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The Effect of Control and Self-Medication of Chronic Gout in a Developing Country. Outcome After 10 Years
JOHN DARMAWAN, JOHANNES J. RASKER, and HENDRI NURALIM
ABSTRACT.
Methods. We studied 299 consecutively self-referred Malayo-Polynesian men with chronic gout, mean age 35 ± 14.3 SD years. Subjects comprised 228 cases with chronic gout without tophi or urolithiasis (Group 1) and 71 with those complications (Group 2). Attacks of acute gouty arthritis were treated with nonsteroidal antiinflammatory drugs (NSAID) and/or corticosteroids. After acute arthritis had settled, urate-lowering drugs were instituted in both groups combined with low dose colchicine and/or low dose NSAID for at least 0.5–2 years. Urate levels were maintained longterm at a mean of < 5 mg/dl. After 10 years, the dropouts were traced and evaluated for comparison with baseline and those who remained in the study. In Group 2 the urate-lowering drugs were continued. Results. Control of gout and hyperuricemia was achieved in all patients who remained under control: 91.6% of the 299 patients for at least 2 years (short-term), up to 5 years in 87.5% (medium term), and up to 10 years in 79.6% (longterm). In Group 1 (chronic gout without complication) only 36.8% had no attacks during 8 years, after they had tapered urate-lowering drug after the first 2 years of the study. In the 61 dropouts the intermittent symptomatic treatment and/or self-medication without longterm control of hyperuricemia resulted after 1 decade in chronic gout with more complications and associated conditions leading to increased morbidity, disability, and comorbidity, and 3 early mortalities. Conclusion. By controlling hyperuricemia, improvement of the prognosis of chronic gout, comorbidity, and early death was achieved compared with self-medication alone. Self-medication in a developing country if continued unchecked may become a public health problem in a population with a high prevalence rate of gout. (J Rheumatol 2003;30:2437-43) Key Indexing Terms:
CHRONIC GOUT
From the World Health Organization Collaborating Center, Community-based Epidemiology, Prevention, and Treatment of Rheumatic Disease, Seroja Rheumatic Center, Semarang, Indonesia; and the Departments of Rheumatology and Communication Studies, University Twente, Enschede, The Netherlands. Supported by an annual research grant of P.T. Sanbe Indonesia. J. Darmawan, MD; H. Nuralim, MD, Seroja Rheumatic Center; J.J. Rasker, MD, University Twente. Address reprint requests to Dr. J. Darmawan, Seroja Rheumatic Center, Jalan Seroja Dalam 7, Semarang 50136, Indonesia. E-mail: jd131035@hotmail.com Submitted March 14, 2002; revision accepted March 26, 2003. |