Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
The GOSPEL 1000 Study. Features of the Metabolic Syndrome in 1003 French Patients with Gout.
Liote7, Frédéric P., Ea2, Hang-Korng, Guggenbuhl1, Pascal, Saraux6, Alain, Lambert, Charles, Lanz4, Sabine, Chiarelli3, Pierre
Gout is often poorly managed in primary care settings. 2006 EULAR gout recommendations (EULARrecs) have been developed on aspects related to the management of gout, but poorly evaluated in clinical practice. A key feature present in these EULARrecs was to determine and to treat specifically the metabolic syndrome (MS). In the GOSPEL study, we aimed to assess and compare the prevalence, features and management of MS associated with gout in primary care and in rheumatology, in concordance with the EULARrecs.
A prospective national survey of 1003 patients (pts) with gout or suspicion of gout was done between September 2008 & July 2009. A panel of 398 general physicians (GP) and 109 rheumatologists (RH) was randomly selected in France, each including 2 consecutive gouty pts. A structured questionnaire, including history with predefined items, allowed to monitor ACR classification criteria, as well as EULAR management recs (proposals 2 & 3); co-morbidities (CM), mainly cardiovascular (CV); clinical evaluation (BMI, MS (FID definition)); medications at visit. MS features and management were compared with the EULAR recs.
1003 pts were included as gout. 879 pts were male (M, 88%; age: 61.6(11), mean(±SD)) and 124 female (F, 12%; age:70.2(11.9)). 810 pts (81%) were seen by GP and 193 (19%) by RH. Mean disease duration was 7.9(8.1) yrs (GP) and 8.6(9.2) yrs (RH). Gout classification ACR criteria were present in 85.2% of pts (87.3% (GP); 76.7% (RH)). 48.6% of pts had acute gout, 24.4% chronic gout. Tophi were present in 19.4%. Mean BMI was 28.4(3.8) in M (BMI>=30: 28.1%) and 28.2(5.7) in F (BMI>=30: 33.1%). Overweight was present in 51.5%. MS was present in 440 pts (47.2%; M: 46.0%, F: 55.8%); with respect to MS features (hypertension (HT) 54.5%; high glycemia 43.6%; low HDL (43.7%); high TG (40.7%)); MS prevalence was more frequent in GP pts (51.9%) vs RH (27.0%). MS severity was also higher (# criteria) in GP pts. CKD was present in 43% (CrCl <60 ml/min). Coronary heart disease was present in 8.9% and 8.4%, GP and RH pts, respectively, whereas CVA was present in 3.5% and 1.6%, respectively.
EULAR proposal (P) #2:
increased calories intake was identified in 27.2% pts. Diet modifications were proposed to 149/286 obese pts (56%), and to 22.6% of the total population. High beer (n=56 pts) and alcohol intake (M: 52.4%; F: 22.8%) were reported by GP<RH (7% and 49%, respectively). Advices for alcohol consumption reduction were only offered to 12.6 pts. Physical activity was recommended in 54 pts (6.0%) (39: GP; 15:RH). P#3: CV CM were present in 71% pts. Treatment was already appropriate or given at time of clinics in 87.2% of pts, with differences between GP (89.0%) and RH (78.7%). Overall 10%, 20%, 5% of pts with dyslipidemia, diabetes, and HT, respectively, were not treated.
MS is more frequent and severe in French gouty pts followed in general practice. Non pharmacological recs are not appropriate. However pharmacological of key features of the MS are largely implemented. Implementation of EULARrecs for management of gout should be regularly recalled since MS and identification of risk factors are underscored by both GP and RH, with differences related to clinical practice and education.
To cite this abstract, please use the following information:
Liote, Frédéric P., Ea, Hang-Korng, Guggenbuhl, Pascal, Saraux, Alain, Lambert, Charles, Lanz, Sabine, et al; The GOSPEL 1000 Study. Features of the Metabolic Syndrome in 1003 French Patients with Gout. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :888