OBJECTIVES: Uncontrolled gout can lead to chronic pain, disability, more healthcare services, and poor health outcomes. This study sought to describe the epidemiology, pharmacotherapy, healthcare utilization, and outcomes for patients with controlled and uncontrolled gout in the United States (US) Veterans Affairs (VA) healthcare system.

METHODS: This retrospective cohort study used electronic health record (EHR) data from VA patients from all US states and territories with gout from 1/1/2016 to 12/31/2022. Uncontrolled gout was defined as a uric acid (UA) level > 8 mg/dL, tophi, or both. Descriptive and bivariate (chi-square, Student’s t-test) statistics were used to summarize and compare baseline characteristics, treatments, healthcare utilization, and outcomes over 12 months for VA patients with controlled and uncontrolled gout.

RESULTS: Of the 331,675 patients who met study criteria, most were prescribed allopurinol (use increased from 60% [2016] to 70% [2022]), followed by colchicine (use decreased from 33% [2016] to 25% [2022]), and febuxostat (use decreased from 7% [2016] to 4% [2022]). Patients with uncontrolled (138,072 [42%]) vs. controlled (193,603 [58%]) gout were younger (mean age 64 vs. 71 years, p<0.01) and saw specialists more often during follow-up: podiatry (23% vs. 19%, p<0.01), rheumatology (17% vs. 6%, p<0.01), and nephrology (15% vs. 7%, p<0.01). Patients with uncontrolled gout were also significantly more likely to have UA levels above 6 mg/dL (85% vs. 44%, p<0.01) and 8 mg/dL (54% vs. 0%, p<0.01), and to be admitted to the emergency room (36% vs. 23%, p<0.01) or hospital (22% vs. 17%, p<0.01), during follow-up.

CONCLUSIONS: Most VA patients with gout received allopurinol or colchicine. Nearly half of the patients met criteria for uncontrolled gout, and those patients experienced greater healthcare utilization and worse health outcomes than patients with controlled gout. Patients with uncontrolled gout could possibly benefit from additional/alternative pharmacotherapy.