Improvement in diagnosis and treat-to-target management of hyperuricemia in gout: results from the GEMA-2 transversal study on practice

Gout was reported as a poorly managed disease. Serum urate (sUA) lowering therapy is the most recommended treatment for gout. But it remains unknown whether such recommendations have an actual impact on gout. Therefore the present study showed that over 50% improvement in targeting therapeutic serum urate. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive.

The study aimed to investigate changes concerning main European League Against Rheumatism (EULAR) recommendations used during gout diagnosis and treatment than the previous assessment.

The rheumatologists used GEMA-2 (Gout Evaluation and Management) for gout valuation. It is a transversal assessment of practice. The evaluation of the earlier GEMA assessment concerning the crystal-proven diagnosis rate and gaining therapeutic serum urate levels under 6 mg/dl at last visit was considered as study's primary outcomes. Other management variables involved lifestyle change advice, prevention, and treatment of flares were also determined along with general attributes. The analysis has the potency to incorporate at least 483 patients with the 50% change.

A total of 38 rheumatology units selected to retrieved data on the management of 506 patients that were engaged in the earlier GEMA audit. A 31% improvement was noticed in the crystal-proved diagnosis rate and gout-dedicated practices. The contribution of ultrasonography in diagnosis was very less; < 1% of cases. The therapeutic serum urate also showed improvements from the last visit and approximate 50% improvement from the prior evaluation. The patients who unable to obtain a target serum urate levels were not using medications as per prescription given on the labels. Clinical indolence to improve doses of either febuxostat or allopurinol still existed in the clinical practice.

Over 50% improvement in targeting therapeutic serum urate has been observed, but clinical inertia is still present. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive.