Real-world survey data reveal persistent gaps in management of uncontrolled gout
Presenter: John A. Albert, MD, Physician/Partner, Rheumatic Disease Center, Glendale, WI.
The care pathway and treatment patterns in patients with uncontrolled gout: a real-world survey of physicians in the United States. Abstract 1043. Presented Oct 27, 2025.
Many patients with uncontrolled gout remain hyperuricemic and experience disease-related symptoms despite prolonged urate-lowering therapy, according to results of a recent study presented at ACR Convergence 2025.
In results of the study, based on a real-world survey of 88 physicians reporting on 400 patients, the decrease in mean serum uric acid levels was modest: approximately 2.5 mg/dL despite nearly 2 years of treatment.
Tophi and flares also persisted despite therapy, investigators said, suggesting a need to optimize treatment and provide alternative options for patients with uncontrolled gout.
The study, presented in a poster session, is believed to be the first real-world examination of the care pathway and treatment patterns for uncontrolled gout, according to the investigators.
“Despite being the most common inflammatory arthritis, gout is most often underdiagnosed [and] undertreated, which leads to long-term morbidity and even mortality,” said investigator John A. Albert, MD, in an interview.
To address these questions, Dr. Albert and co-investigators extracted data from a cross-sectional survey completed by US rheumatologists, nephrologists, primary care physicians, and their patients with gout between August 2023 and March 2024. All participating physicians managed at least 8 patients with gout per month, and all patients included were receiving urate-lowering therapy.
At the point of data collection, patients had been treated for a mean of 21.2 months on their current urate-lowering therapy.
Data across the patient care pathway showed only modest decreases in serum uric acid levels. The mean uric acid level for patients with uncontrolled gout was 11.7 mg/dL at diagnosis, and 10.8 mg/dL at the time urate-lowering therapy was initiated. At the point of data collection, a mean of 21.2 months later, the mean was 9.1 mg/dL.
The number of tophi remained relatively unchanged over time, from a mean of 2.8 at diagnosis, to 3.7 at treatment initiation, to 2.9 at the point of data collection.
Likewise, the number of signs and symptoms of gout remained steady, at a mean of 3.2 at diagnosis, 3.1 at treatment initiation, and 2.7 at the point of data collection.
The mean number of flares in the preceding 12 months was 2.3, the investigators also reported.
The prescriber of the current treatment was a rheumatologist in 56% of patients, a nephrologist in 29%, and a primary care physician in 12%. The most common urate-lowering therapies prescribed were allopurinol (prescribed to 63% of patients), followed by febuxostat (29%) and pegloticase (13%).
The most commonly cited reasons for prescribing the current medication were overall efficacy, long-term efficacy, and uric-acid reduction; however, these three characteristics were also cited as the most common areas where treatments could perform better, according to the report.
Taken together, the authors said, these data highlight a burden of elevated uric acid and clinical manifestations of uncontrolled gout despite nearly 2 years of urate-lowering therapy, even when patients are being treated by a specialist.
In the interview, Dr. Albert said the biggest opportunities to improve outcomes for patients whose gout remains uncontrolled despite therapy are early referral to a rheumatologist, escalating therapies based on guidelines, and patient education and involvement.
“Our poster clearly conveys the message that early referral to a rheumatologist or a physician who is ‘gout aware’ leads to better uric acid control,” Dr. Albert said.
For rheumatologists and other treating physicians, the key messages of the study are “treat to target” and “tight control,” with a goal uric acid level below 6 mg/dL with oral urate-lowering therapies.
If this is not possible, then the patient should be referred to a rheumatologist for aggressive uricase therapy, he added.
Disclosures
John A. Albert, MD, reported relationships with Amgen (consulting and speaker fees).
References
Lam G, Bhor M, Hawthorne J, Dada A, Edwards M, Goddard E, Albert J. The care pathway and treatment patterns in patients with uncontrolled gout: a real-world survey of physicians in the United States [abstract]. Arthritis Rheumatol 2025; 77(suppl 9). https://acrabstracts.org/abstract/the-care-pathway-and-treatment-patterns-in-patients-with-uncontrolled-gout-a-real-world-survey-of-physicians-in-the-united-states/. Accessed October 27, 2025.