Background/Purpose: gout is well known to be associated with comorbid conditions; the Kaiser Permanente Pyramid (KPP) identify high risk people (two higher strata) in the population, in order to support them in an individualized and multidisciplinary management, respectively, to avoid admissions. This study intends to evaluate whether severity of gout is also associated with higher KPP.

Methods: prospective cohort of follow-up of gout patients in whom KPP distribution was endorsed by the health system in the patientsx electronic file from Sept 2012. Comorbid conditions known to be cardiovascular risk factors (hypertension, glomerular filtration, diabetes, hyperlipidemia, vascular events), were recorded in the patientsx record file at baseline. In addition, evaluation of the severity of gout according to the number of flares (previous year), joint distribution, presence of subcutaneous tophi, and X-ray abnormalities related to gout, along with acute kidney injury related to the previous use of NSAIDs were also recorded at baseline evaluation.

Results: 256 patients, 92.2% men, 77% crystal and 11% hs-ultrasound based diagnosis, have been evaluated using the KPP.  KPP higher strata included 132 (51.5%) of all the patients: 72 (28.1%) considered as high risk /disease care patients and 60 (23.4%) as very complex/case management patients. Comorbidities associated with gout were much more prevalent in the two higher strata of KPP (Table), but also showed that polyarticular distribution, presence of tophi, and X-ray abnormalities were more prevalent in these patients. Interestingly, previous acute kidney injury attributed to NSAIDs was ten-fold in these high-risk patients compared to low-risk patients.

Conclusion: patients with the highest clinical complexity according to Kaiser Permanente Pyramid also showed the most severe gout, indicating that these complex-severe patients could well deserve specific rheumatologic or even multidisciplinary management.