According to a study published in the JAMA, only a minority of gout patients in England receive urate-lowering treatment according to guideline recommendations.
Existing guidelines in England recommend urate-lowering treatment for patients with more severe gout or accompanying conditions. However, it remains unclear when such treatment is appropriate.
Researchers investigated the timing of eligibility for and prescription of urate-lowering treatment following first gout diagnosis. Out of 52,164 patients with incident gout, the median time to first treatment indication, such as multiple attacks, chronic kidney disease, diuretic use was 5 months and the cumulative probability of fulfilling any indication was 44 percent at 0 years from diagnosis, 61 percent at 1 year, 87 percent at 5 years, and 94 percent at 10 years. The cumulative probabilities for prescription at the same time points were 0 percent, 17 percent, 30 percent, and 41 percent.
The median prescription rate for urate-lowering treatment among practices was 32.5 percent. The authors explain, "The unexplained variance may be accounted for by factors not available in the database. Recognized barriers to care include suboptimal patient and physician knowledge of gout, its treatment, and clinical recommendations, and patient and physician preferences for treatment. In conclusion, our study supports including urate-lowering treatment in the information about gout provided to patients around the time of first diagnosis."