Gout Undertreatment Persists Save

Despite updated gout management guidelines from European (EULAR) and British (BSR) societies, treatment of gout is suboptimal with regard to the use of urate-lowering therapy (ULT) and normalizing serum uric acid (< 6.0 mg/dl) levels.

A cohort analysis using UK gout patients (n = 129,972) from the Clinical Practice Research Datalink (between 2004-2020) to assess initiation of ULT, achieving serum urate ≤360 µmol/L and ≤300 µmol/L and treat-to-target urate monitoring.

Of 129,972 newly-diagnosed gout patients, 37,529 (28.9%) had ULT initiated within 12 months. Over time, ULT initiation improved modestly from 27% in 2004 to 37% in 2019 and 35% in 2020.

In 2020 only 17% of gout patients attained a urate ≤300 µmol/L, 36% attained a urate ≤360 µmol/L and 19% received treat-to-target urate monitoring.

Publication of the BSR or EULAR management guidance on gout did not improve the rates of ULT initiation or urate target attainment.

Comorbidities, including chronic kidney disease (CKD), heart failure and obesity, and diuretic use associated with increased odds of ULT initiation but decreased odds of attaining urate targets within 12 months.

Initiation of ULT and achieving urate targets remains poor in the UK, despite updated gout management guidelines.