Proportion Of Patients Achieving Serum Urate Target In a Longitudinal Veterans Administration (VA) Gout Registry: Crystal Registry

Puja Khanna^1,2, Andreas M. Reimold³, Gail S. Kerr⁴, J. Steuart Richards⁵, Elizabeth Chang⁶, Jasvinder A. Singh⁷, H. Ralph Schumacher⁸, Tanima Bannerjee⁹ and Dinesh Khanna¹⁰, ¹Rheumatology, Ann Arbor VA, Ann Arbor, MI, ²Division of Rheumatology, University of Michigan Medical Center, Ann Arbor, MI, ³Rheumatology, Dallas VA and University of Texas Southwestern, Dallas, TX, ⁴Rheumatology, Washington DC VAMC, Georgetown and Howard University, Washington, DC, ⁵Rheumatology, Washington DC VAMC and Georgetown University, Washington, DC, ⁶Phoenix VAHCS, Phoenix, AZ, ⁷Department of Medicine, University of Alabama, Tuscaloosa, AL, ⁸Department of Medicine, University of Pennsylvania and VA Medical Center, Philadelphia, PA, ⁹Biostatistics, University of Michigan, Ann Arbor, MI, ¹⁰University of Michigan Health System, Ann Arbor, MI

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Gout and registries

Session Information

Title: Metabolic and Crystal Arthropathies I

Session Type: Abstract Submissions (ACR)

Background/Purpose: Gout is the most common inflammatory arthritis managed by healthcare providers at the VA Healthcare System. CRYSTAL registry is a longitudinal observational study at six VA centers across US to help understand and improve quality of care of gout. The current objective is to present data from first follow-up in patients who achieved disease control as defined by a target serum urate (sUA) of < 6 mg/dL per recommendations of the 2012 American College of Rheumatology (ACR) guidelines.

Methods: Patients who met the ACR and/or New York criteria are enrolled. At each visit, gout medications (acute and chronic) and comorbidities are reviewed. Subjects complete standardized gout-related questions on flares, interval hospitalizations, HAQ-DI, pain and severity of disease (VAS, 0-10), patient global assessment (0-10 VAS), and alcohol use. Joint exam is performed to assess disease activity and acute phase reactants, sUA, estimated glomerular filtration rate (eGFR), and complete blood counts are monitored as routine care. Data are presented as mean ± standard deviation (SD) or percentage (%). P-values of <0.05 were considered statistically significant.

Results: Of 355 enrolled in the registry, 205 (57%) had at least 1 FU visit, with average FU for 2^nd visit was 8 months (range 17 days-46 months). Patients were predominantly male (96%), mean (SD) age was 67.2 (10.5) years, 34% were Caucasian and 63% were African American, and 58% had crystal proven gout. Significant improvement was seen at FU for sUA (-0.94 mg/dl, p<0.0001), patient severity scores (-1.2, p=0.002), physician severity score (-1.2, p=0.01), and HAQ-DI (-0.12, p=0.04). However, there was no significant change in number of flares between 2 visits (p=0.84). Of patients who had sUA > 6 mg/dL at baseline (N=129), 96 (74.4%) achieved the target sUA < 6 mg/dL.

Conclusion: Of gout patients who started with a sUA above 6 mg/dL at enrollment, 74% achieved sUA target of 6 mg/dL at a mean follow-up of 8 months. Further analysis will determine the predictors of sUA target in this cohort. These analyses provide a benchmark to improve quality of care for the Veterans and highlight the need for continued monitoring.

Disclosure:

P. Khanna,

NIH,

A. M. Reimold,
None;

G. S. Kerr,

Genentech and Biogen IDEC Inc.,

Pfizer Inc,

Bristol Myers Squibb,

J. S. Richards,
None;

E. Chang,
None;

J. A. Singh,

Takeda, Savient,

Savient, Takeda, Ardea, Regeneron, Allergan,

URL pharmaceuicals Novartis,

H. R. Schumacher,

Penn Center for Musculoskeletal Disorders,

T. Bannerjee,
None;

D. Khanna,

NIH,

Scleroderma Foundation,

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