痛風發生率增加但多數病患未進行治療


  【24drs.com】線上發表於1月15日風濕性疾病年報的一篇新報告,破滅了英國痛風發生率和盛行率已趨於穩定的希望。
  
  資料顯示,從1997至2012年,痛風發生率持續增加;此外,研究者發現,多數病患並未進行降尿酸治療(ULT),僅有18.6%病患在診斷後的6個月內開始治療。
  
  作者們寫道,痛風盛行率和發生率在過去16年皆攀升,是歐洲地區最高的。不過,儘管這是最常見的發炎性關節炎,但痛風未被適當處置的狀況依舊未變,僅有少數病患接受降尿酸治療,且新病患並未及時治療。雖然有所改善,病患對於降尿酸治療的順從性仍然不佳,迫切需要有教育活動來改善執業者對於此一可治癒之發炎性關節炎的知識、興趣及標準照護。
  
  英國諾丁罕大學醫學院風濕免疫科、骨科、皮膚科的Chang-Fu Kuo醫師等人發現,痛風盛行率從1997年的1.52%增加到2012年的2.49%,相對增加率為63.9%;痛風發生率也增加,每1000人-年從1.36增加到1.77。研究者使用了英國臨床實務研究資料庫,包括了1,200萬人的醫療紀錄數據。
  
  美國的報告也有類似的增加趨勢,痛風盛行率從1988-1994年間的2.7%增加到2007-2008年間的3.9%。
  
  Kuo醫師等人也發現,2012年患有痛風者之中,只有48.48% (95%信心區間([CI])48.08% - 48.89%)有針對痛風進行諮商,37.63%(95% CI,37.28% - 38.99%)接受降尿酸治療。
  
  資深作者Weiya Zhang博士表示,雖然我們察覺痛風處置不佳的某些議題,我們並不預期這會導致目前的痛風案例迅速增加(每年4%);這是一種已經有完善治療方式的疾病,慚愧的是我們在過去的15年並未適當控制它,這點出了如何改善目前的痛風處置問題。
  
  諾丁罕大學風濕學院副教授Zhang博士表示,幸運的是,我們在過去10年發展出一些實證指引,形成發展基礎。這次的研究提出2個問題:我們為什麼做不好?我們如何改善?
  
  英國各地的痛風盛行率和發生率各異,案例最多的是在威爾斯和英格蘭東北部,Zhang博士表示,這些區域性差異的原因未知,但比較可能是涉及處置上的差異,而不是生活型態差異。
  
  加州聖地牙哥退伍軍人醫學中心風濕科主任、加州大學聖地牙哥分校醫學教授Robert Terkeltaub醫師表示,這是相當有趣和詳實的研究。痛風是已被充分暸解的疾病,基本上有具治癒性的降尿酸治療方法,在過去的15個月內,國際上已有兩套完整的處置指引公佈。然而,對於在英國、美國及其他西方國家盛行率以類似趨勢上升的這個疾病,在照護品質、病患的治療順從性方面皆是未達標準,這是令人失望且無法接受的。
  
  未參與此篇研究的Terkeltaub醫師指出,這個狀況反映出,在醫療和病患教育上有全面性的疏失,需要相當大的努力來解決這些問題。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7046&x_classno=0&x_chkdelpoint=Y
  

Gout Incidence Increasing, but Most Patients Go Untreated

By Janis C. Kelly
Medscape Medical News

Previous hopes that gout incidence and prevalence had plateaued in the United Kingdom were dashed by a new report published online January 15 in the Annals of the Rheumatic Diseases.

The data showed continued increases in gout incidence from 1997 to 2012. In addition, researchers found most patients were not being treated with urate-lowering therapy (ULT), and only 18.6% of patients began treatment within 6 months of diagnosis.

"[B]oth the prevalence and incidence of gout have risen in the past 16 years and are the highest reported within Europe. However, despite being the commonest inflammatory arthritis the suboptimal management of gout continues unchanged, with only a minority of patients receiving ULT and new patients not being treated in a timely fashion," the authors write. "Although somewhat improved, patient adherence to ULT remains poor[, it] is apparent that educational initiatives to improve practitioner knowledge, interest and standard of care of the only 'curable' form of inflammatory arthritis are urgently required."

Chang-Fu Kuo, MD, from the Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, United Kingdom, and colleagues found that gout prevalence had increased from 1.52% in 1997 to 2.49% in 2012, a relative increase of 63.9%. The incidence of gout has also risen, going from 1.36 to 1.77 per 1000 person-years. The researchers used data from the UK Clinical Practice Research Datalink, which includes the medical records of about 12 million people.

A similar increase had been reported for the United States, where gout prevalence rose from 2.7% in 1988-1994 to 3.9% in 2007-2008.

Dr. Kuo and colleagues also found that of those individuals with gout in 2012, just 48.48% (95% confidence interval [CI], 48.08% - 48.89%) had consultations specifically for gout, and 37.63% (95% CI, 37.28% - 38.99%) received ULT.

"Although we were aware that there are some issues related to the poor management of gout, we did not expect this could lead to the rapid increase (4% annually) of current gout cases," senior author Weiya Zhang, PhD, told Medscape Medical News. "Since this is a disease with well-established treatments, it is a shame that we haven't controlled it properly in the past 15 years. This does raise a question on how to improve the current management of gout.

"Fortunately, we have developed a number of evidence-based guidelines in the past 10 years, which may form a basis to start. The study does raise 2 questions: Why we have done poorly? And how [do we] improve?" Dr. Zhang is associate professor and reader in academic rheumatology, University of Nottingham.

Gout prevalence and incidence varied across the United Kingdom, with the highest numbers of cases seen in Wales and the Northeast of England. Dr. Zhang said the reasons for these regional differences are unknown but are more likely to involve variations in management than lifestyle differences.

"This is a very interesting and informative study," said Robert Terkeltaub, MD, professor of medicine at the University of California, San Diego, and rheumatology section chief at the San Diego Veterans Affairs Medical Center in California. "Gout is an extremely well-understood disease, where essentially 'curative' urate-lowering therapy is available, and 2 sets of sound international medical guidelines for management have been published in the last 15 months. Yet quality of care, and patient adherence to treatment, remain substandard, a disappointing and unacceptable circumstance for a disease clearly increasing in prevalence in a similar way in the [United Kingdom] and [United States] and other Western countries."

"This situation is indicative of a systematic failure in both medical and patient education. There is lots of work to do to rectify these problems," added Dr. Terkeltaub, who was not involved in the study.

The authors and Dr. Terkeltaub have disclosed no relevant financial relationships.

Ann Rheum Dis. Published online January 15, 2014.

    
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