Evaluation of a Specialized Pharmacist-Managed Gout Clinic in a Veteran Population

Background: Gout is the most common inflammatory arthritis, and the underlying cause of gout, chronic elevation of serum uric acid (sUA), is well understood. Despite this, only a minority of patients receive optimal therapy as it requires adherence to frequent lab monitoring and urate lowering therapy (ULT) titration to achieve target goals. Objective: To evaluate the effectiveness of the pharmacist-managed gout clinic at VA San Diego Healthcare System (VASDHS) in lowering sUA. Methods: This was a single center, retrospective chart review of all Veterans enrolled in the pharmacy gout clinic from January 1, 2017, to December 31, 2021, comparing baseline and final sUA. The primary outcome was reduction of sUA from baseline. Results: There was statistically significant reduction of sUA from baseline at months 3, 6, 9, and 12, with average sUA levels of 6.8 ± 1.7 mg/dL, 6.4 ± 1.5 mg/dL, 6.0 ± 1.6 mg/dL, and 6.1 ± 2.2 mg/dL, respectively (P < 0.001 for all values). Conclusion: This study suggests that the pharmacist-managed gout clinic can effectively lower and maintain sUA levels through the treat-to-target approach. Though the results of this study showed statistically significant sUA reduction, most patients did not reach their sUA goals by the end of the study. However, this finding may not be clinically relevant as patients can be above their sUA goal and still be gout flare free or have low frequency of flares.