Addition of allopurinol to traditional Vietnamese medicine shows major improvement of 100 gout patients in a single center one-year prospective study

Abstract

Objectives: Gout is frequently severe in Vietnam, where urate-lowering drugs (ULDs) are seldom used and many patients are treated only with traditional herbal medicine. We assessed the addition of Western medicine on severe gout in Vietnamese people.

Methods: One hundred Vietnamese, ULD-free, crystal-proven gout patients with a GFR>60mL/min, were prospectively followed for 1year after allopurinol initiation. The treatment protocol included allopurinol given according to the 2016 EULAR recommendations, flare prophylaxis with colchicine during the first months, and traditional herbal medicine. At each visit, gout flares were counted by a daily diary, digital foot photographs were taken for semi-quantitative tophus scoring, serum urate (SU) was measured. Ultrasound (US) scan was performed at baseline, 6 and 12months for double contour (DC) and index tophus measurement. Quality of life (Gout Impact Score [GIS]) and function were recorded at inclusion and after 12months. Foot gout radiographic erosion scores were obtained at baseline, 6 and 12months. Outcomes were compared in patients who had reached SU targets at 3months and those who did not.

Results: Patients' median age and disease duration were 47 and 8years respectively, 91 had clinical tophi and 70 foot gouty erosions. Eighty-four patients were seen at 6months and 68 at 12months. Allopurinol dosage was progressively increased to a median of 600mg/d. Significant improvement of flare rates at M6 and M12, and of GIS and function at M12 were noted and did not associate with SU targets. Tophi (assessed by photograph and US measurements) and DC sign significantly decreased from M6 in association with achievement of<300μmol/L SU target. Foot erosion scores significantly decreased with no association with SU targets. Mild skin rash to allopurinol developed in 7 patients.

Conclusion: This one-year open study tested a global gout care delivery model in which treat to uricemia target allopurinol, Western medicine self-treatment of flares, and patient education were added to a background of traditional herbal medicine in a Vietnamese population where gout is traditionally treated with herbal medicine. This shift in practice resulted in dramatic gout improvement.

Keywords: Allopurinol; Gout; Gouty erosion; Herbal medicine; Utrasound scan; Vietnam.