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Management of Gout in the United States: A Claims-based Analysis

Author

ACR Open Rheumatol. 2020 Mar;2(3):180-187. doi: 10.1002/acr2.11121. Epub 2020 Mar 1

N Lawrence Edwards 1, Naomi Schlesinger 2, Sanders Clark 3, Theresa Arndt 3, Peter E Lipsky 4

Author Information

1 University of Florida, Gainesville, Florida.

2 Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.

3 HVH Precision Analytics, LLC, Wayne, Pennsylvania.

4 RILITE Research Institute, Charlottesville, Virginia.

Abstract

Objective: Gout is the most common inflammatory arthritis in the United States. Although numerous guidelines exist for the management of gout, they are not routinely implemented. This study evaluated the real-world practice patterns in gout patients using large administrative claims databases.

Methods: An analysis of patients diagnosed with gout from October 2015 to November 2018 was carried out using the Symphony Integrated Dataverse and Truven Marketscan administrative claims databases. Patients were identified as having gout if they were more than18 years of age and had 2 or more primary gout diagnoses on different days, separated by 3 or more months. Patients were further identified as having either acute gout or advanced forms of gout including chronic nontophaceous, tophaceous, and uncontrolled gout. Percent and frequency of serum urate testing, rheumatology specialist visits, prescriptions for urate lowering therapies (ULTs), and emergency room (ER) visits for gout flares were evaluated.

Results: We identified 1 162 747 gout patients. Gout patients were seen most frequently by internists and family medicine practitioners. Neither urate testing nor prescriptions for ULTs were uniform. Patients with acute gout were infrequently seen by rheumatologists, whereas rheumatologist care progressively increased in patients with advanced gout. The frequency of serum urate testing and prescriptions for ULTs significantly increased, whereas the frequency of ER visits decreased in gout patients seen by a rheumatologist.

Conclusion: Measurement of serum urate and prescriptions for ULTs are not consistent in gout patients. Rheumatologist care increases the frequency of urate measurement and ULT prescriptions and may also improve outcomes for gout patients.