Percentage of patients aged 18 and older with a diagnosis of gout treated with urate-lowering therapy (ULT) for at least 12 months, whose most recent serum urate result is less than 6.8 mg/dL

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Patients with hyperuricemia are subject to recurrent gout flares and formation of tophi, which can lead to joint and other tissue damage. Urate lowering therapy reduces the frequency of acute gouty attacks [1,2] and reduces the rate of growth of tophi and decreases the size of tophi [5].

For patients with indications for serum urate lowering therapy, after starting therapy, the goal of treatment is serum urate < 6 mg/dl. Lower serum urate levels are associated with fewer acute gout attacks [3] and decreased formation (and improvement) of tophi [4]. Patients on ULT that do not achieve target serum urate < 6 mg/dl are 75% more likely to flare than patients who reach target [5].

The American College of Rheumatology (ACR) guidelines on gout recommends that if a patient with gout has been treated with urate lowering therapy for at least 12 months, then the serum urate should be checked at least once yearly and the most recent serum urate should be < 6.8 mg/dl.

As a quality measure, the ACR quality improvement panel recommended a less stringent target and selected the solubility concentration of urate 6.8 mg/dl for a quality target.

The 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia recommend that all gout patients with indications for UTL should have their serum urate lowered to 6 mg/dl.  Serum urate is the hemoglobin A1C of gout.  Lower levels of serum urate are associated with less frequent gout attacks and reduction of tophaceous deposits. Based on feedback from public comment and expert panel, the less stringent level of 6.8 mg/dl cut-off was used to evaluate quality of care.  6.8 mg/dl is the solubility concentration of urate crystals.  Serum urate responds to changes in urate lowering therapy within 14-days.  The Guidelines recommends dose titration every 2-5 weeks.  Twelve months was selected as sufficient time to achieve serum urate target, evidence Level C.

Khanna, Dinesh, et. al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1: Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. Arthritis Care & Research 2013; 64: 1431-46.

Higher score indicates better quality

[1] Shoji A, Yamanaka H, Kamatani N. A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004; 51:321-325.

[2] Perez-Ruiz F, Atxotegi J, Hernando I, Calabozo M, Nolla JM. Using serum urate levels to determine the period free of gouty symptoms after withdrawal of long-term urate-lowering therapy: a prospective study. Arthritis Rheum 2006; 55:786-790.

[3] Becker MA, Schumacher HR, Espinoza LR, Wells AF, Mac-Donald P, Lloyd E, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 2010;12:R63.

[4] Perez-Ruiz F, Calabozo M, Pijoan JI, Herrero-Beites AM, Ruibal A. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum 2002; 47: 356–60.

[5] Sarawate CA, Patel PA, Schumacher HR, Yang W, Brewer KK, Bakst AW. Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol. 2006 Apr;12(2):61-5.

Patients with a history of solid organ transplant are identified through a diagnosis on the problem list or through an active medication of tacrolimus or cyclosporine in the measurement year or year prior.

If a patient has ever had an eGFR < 30 mL/min meeting the specified timing constraint, the patient would qualify for a denominator exception. For example, if a patient had three eGFR lab results within 24 months of the measurement period end date, and one is below the threshold and two are above the threshold, they could qualify as a denominator exception at the discretion of the EP.

TBD

Adult patients aged 18 and older with a diagnosis of gout treated with urate lowering therapy (ULT) for at least 12 months

Equals Initial Patient Population

Patients with a history of solid organ transplant

Patients whose most recent serum urate level is less than 6.8 mg/dL

Not Applicable

Documentation of medical reason(s) for not expecting a serum urate target level of < 6.8 mg/dL (ie, any eGFR level < 30 mL/min or Stage 3 or greater chronic kidney disease in the measurement year or year prior)

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.