Background/Purpose: The burden of gout is rising in low-income and middle-income countries in the Asia-Pacific region. However, individuals with gout in this region remain underrepresented in research, resulting in a limited understanding of the unique challenges and pain points shaped by their geographic and cultural context. The Asia Pacific League of Associations for Rheumatology (APLAR) Gout Registry was established to gain a deeper understanding of the characteristics and management of gout among patients in this region.

Methods: This is a longitudinal, multinational, rheumatologist-reported registry that began in August 2023. It includes adults (aged 18 years or older) diagnosed with gout who are under the care of, and being followed by, participating rheumatologists. Gout was defined as having experienced at least one gout flare and receiving a diagnosis of gout by the reporting physician. Data on demographics, comorbidities, gout symptoms, gout treatments, serum urate levels, and flares were collected over a 12-month period from the time of recruitment.

Results: A total of 549 participants from eight countries were recruited, and data from 903 visits were collected by December 2024 (Figure 1). The cohort was predominantly male (512/549, 93%) with a mean age of 53 years. The most common comorbidities were hypertension (196/549, 36%), followed by hyperlipidemia (123/549, 22%) and chronic kidney disease (103/549, 19%). The mean duration of gout since the first flare was 8.2 years. The first metatarsophalangeal joint was the most commonly affected site (311/549, 57%). Tophaceous gout was present in 144 individuals (27%), and chronic symptoms were reported in 90 individuals (17%) (Figure 2). At baseline, 314 participants (57%) were receiving at least one urate-lowering therapy (ULT); however, only 128 of 498 individuals (30%) had a serum urate level below 6 mg/dL (0.36 mmol/L). Among those not taking ULT at baseline, 17% (40/235) were using colchicine for gout flare prophylaxis. At the 12-month follow-up, 75% (37/49) of individuals had achieved serum urate levels below 6 mg/dL, and 88% (43/49) were prescribed at least one ULT. Gout flares were reported in 46% (152/326) of participants at baseline, decreasing to 4% (2/49) at the 12-month follow-up (Figure 3).

Conclusion: Gout patients in the Asia-Pacific region face multiple challenges, including severe disease manifestations, low rates of ULT prescription, and poor attainment of serum urate targets. These suboptimal outcomes persist even under specialist care, highlighting the urgent need for improved gout management strategies in this population.

Figure 1. Participating Asia-Pacific countries

Figure 2. Clinical manifestations at baseline categorized by the presence of tophi and pattern of articular symptoms

Figure 3. Prevalence of ULT prescription, gout flare and serum urate at target during 12-month period

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/characteristics-and-management-of-gout-patients-under-rheumatologist-care-from-low-income-and-middle-income-asia-pacific-countries-data-from-the-aplar-gout-registry/