Target SU Levels in Gout Patients in the ACR’s RISE Registry

Affecting upwards of 9 million adults in the US, gout is one of the most common forms of inflammatory arthritis. Patients with gout experience recurrent flares of joint pain and swelling, which can lead to joint damage and functional impairment if undertreated or not treated at all. It’s also associated with other conditions, including chronic kidney disease.

There has been ample research on gout, and there are effective and inexpensive medications to treat it; however, there has been research published that just one in three individuals diagnosed with gout are prescribed preventative medications. Medicated treatment typically follows The American College of Rheumatology’s (ACR) 2020 guidelines, which involves using a treat-to-target (T2T) approach to lower serum urate (SU) levels in the blood. The target SU level has been previously defined as <6.0 mg/dL, yet many individuals with gout have difficulty reaching this level without the aid of medications in conjunction with lifestyle changes.

A retrospective observational study published in Arthritis Care & Research utilized the ACR’s Rheumatology Informatics System for Effectiveness (RISE) registry and assessed the use of a T2T approach among gout patients receiving long-term SU lowering therapy while being followed longitudinally by rheumatologists. The RISE registry, comprised of data collected during routine clinical care at participating rheumatology practices across the US, allowed the authors of the study to include 9560 patients in their analysis. The main outcomes measured included the proportions of patients with SU monitoring, who achieved the target SU level during the measurement year. Sociodemographic information, comorbidities, and health care utilization were used to determine factors associated with SU monitoring and achievement of target SU levels through the use of multilevel logistic regression.

The mean age of the patients was 67.2 years, 73.5% were male, and 32.3% were non-White. Fifty-six percent had recorded at least one SU during the measurement year. Of these patients, 74% achieved the SU target level of <6.0 mg/dL. Patients receiving long-term urate lowering therapy were significantly more likely to achieve target SU levels compared with those not receiving treatment. Multivariate analysis showed that non-white patients were slightly less likely to be tested or achieve a target SU.

“Routine monitoring of SU is a first step toward improving quality of care for patients with gout,” the authors wrote.