Prevalence and Risk Factors of Symptomatic Hyperuricemia; Quality of Care of Patients with Hyperuricemia in A University Hospital
Praveena Chiowchanwisawakit MD*, Apiradee Taweesuk MD*, Wanruchada Katchamart MD*, Varalak Srinonprasert MD*
Affiliation : * Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To determine the prevalence and to identify the risk factors of symptomatic hyperuricemia (SHU) and the proportion
of patients given advice and treatment of urate lowering agent (ULA) with appropriate indication.
Material and Method: One hundred and sixty patients who were new patients at Siriraj Hospital in 2009 with hyperuricemia
were reviewed from medical records and collected demographic data, common risk factors of hyperuricemia and management.
Patients were excluded if they had previously been diagnosed as SHU, took ULA, or had hematologic malignancy. Logistic
regression was applied to explore the risk factors associated with SHU.
Results : Seventy-six percent of patients were male; mean (SD) age was 56.5 (14.7) years; mean (SD) of follow-up duration
was 14.5 (7.5) months. The prevalence of SHU was 35 (95% confidence interval (CI): 28, 43) %; gout was the most common
manifestation and accounted for 89%. The significant risk factors of SHU identified from univariate analysis were male,
serum uric acid > 9 mg/dL and renal insufficiency with odds ratio (OR) (95% CI) of 3.7 (1.4-9.5), 4.1 (2.1-8.3) and 2.6 (1.3-
5.4), respectively. In multivariate analysis, these variables remained significantly associated with SHU with OR (95% CI) of
3.4 (1.2-9.4), 3.6 (1.7-7.7) and 2.3 (1.0-5.0), respectively. Thirty-one percent of patients were given advice as recorded in
medical records which included reducing alcohol drinking (24%), stopping smoking (26%), reducing body weight (13%),
performing exercise (10%) and restricting diet (18%). Thirty patients (67%) were prescribed ULA according to the
recommended indication.
Conclusion : SHU was quite common among hyperuricemia in the university hospital. Male and serum uric acid concentration
were associated with SHU while renal insufficiency had a marginal association. Only 31% of patients were given education
and 67% of patients treated with allopurinol with appropriate indication. There was an opportunity to improve quality of
hyperuricemic care.
Keywords : Hyperuricemia, Symptomatic hyperuricemia, Gout, Allopurinol, Quality of gout care, Quality of hyperuricemia care
