Patients in this cohort had a diagnosis of gout, had at least 2 visits with a Cleveland Clinic rheumatologist, and were prescribed a uric acid-lowering agent (allopurinol, febuxostat, probenecid, or lesinurad). Two 6-year periods were compared: 2001–2007 and 2014–2020. The recommended target uric acid level was ≤ 6.0 mg/dL. The percentage of patients who achieved a uric acid level of ≤ 6.0 mg/dL increased from 62.0% in 2001–2007 to 84.0% in 2014–2020. In the period 2001–2007, 22.6% of patients did not achieve a uric acid level < 7.0 mg/dL; in the period 2014–2020, fewer patients (8.7%) did not achieve a uric acid level < 7.0 mg/dL.
The percentage of patients who achieved target plus acceptable uric acid levels increased in the period 2014–2020, although 1 in 10 did not achieve target uric acid levels of < 7.0 mg/dL. Substantial numbers of patients do not achieve target uric acid levels and are undertreated with urate-lowering therapy. Defined systems approaches will be needed to improve treatment in gout patients.