Background/Purpose: In patients with gout, hyperuricemia leads to inflammation induced by mono-sodium urate crystal deposition. This causes irreversible physical and radiographically evident destruction of the affected joint. Current guidelines recommend a serum uric acid (sUA) level < 6 mg/dL, while data has shown that sUA of < 5 mg/dL has benefit. The aim of this performance improvement project was to assess how to better achieve these goals. We hypothesized that through a multidisciplinary approach, we could more effectively achieve sUA goal levels.

Methods: We enrolled patients with a new or chronic diagnosis of gout. We excluded pregnant women and those under the age of 18. Baseline sUA levels were obtained on all patients. If elevated and not already on urate lowering therapy, patients were started on 100mg Allopurinol daily and 0.6mg Colchicine twice daily. A clinical pharmacist followed our algorithm for a step wise increase in therapy intensity every two weeks, with a corresponding sUA level.

Results: A total of 40 patients participated. The average starting uric acid level of the experimental group was 8.06 mg/dL. After 12 months, 48% (n=19) of patients reached a level below 6 mg/dL. After an average of 18.5 months of enrollment, 33% of patients (n=13) reached a serum uric acid level below 5 mg/dL and 53% (n=21) reached a serum uric acid level below 6 mg/dL.

Conclusion: The aim of our approach to gout treatment is to decrease sUA, gout attacks, and ultimately joint damage. We were able to show that a multidisciplinary approach could improve sUA level compared with primary physicians alone. This effect is due to clinical pharmacists’ ability to perform more frequent sUA evaluations and medication changes for patients. Future work will evaluate secondary end points, like the number of acute care visits and gout attacks during the study period. The summation of this data supports the multidisciplinary approach to the treatment of gout.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-multidisciplinary-performance-improvement-approach-to-achieving-goal-serum-uric-acid-levels-in-patients-with-gout/