Background/Purpose: Gout is the most common form of inflammatory arthritis, with an increasing prevalence worldwide. ACR management guidelines recommend a target serum uric acid (sUA) <6 mg/dL, or <5 mg/dL in patients with tophaceous disease. Patients with significant crystal burden (tophaceous gout) are considered to have higher humanistic and economic burden of illness. These analyses describe patient and treatment characteristics and resource utilization in gout patients with and without tophi.

Methods:  Data were assessed from physician surveys and in-depth patient chart audits in France, Germany, Italy, Spain, UK, and USA. Flares, organ/joint damage and tophi were extracted from clinical charts. Type/dose gout treatment, time on current therapy, physician type, and patient sociodemographic factors were identified. Demographic characteristics and comorbidities, sUA levels, and use of colchicine for acute flares during the 12-month study period were compared using chi-square or Fisher’s exact tests.

Results:  Of the 2505 patients identified, 612 (24. 43%) had physician-confirmed tophaceous gout and 1893 (75.57%) had non-tophaceous gout. Patients with tophi were older (61.6 vs 57.4 years), had gout for a slightly longer period (2.8 vs 2.4 years), reported more flares (3.2 vs 1.7 per year) over the last 12 months, and were more likely to have higher sUA (12-month mean 7.80 vs 7.34 mg/dL) (all p<0.001). Levels of comorbidities were significantly higher in patients with tophi including cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, diabetes, depression, hypertension, osteoarthritis, and Stage III and Stage IV/V chronic kidney disease (all p<0.001). Patients with tophi were more likely to be treated with urate-lowering therapy (87.9% vs 72.4%; p<0.001). Of the urate-lowering therapies, patients with tophi were less likely to use allopurinol (52.5% vs 59.0%; p=0.003) and more likely to use febuxostat (28.9% vs 11.0%; p<0.001). Patients with tophi were more likely to use colchicine (40.7% vs 29.2%; p<0.001) and steroids (43.8% vs 18.7%; p<0.001), and less likely to use NSAIDs (35.6% vs 42.9%; p=0.001) for acute flares. Fewer patients with tophi achieved sUA targets of ≤6 mg/dL and no flares (15.7% vs 27.0%; p<0.001) or ≤5 mg/dL and no flares (5.9% vs 12.4%; p<0.001) versus patients without tophi. Patients with tophi made more gout-related office visits (5.18 vs 4.42; p=0.155) and more made ≥1 gout-related emergency visit (26.8% vs 7.9%; p<0.001), hospitalization (12.7% vs 2.2%; p<0.001), or had gout-related surgery (4.4% vs 0.1%; p<0.001) over 12 months.

Conclusion:  Less than 30% of gout patients achieve treatment targets and patients with tophi are less likely to achieve these goals than patients without tophi. Patients with tophi have significantly greater burden of disease and greater frequency of comorbidities than patients without tophi. Preventing development of tophi or resolving crystal burden by treating to guideline targets is an important but rarely achieved goal for patients with and without tophi.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparing-the-burden-of-illness-of-patients-with-tophaceous-and-non-tophaceous-gout-in-france-germany-italy-spain-uk-and-usa/