Only a minority of gout patients receive recommended urate-lowering treatment, despite their eligibility for it, a new study finds. With undertreatment comes a potential for consequences from high uric acid levels.
Current guidelines recommend long-term urate-lowering treatment to prevent crystal deposition and encourage crystal dissolution in patients with severe gout or accompanying conditions. It remains unclear, however, when such treatment is appropriate.
For the study, Chang-Fu Kuo, MD, of Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues investigated the timing of eligibility for and prescription of urate-lowering treatment following a gout diagnosis. They identified 52,164 gout patients from the United Kingdom using the Clinical Practice Research Datalink, which includes patient demographics, diagnoses, examination findings, laboratory results, and medication prescriptions. The average age at gout diagnosis was 62.5 years and 73% of patients were men.
The median time to first treatment indication was 5 months, according to results published online in the Journal of the American Medical Association. Indications included multiple gout attacks, tophi, chronic kidney disease (CKD), urolithiasis, and diuretic use.
According to the report, 44% of patients met criteria for urate-lowering treatment at diagnosis, 61% at 1 year, 87% at 5 years, and 94% at 10 years. At the same time points, prescriptions were given to only 0%, 17%, 30% and 41%.
Most indications were associated with increased prescribing by general practitioners: 60% greater odds for acute gout attacks during the first year, 87% for tophi, 67% for CKD, and 57% for diuretic use at diagnosis.
Patient- and practice-related factors recorded in the database accounted for just one-fifth of the variance in prescriptions.
“Recognized barriers to care include suboptimal patient and physician knowledge of gout, its treatment, and clinical recommendations, and patient and physician preferences for treatment,” the researchers concluded.