An audit of the variability of diagnosis and management of gout in the rheumatology setting: the gout evaluation and management study.

OBJECTIVE: The objectives of the study were to evaluate the rate of variability in diagnosis and treatment of the patients with gout in the rheumatology setting and to estimate the rate of adjustment to the European League Against Rheumatism recommendations as a key step to improve the quality of care in gout.
METHODS: The GEMA (Gout Evaluation and MAnagement) study is a cross-sectional audit in which 803 files of patients with an International Classification of Diseases code of gout were randomly chosen from 41 rheumatology units. The data collected regarded the clinical management of gout. Indicators based on the European League Against Rheumatism recommendations were created, and information on the fulfillment of the recommendations was retrieved. The mean adjustment and 95% confidence interval (CI) were estimated for each recommendation.
RESULTS: Patients from whose files information was retrieved were very representative of gout (94% were men, with a mean age of 60 years, 43% obese, 62% hypertensive, more than 25% with tophaceous gout, 61% hyperlipidemic). A diagnosis based on the observation of monosodium urate crystals on the microscope had been made in only 26%; thus, the adjustment to diagnostic recommendations was low, 26.0% (95% CI, 18.9%-33.1%). The adjustment to the recommendations on evaluating comorbidity was 50.6% (95% CI, 46.6%-54.5%). Mean adjustment to recommendations on management, in general, was better, especially those regarding acute flares (100%), and lifestyle changes, with 71.4% (95% CI, 63.7%-79.1%) with treatment using urate-lowering drugs could be improved (mean adjustment, 52.1% [95% CI, 43.1-61.1]).
CONCLUSIONS: Overall, implementation of clinical care in gout should be put on further attention to diagnosis, time-consuming evaluation of comorbidities, and long-term control of serum urate levels.