Patients in this cohort had a diagnosis of gout, at least 2 visits with a Cleveland Clinic rheumatologist, and were prescribed a serum urate lowering agent (allopurinol, febuxostat, probenecid, or lesinurad). Two 6-year periods were compared: 2001–2007 (period before the initial American College of Rheumatology Guidelines for Management of Gout)¹ and 2016–2022. The recommended target serum urate level was ≤ 6.0 mg/dL.² The percentage of patients who achieved a urate level of ≤ 6.0 mg/dL increased from 61.9% in 2001–2007 to 83.3% in 2016–2022. In the period 2001–2007, 22.7% of patients did not achieve a urate level < 7.0 mg/dL; in the period 2016–2022, fewer patients (9.3%) did not achieve a urate level < 7.0 mg/dL.
The percentage of patients who achieved target urate levels increased in the period 2016–2022, although 1 in 10 did not achieve target urate levels of < 7.0 mg/dL. Substantial numbers of patients do not achieve target urate levels and are undertreated with urate-lowering therapy. Defined systems approaches will be needed to improve treatment in gout patients.
¹Khanna D, Fitzgerald JD, Khanna PP et al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care & Research Vol. 64, No. 10, October 2012, pp 1431-1446.
²FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Rheumatol. 2020 Jun;72(6):879-895.