Background/Purpose: Gout is a chronic, inflammatory arthritis driven by monosodium urate (MSU) crystal deposition and elevated serum uric acid (SUA) levels, increasing the risk for cardiometabolic comorbidities and premature mortality. While gout and hyperuricemia result from complex gene-environment interactions, emerging evidence suggests that disparities in gout outcomes across racial/ethnic groups are more strongly influenced by social determinants of health than genetic factors. While prior studies have largely focused on differences in gout diagnosis and initiation of urate-lowering therapy (ULT), there is limited data on factors influencing long-term disease control. This project examined racial/ethnic and seasonal differences in maintaining target SUA (< 6 mg/dL) among patients on ULT to better understand non-genetic drivers of disease progression.

Methods: We analyzed data from the San Francisco Quality Enrichment Research Initiative, comprising 747 U.S. veterans in Central California with physician-diagnosed gout on ULT from 1999 to 2023. We excluded patients who declined to report race/ethnicity, were of mixed origin, or lacked recent SUA testing. Seasonal variation was assessed using the subset of patients with ULT and SUA measurements in 2023.

Results: Of the 386 self-identified Caucasian patients, 103 (27%) achieved target SUA, compared to 348 patients identifying as persons of color (POC) (African American, Hispanic/Latinx, Asian, American Indian, Native Hawaiian), of whom only 76 (22%) were at target SUA. African American patients were particularly affected, with just 30% achieving target levels. Overall, POC patients were significantly less likely to reach target SUA despite appropriate ULT [Odds ratio 0.61, 95% CI 0.412-0.899, P = 0.0063].Seasonal analysis revealed a notable decline in target SUA achievement in the spring and early summer, with only 38% of patients reaching goal, compared to other times of the year [Figure 2]. This seasonal effect highlights the potential impact of environmental factors like heat, dehydration, and air pollution, particularly in regions like the Central Valley, known for severe particulate and ozone pollution.

Conclusion: Our findings emphasize the need to move beyond one-size-fits-all gout management and consider the complex interplay of racial/ethnic and environmental factors that influence disease control. Providers should account for the broader social and environmental contexts, including housing location, humidity, seasonal changes, and air quality, as they may contribute to elevated SUA and increased flare risk. Addressing these factors could improve outcomes for historically marginalized groups and reduce the overall burden of gout.

Figure 1. Weekly average proportion (%) of patients on ULT with uric acid labs at target (UCL = upper collection limit and LCL = lower collection limit) in the 2023 year

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/seasonal-and-racial-ethnic-variation-in-achieving-target-uric-acid-levels-in-gout-patients-on-urate-lowering-therapy-in-us-veterans-in-central-california/