The management of gout in primary and secondary care in England and Wales: a descriptive study

Date of Approval
Application Number
Technical Summary

Background: Gout is the most common form of inflammatory arthritis, with a rising incidence and prevalence worldwide. There are highly effective medications available to treat and prevent gout flares, yet previous research has shown that the management of gout in primary and secondary care is poor. One consequence of this is recurrent hospital admissions, which have doubled in England over the last 15 years. Many gout admissions are likely to be preventable with more widespread use of existing treatments.

Objectives: To describe the management of gout in primary and secondary care in England and Wales, including analyses of individual and structural predictors of hospitalisation and sub-optimal care.

Methods: The study population of interest is patients aged 18 years and above with index gout diagnoses between 2004 and 2021. We will describe the number and proportion of patients who are commenced on urate-lowering therapy (e.g. allopurinol) within 12 months of diagnosis. We will describe the pattern of serum urate monitoring and the proportion of patients who achieve target serum urate levels. We will use multi-level logistic regression to analyse individual and structural predictors associated with adherence to recommendations in national gout management guidelines. Through linkage with NHS Digital Hospital Episode Statistics Admission and A&E datasets, we will analyse predictors of hospitalisation and emergency department attendances for gout flares, and investigate post-discharge management, including time to first urate-lowering therapy prescription and/or re-admission, using Cox proportional hazards models.

Public health benefits: Our analyses will inform the development of a strategy to improve gout management in primary and secondary care in England and Wales; the impact for patients will be reduced morbidity, with fewer painful gout flares and reduced disability; the impact for NHS clinicians will include improved integration of care; and for commissioners, the impact will include reduced costs of unplanned admissions.

Health Outcomes to be Measured

Co-primary outcomes: Initiation of urate-lowering therapy (ULT); attendance at emergency departments (ED) for gout flares; admission to hospital for gout flares.

Key secondary outcomes: Target serum urate level attainment; treat-to-target monitoring and uptitration of ULT.


James Galloway - Chief Investigator - King's College London (KCL)
Mark Russell - Corresponding Applicant - King's College London (KCL)
Abdel Douiri - Collaborator - King's College London (KCL)
Martin Gulliford - Collaborator - King's College London (KCL)


HES Accident and Emergency;HES Admitted Patient Care