Background: Gout is a common, treatable inflammatory arthritis, yet adherence to guideline-based care remains suboptimal worldwide. Data from Saudi Arabia evaluating real-world gout care processes are limited. Methods: We conducted a retrospective cohort study of adults with a a physician-documented diagnosis of gout who newly initiated allopurinol within a tertiary academic health system in Riyadh, Saudi Arabia, from January 2022 through December 2024. Pharmacy records were used to identify eligible patients, and electronic medical records were reviewed to extract demographic, clinical, and treatment data. Adherence to American College of Rheumatology (ACR) 2020 guideline-derived quality indicators was assessed, including guideline-concordant initiation of urate-lowering therapy (ULT), serum uric acid (SUA) monitoring, achievement of SUA < 6 mg/dL, and use of anti-inflammatory prophylaxis. Multivariable logistic regression was used to identify predictors of adherence. Results: Among 120 patients, 35.8% met ACR 2020 criteria for ULT initiation. SUA was measured within 6 months of initiation in 41.7% of patients, and at least annually in 61.7% of patients with at least 12 months of follow-up. Among 115 patients with at least 12 months of follow-up and at least one documented SUA measurement, 32.2% achieved SUA < 6 mg/dL. Anti-inflammatory prophylaxis was received at ULT initiation by 15 out of 107 eligible patients (14%). Primary care management was independently associated with lower odds of meeting initiation criteria (OR 0.05, 95% CI 0.01– 0.16) and of achieving the target SUA (OR 0.23, 95% CI 0.06– 0.89) compared with rheumatology. Older age (OR 0.97, 95% CI 0.92– 1.00) and male sex (OR 0.29, 95% CI 0.10– 0.83) were also associated with lower SUA target attainment. Conclusion: In this tertiary academic health system, guideline-recommended gout care processes were inconsistently executed across initiation, monitoring, target assessment, and prophylaxis domains. Primary care management was associated with lower odds of appropriate ULT initiation and target SUA attainment, and older age and male sex were also associated with lower target achievement. Standardized treat-to-target pathways supported by pharmacist- or nurse-led titration may improve performance. Plain Language Summary: Gout is a common and painful form of arthritis. It can be effectively treated when care follows clear medical guidelines. These guidelines recommend starting urate-lowering medicines only when they are truly needed, checking blood uric acid levels regularly, adjusting treatment until a safe target level is reached, and giving short-term anti-inflammatory medicines to prevent early gout attacks. We studied 120 adults with gout who were newly started on allopurinol at a large academic health system in Riyadh. We reviewed their medical records to see how often these recommended steps were followed in routine care. We found that only 35.8% of patients met guideline criteria for starting urate-lowering treatment. Serum uric acid was checked within 6 months in 41.7% of patients, and among those with assessable follow-up, 61.7% had at least yearly monitoring of serum uric acid. Among patients with enough follow-up and at least one uric acid test, 32.2% (37 of 115 patients) reached the recommended uric acid target of less than 6 mg/dL. Preventive anti-inflammatory treatment at the time allopurinol was started was received by 14.0% of eligible patients (15 out of 107). Patients managed in primary care were less likely than those managed by rheumatologists to meet guideline standards for treatment initiation and uric acid target attainment. This suggests that the main gaps may relate to how care is organized and followed over time, not just to which medication is prescribed. Our findings show that many people with gout are not receiving all the recommended steps of care. Standardized care pathways, automatic reminders for uric acid testing, bundled prescribing of prophylaxis, and pharmacist- or nurse-supported follow-up may help improve gout care and reduce avoidable flares. Keywords: gout, allopurinol, guideline adherence, quality indicators, Saudi Arabia
Aboabat et al. (Wed,) studied this question.