Serum urate testing fails to meet recommended levels in older patients with gout
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Key takeaways:
- Physicians who are not rheumatologists are less likely to test serum urate levels.
- Researchers said there are “potentially modifiable factors” to correct the “care gap” in urate monitoring.
Serum urate testing in older patients with gout does not occur as regularly as it should, based on international recommendations, in those beginning urate lowering therapy, according to data published in Arthritis Care & Research.
“Our clinical impression was that despite available therapeutics that effectively lower serum urate and the risk of gout flares, that patients are still experiencing disease related adverse effects,” Timothy S.H. Kwok, MD, MSc, FRCPC, of the University of Toronto, told Healio. “Since serum urate monitoring is a prerequisite to guiding the escalation of doses of urate lowering therapy we wanted to see how well monitoring was done, in particular in the older adult patient population who are disproportionately affected by gout.”
To investigate the relationship between urate lowering therapy and serum urate testing in older patients with gout, Kowk and colleagues conducted a population-based retrospective cohort study using data from the Registered Persons Database, the OHIP claims database, the ODB pharmacy claims database, the Canadian Institute for Health Information Discharge Abstract Database and the National Ambulatory Care reporting System.
The study included patients aged older than 65 years who were diagnosed with gout and received a prescription for urate-lowering therapy between Jan. 1, 2010, and March 31, 2019. Patients were excluded if they were not permanent residents of Ontario, Canada, had missing pertinent information or had previously received urate-lowering therapies. In addition, patients were excluded if they had an acute hematological malignancy associated with tumor lysis syndrome, or if they had end-stage renal disease. All variables used for the study were obtained from medical records or hospital diagnostic codes.
The study included 44,438 patients. According to the researchers, physicians who were not rheumatologists were less likely to initiate urate lowering therapy without serum urate testing. These included primary care doctors (OR = 0.26; 95% CI, 0.23-0.29), internal medicine doctors (OR = 0.34; 95% CI, 0.29-0.39), nephrologists (OR = 0.37; 95% CI, 0.3-0.45) and other specialty doctors (OR = 0.25; 95% CI, 0.21-0.29).
In addition, male physicians were less likely to conduct serum urate surveillance than female physicians (OR = 0.87; 95% CI, 0.83-0.91). Patient factors that correlated with reduced testing included living in rural residences, having a lower socioeconomic status and certain comorbidities.
“We demonstrated that serum urate testing after index urate lowering therapy dispensation among older gout patients was lower than currently recommended by guidelines for gout, though serum urate testing appears to be improving over time,” Kwok and colleagues wrote. “There is large variation in practice patterns for monitoring across different physician specialties, with rheumatologists and family physicians having the highest and lowest percentages of their patients having serum urate testing, respectively.”
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