Background/Purpose: 1) assess the current quality of care in gout patients  and 2) compare the current management with previous audit data.

Methods: a second audit of clinical management of gout was conducted in 2014, including centers audited in 2006. The current Gout Evaluation and MAnagement-II audir included patients whose first visit was prior to the release of the ACR guidelines. In both audits, the degree of agreement was assessed according to the EULAR 2006 recommendations. The selection of patient’s files for review was performed by a stratified 2-stage sampling. The number of centers per stratum was proportional to the population ≥50 years according to national statistics. In a second stage, a random sample from all patients in each participant unit with a diagnosis code of gout (ICD, R9), and who had been attended in 2006 and 2012 respectively was centrally selected. The sample size was estimated at 1,000 patients in 50 units for GEMA and then 500 patients from 40 units for GEMA-II according to previous results and expected outcomes. The main co-principal variables for GEMA-II were >50% improvement from GEMA in the rate of gold-standard diagnosis (based on crystal observation) and >50% improvement in the rate of patients at target serum urate levels (< 6 mg/dl in the last visit). In addition, an aprioristic evaluation of whether gold standard diagnosis was to be obtained in >50% of patients and target serum urate in > 50% of patients was asked from principal investigators prior to the inclusion of patient data. 

Results: data from 511 randomly selected clinical records from 38 units were included. Out of the 38 units, 93% reported having a polarized microscopy facility at the office. sUA at final visit was available in 479/511 (93.7%). Samples from the two audits (GEMA and GEMA-II) did not differ in age, sex distribution or time from onset to first visit. Crystal-based diagnosis was performed in 209/803 (26.0%) and 162/511 (31.7%) in the GEMA and GEMA-II studies, not reaching endpoint. By contrast, the pre-defined improvement >50% for the rate of patients achieving target serum urate (< 6 mg/dl) was achieved (Table) for the overall population, independently of the aprioristic perception of the rate of control of target sUA. A post-hoc analysis including only patients on urate-lowering medications, the improvement in the rate of patients achieving  sA target was 49.31%, very close to the >50% improvement (Table).

Conclusion: Overall the improvement in the rate of patients achieving target serum urate over a 6-year period exceeded 50%. The rate of gold-standard diagnosis improved, but did not reach the expected outcome. Although still under further analysis, these preliminary data show for the first time that substantial improvement has been achieved in treat to target serum urate levels strategy for gout in the Rheumatology community.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvement-in-treat-to-target-serum-urate-levels-preliminary-results-from-a-comparison-between-two-audits-of-management/