A recent study showed that patients with gout receiving rheumatologist care was associated with better disease management compared with care from general practitioners. Furthermore, many patients not seen by a rheumatologist were not being cared for according to established treatment guidelines from rheumatology societies.
“Our findings imply that many gout patients are not receiving the management recommended in the majority of published gout management guidelines to prevent irreversible consequences of advanced disease,” wrote the researchers in ACR Open Rheumatology. “More frequent referral to rheumatologists and closer adherence to guidelines may improve outcomes for gout patients.”
Using the Symphony Integrated Dataverse and Truven Marketscan administrative claims databases, researchers evaluated real-world practice patterns in patients (N=1,162,747) diagnosed with gout from October 2015 and November 2018. Inclusion criteria included patients aged 18 years and older who had at least two medical claims for a gout diagnosis on different days, separated by at least 3 months. Patients were further identified as having either gout or advanced forms of gout. Researchers then evaluated the frequency of serum urate testing, treatment with urate lowering therapies (ULTs), rheumatologist specialist visits, and emergency room (ER) visits for gout flares.
During the 3-year study period, even in patients diagnosed with advanced forms of gout, researchers found that serum urate testing, ULT prescriptions, and rheumatology consults were lower than expected. Serum urate testing was carried out in only 60% to 70% of patients with chronic gout with a mean number of tests far below the American College of Rheumatology recommendation for measurement every 6 months once target serum urate levels are reached. Less than 80% of patients with advanced gout received prescriptions for ULT, with prescriptions covering only 50% of the year. Additionally, the frequency of ER visits was significantly (P<.001) reduced in patients who had not been seen by a rheumatologist.
However, patients seen at least once by a rheumatologist had a significantly increased adherence to guidelines, including serum urate testing and ULT recommendations. For example, 62.5% of patients with acute gout seen by a rheumatologist had serum urate testing compared with 54% who did not, and 74.5% of patients received prescriptions for ULT compared with 62.3% of patients who did not. Additionally, patients seen by a rheumatologist at least once had a significantly decreased frequency of ER visits for gout flares (P<.001).
“Together, this study provides data on real-world management of acute and advanced gout and highlights the need for increased gout clinical management awareness and education,” said the researchers. —Eileen Koutnik-Fotopoulos
Edwards NL, Schlesinger N, Clark S, Ardnt T, Lipsky PE. Management of gout in the United States. A claims-bases analysis [published online March 1, 2020]. ACR Open Rheumatol. doi:10.1002/acr2.11121