Monitoring of Urate-Lowering Therapy Among US Veterans Following the 2012 American College of Rheumatology Guidelines for Management of Gout

Abstract

Rates of ULT monitoring at a major VA medical center were suboptimal, and improved adherence to guideline recommendations is needed.

Variation in methods, results and reporting in electronic health record-based studies evaluating routine care in gout: A systematic review

“…The proportion with PDC≥80 in the first year was 38.6% among patients with ≥1 diagnosis [27, 39] and 59% among patients with ≥1 diagnosis validated through a survey [40]. MPR was only measured using a liberal definition [41].…”

“…ULT doses were low with limited up-titration although greater in studies with a specific gout definition. The mean proportion of patients with ULT up-titration was 5.4% (range 4–36%) and 29.0% (range 22.4–39.3%) when using liberal and specific definitions respectively [35, 37, 41–44]. The mean initial allopurinol dose was 148.1 mg/day and overall dose was 223.3 mg/day: 194.1 mg/day and 231.4 mg/day in studies with liberal and specific definitions respectively [21, 34, 42, 45–50].…”

Development of the American College of Rheumatology Electronic Clinical Quality Measures for Gout

“…It should be acknowledged that the recommendations in guidelines may change as new data become available, but those recommendations should always represent the best evidence and the best expert opinion currently available” . After a decade of gout guideline development without measuring physician performance, data support that a significant performance gap continues to exist . Continued absence of measurement will not improve this situation.…”

Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners®: Etiology, Diagnosis, and Treatment Consensus for Gouty Arthritis of the Foot and Ankle

“…Reducing serum urate levels between 4.6 and 6.6 mg/dL is associated with a 30% decline in recurrences of gouty arthritis compared with patients whose sUA remained above this range (126). The serum urate should be monitored every 2 to 5 weeks with dose titration until the target sUA level is achieved and the patient has shown signs of clinical improvement (138). Lowering the sUA too quickly or aggressively can lead to gouty flare (137).…”