Background/Purpose: Long term serum urate (SU) lowering to a target of <6mg/dL is recommended for effective gout management.  However, many studies have reported low achievement of SU targets.  The aim of this 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 <6mg/dL 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 including flare frequency in the preceding three months was also analysed. 

Results: Of the 273 patients enrolled into the study, 89 (32.6%) had SU concentration <6mg/dL.  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 (Table).  Other patient psychological factors 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).

Conclusion: 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. 

Table. Forward stepwise logistic regression analysis of factors associated with SU target in those taking ULT. Model included all factors with p<0.15 between groups in univariate analysis.