Factors Influencing The Response To Urate-lowering Therapy In Patients With Gout

Background: The key to gout treatment is to continuously control blood uric acid to reach the target range,but the current status of treatment of blood uric acid in gout treatment is not ideal.The clinical strategy for the treatment of blood uric acid is to use uric acid-lowering drugs from a low dose and gradually increase the dose until the patient achieves the standard treatment.Because the sensitivity of gout patients to urate-lowering treatment varies greatly,the time to achieve the standard is also quite different.Judging the sensitivity of gout patients to urate-lowering therapy can better guide the clinical treatment as soon as possible,thus increasing patient compliance.Objectives: To explore the influencing factors of gout patients' sensitivity to urate-lowering therapy,and to provide reference for clinicians to use uric acidlowering drugs.Method: A total of 123 patients were diagnosed with gout,which receive regular uric acid-reducing treatment and regular follow-up in department of rheumatology and immunology,the first affiliated hospital of nanchang university from June 2017 to June 2018.According to the dose of uric acid-lowering drugs used when the patient's blood uric acid decreased to 360 umol/L,they were divided into sensitive groups(using allopurinol ? 100 mg qd,benzbromarone ? 50 mg qd,febuxostat ? 40 mg qd respectively),medium sensitive group(using 100 mg qd <allopurinol? 100 mg tid,50 mg qd < bebromomarone ? 100 mg qd,40 mg qd <febustat ? 80 mg qd respectively),drug resistant group(allopurinol >100mg tid,benzbromarone >100mg qd,febuxostat >80mg qd or combination therapy achieve standard and non-standard patients).Collect all patients' gender,age,disease course,family history,smoking history,drinking history,body mass index(BMI),pre-treatment blood uric acid,serum creatinine,blood urea nitrogen,erythrocyte sedimentation rate(ESR),C-reaction protein(CRP),whether there are tophi,hypertension,diabetes,hyperlipidemia,atherosclerosis,coronary heart disease,stroke,kidney stones,chronic renal insufficiency and other complications and comorbidities.Results: A total of 123 patients were included in this study,including 115 malesand 8 females.29 patients(23.6%)In the sensitive group: 11 patients(9.0%)in the allopurinol group,9 patients(7.3%)in the benzbromarone group,9 patients(7.3%)in the febuxostat group.44 patients(35.8%)in the moderately sensitive group : 14 cases(11.4%)in the allopurinol group,9 cases(7.3%)in the benzbromarone group,21cases(17.1%)in the febuxostat group.50 patients(40.6%)in the resistant group: 8cases(6.5%)in the allopurinol group,8 cases(6.5%)in the benzbromarone group,10cases(8.1%)in the febuxostat group,and 9 cases(7.3%)in the combined treatment group reached the standard;15 cases(12.2%)in the combined treatment group did not reached the standard.Univariate analysis showed that family history of gout,disease duration,BMI,pre-treatment blood uric acid value,serum creatinine value,ESR,CRP,diabetes,cerebral infarction,and chronic renal insufficiency were the influencing factors of gout patient compliance(P<0.05).Multivariate regression analysis showed that family history of gout,long course of disease,high BMI,and diabetes were the factors affecting the sensitivity of uric acid in patients with gout(P<0.05).Conclusion: The patients of gout with family history,long course of disease,high BMI,and diabetes mellitus had poor response to uric acid lowering drugs.In the course of reaching the standard treatment,the initial dose of uric acid-lowering drugs can be increased,which is beneficial to shorten the treatment time of gout patients.