not independently associated with SU target in those taking ULT. Creatinine clearance, diuretic use, age, and body mass index were not associated with SU target. Patients at SU target reported lower gout flare frequency, compared with those not at target (p = 0.03).
  
  
  CONCLUSIONS
  ULT prescription and dosing are key modifiable factors associated with achieving SU target. These data support interventions focusing on improved use of ULT to optimise outcomes in patients with gout.
authors.affiliation: Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand. n.dalbeth@auckland.ac.nz
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
authors.forename: Meaghan E
authors.initials: ME
authors.lastname: House
authors.forename: Anne
authors.initials: A
authors.lastname: Horne
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Petrie
authors.forename: Fiona M
authors.initials: FM
authors.lastname: McQueen
authors.forename: William J
authors.initials: WJ
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D015536:Down-Regulation; D054796:Drug Dosage Calculations; D005260:Female; D006073:Gout / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D006074:Gout Suppressants / Q000008:administration & dosage*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol