Charles Lambert

GOSPEL: prospective survey of gout in France. Part I: design and patient characteristics (n = 1003).

OBJECTIVES To assess diagnoses and management of acute and chronic gout in primary care and rheumatology settings relative to 2006 European League Against Rheumatism (EULAR) gout recommendations. Secondary objectives were to describe patient demographics, clinical features, lifestyle modifications, and short- and mid-term outcomes. METHODS Prospective, cross-sectional, descriptive survey of patients with chronic gout, acute gout, or suspected gout, included by randomly selected general practitioners (GPs, n = 398) and rheumatologists (n = 109) between October 2008 and September 2009, in France. At the first visit, a structured questionnaire was completed. Each patient completed self-questionnaires at the first visit and 3 to 6 months later. RESULTS We included 1003 patients, including 879 (87.6%) males (mean age, 61.6 ± 11.4 years; 28.1% obese) and 124 (12.4%) females (70.2 ± 11.9 years; 33.1% obese). Mean disease duration was 8.0 ± 8.3 years and mean time since hyperuricemia diagnosis 8.2 ± 8.4 years. Mean annual number of flares was 1.9 ± 1.5. ACR criteria for gout were met in 855 pts. Gout was acute in 487 (48.6%) patients and chronic in 241 (24.4%). Tophi (19.4% of patients) were associated with disease duration but not gender or chronic kidney disease (CKD). The main co-morbidities were hypertension (53.8%), dyslipidemia (47.2%), and hyperglycemia/diabetes mellitus (15.0%). CKD 3-5 was present in 43% of patients but was identified by physicians in only 5.2%. CKD severity was significantly associated with age, gender, hypertension, and diuretic use. CONCLUSION This cohort will prove valuable for addressing the concordance with EULAR recommendations and for future studies of gout in everyday practice, most notably regarding metabolic syndrome, other co-morbidities, and identification of difficult-to-treat patients.

Identification of patients with gout: elaboration of a questionnaire for epidemiological studies

Objectives In France, the prevalence of gout is currently unknown. We aimed to design a questionnaire to detect gout that would be suitable for use in a telephone survey by non-physicians and assessed its performance. Methods We designed a 62-item questionnaire covering comorbidities, clinical features and treatment of gout. In a case–control study, we enrolled patients with a history of arthritis who had undergone arthrocentesis for synovial fluid analysis and crystal detection. Cases were patients with crystal-proven gout and controls were patients who had arthritis and effusion with no monosodium urate crystals in synovial fluid. The questionnaire was administered by phone to cases and controls by non-physicians who were unaware of the patient diagnosis. Logistic regression analysis and classification and regression trees were used to select items discriminating cases and controls. Results We interviewed 246 patients (102 cases and 142 controls). Two logistic regression models (sensitivity 88.0% and 87.5%; specificity 93.0% and 89.8%, respectively) and one classification and regression tree model (sensitivity 81.4%, specificity 93.7%) revealed 11 informative items that allowed for classifying 90.0%, 88.8% and 88.5% of patients, respectively. Conclusions We developed a questionnaire to detect gout containing 11 items that is fast and suitable for use in a telephone survey by non-physicians. The questionnaire demonstrated good properties for discriminating patients with and without gout. It will be administered in a large sample of the general population to estimate the prevalence of gout in France.

GOSPEL 2 – Colchicine for the treatment of gout flares in France – a GOSPEL survey subgroup analysis. Doses used in common practices regardless of renal impairment and age

OBJECTIVES The objective of this sub-study was to assess the use of colchicine for the treatment of gout flares in real life conditions in the GOSPEL cohort following the 2006 EULAR recommendations for gout management. METHODS This national cross-sectional epidemiologic survey included outpatients with gout suffering from acute flare followed by randomly selected primary care physicians (n=398) and private practice rheumatologists (n=109) between October 2008 and September 2009 in France. Data regarding patient characteristics and treatment prescription was collected by each physician. Glomerular filtration rate (eGFR) was estimated using the Cockroft-Gault formula. Patients included in the survey for a gout flare filled in a specific self-questionnaire including colchicine effective intake and pain relief (numeric scale). RESULTS This analysis focused on the 349 patients presenting with gout flare and treated with colchicine. Mean (±SD) prescribed dose of colchicine was 2.8 (±0.7) mg within the first 24hours and the cumulative dose over the first three days of treatment was 6.9 (±1.8) mg. Patients with mild decline in eGFR (eDFG 60-80mL/min) were prescribed an average initial dose of 2.8mg (±0.8) mg (n=58), 2.7 (±0.8) mg in chronic kidney disease (CKD) stage 3 (n=43) and 2.5 (±0.7) mg in CKD stage 4 (n=2). Cumulative doses of colchicine did not take into account either renal impairment or age. CONCLUSIONS This study draws attention to some misuse of colchicine in daily practice and the prescription of excessive doses especially in case of renal impairment. eGFR should be enforced in daily practice.

SAT0544 Prevalence of Gout in the Adult Population of France in 2013

Background The prevalence of gout has been studied in several Western countries and has been estimated to vary from 0.9 to 3.9%. The prevalence of gout remained unknown in France. Objectives To design a tool that allows a confident diagnosis of gout in an epidemiological setting and to assess the current prevalence of gout in France. Methods This was a two-phase study. In phase one, we designed a questionnaire to detect gout that would be suitable for telephone interviews by non-physicians. A 62-item questionnaire covering clinical features, co-morbidities and treatment of gout was administered by phone, by non physicians unaware of the patient diagnoses in a case control study. 102 people with crystal-proven gout and 142 controls who had other types of arthritis with joint effusion and no urate crystal in their synovial fluid were included. Logistic regression analysis and classification and regression trees (CARTs) were used to select items discriminating cases from controls. In phase two, a random sample of 10 000 adult residents in metropolitan France was derived from the national telephone (fixed and mobile) directory. The results were weighted to be representative of the French population distribution according to socio-demographic characteristics. The telephone questionnaire was administered by non-physicians. Models derived from phase one were used to estimate the gout prevalence in subjects who acknowledged present or past non traumatic acute pain in a peripheral joint. Results In phase one, two logistic regression models (sensitivity 88.0% and 87.5%; specificity 93.0% and 89.8%, respectively) and one CART model (sensitivity 81.4%; specificity 93.7%) revealed 11 informative items that allowed correct classification of 90.0%, 88.8% and 88.5% of patients respectively. In the second phase the response rate varied between 34% (fixed phone sample) and 38% (mobile sample). 10,026 participants were interviewed between March and June 2013. 373 declared having suffered from acute, non traumatic joint pain, of whom a diagnosis of gout was made in 84 to 102 subjects, according to the algorithm used. This led to an estimated prevalence of gout of 0.9% (95% CI: 0.8, 1.1) in the general population, with no significant geographic variation. Conclusions Gout prevalence in the adult population of metropolitan France in 2013 was estimated to be 0.9%. Disclosure of Interest T. Bardin Consultant for: Ipsen, Menarini, Novartis, Sobi, Astra Zeneca, Savient, Speakers bureau: ipsen, Menarini, Novartis, Savient, S. Bouée Consultant for: Menarini, Ipsen, P. Clerson Consultant for: Ipsen, Menarini, G. Chalès Consultant for: Mayoli Spinder, Menarini, Ipsen, Novartis, Speakers bureau: Ipsen, Menarini, M. Doherty Consultant for: Menarini, Ardea, Novartis, R.-M. Flipo Consultant for: Ipsen, Menarini, Savient, C. Lambert Employee of: Ipsen, F. Lioté Consultant for: Ipsen, Menarini, Savient, Novartis, Astra Zeneka, Sobi, Mayoli Splindle, Ardea, Speakers bureau: Ipsen, Menarini, Savient, T. poiraud Employee of: Menarini, T. Schaeverbeke Consultant for: Ipsen, Menarini, P. Richette Consultant for: Ipsen, Menarini, Savient, Novartis, Astra Zeneka, Speakers bureau: Ipsen, Menarini, Savient DOI 10.1136/annrheumdis-2014-eular.5164