Background/Purpose: Gout is the most common form of inflammatory arthritis and is caused by chronic hyperuricemia, leading to urate crystal deposition disease and subsequent intermittent flares and tophi development. ACR guidelines recommend treating to target SUA levels (<6 mg/dL or, in some cases, <5 mg/dL as needed to control signs/symptoms). This study aimed to describe overall rates of SUA testing and differences in patient characteristics, comorbidities, treatments, and flare rates by SUA testing status.

Methods: Gout patients treated with urate-lowering therapy (ULT) were identified between Feb 1, 2011 and Jan 31, 2012 from the HealthCore Integrated Research Environment. Index event was considered to be the earliest of the following: a prescription for ULT; or a gout diagnosis (ICD-9 274.xx) or a claim for colchicine with ULT therapy in the year prior. Patients with <12 months pre- and post-index enrollment or with a diagnosis of cancer, evidence of hematologic cancer, tumor lysis syndrome, Lesch-Nyhan syndrome or juvenile gout, familial Mediterranean fever, or pregnancy in the pre- or postindex periods were excluded. Patient demographics and comorbid conditions were captured during the 12-month pre-index period. SUA laboratory testing, treatment characteristics, and overall gout control (SUA ≤6 mg/dL, no flares, no tophi) were examined during the 12 month post-index period. Target SUA level was ≤6 mg/dL. Flares were defined during the post-index period as either a claim for colchicine, or a healthcare visit recording gout together with ≥1 of the following within 1 week: joint aspiration/injection (corticosteroids), prescription of NSAIDs, corticosteroids, adrenocorticotropic hormone, or IL-1 antagonist.

Results: 50,602 ULT-treated patients met inclusion criteria (average age, 59; 82% male). During follow-up, 90% of patients received allopurinol, 6% febuxostat, and 4% probenecid. SUA testing occurred in 47% of patients during 1-year follow-up. Those with SUA testing were younger (57 vs. 61 years) and had higher rates of colchicine use (23% vs 13%), hyperlipidemia (64% vs. 59%), and chronic kidney disease (15% vs 13%) compared to those without testing. Patients without SUA testing had higher rates of cardiac-related comorbidities: coronary artery disease (21% vs 17% in those with testing), angina (21% vs 16%), and peripheral vascular disease (10% vs 8%). A higher proportion of patients seen by a rheumatologist had testing compared with those not visiting a rheumatologist (75% vs 44%, respectively). Among patients with available SUA results (n=6649), 47% of subjects had SUA levels ≤6 mg/dL, and 30% achieved overall gout control.

Conclusion: Guidelines describe treating to target SUA as appropriate care. This study finds <50% of all gout patients treated with a ULT have SUA assessed at any time during a 12-month period. Patients most likely to have SUA assessments are younger, have more flares, or visit a rheumatologist. In patients with SUA assessment, <50% achieve SUA goal and less than a third achieve overall gout control. These findings suggest that contemporary gout care is suboptimal, leaving considerable room for improvement.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rate-of-serum-uric-acid-sua-assessment-in-gout-patients-treated-with-urate-lowering-therapy-treating-to-target/