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Strategies
to improve long-term management of gout focusing on urate lowering as well as anti-inflammatory
treatment during the inpatient period should be emphasized in hospital
protocols.
A recent study published in “The Journal of Rheumatology” showed that the gout patients admitted to hospital failed to achieve target urate which suggests that the long term management of gout in the hospital setting is a lost opportunity.
Gout is one of the most prevalent crystal-induced arthropathy widespread in 1-4% population globally with subprime management agendas.
A retrospective audit was conducted in Christchurch Hospital from June 1, 2013, to May 31, 2014, by Sarah Wright and colleagues to examine if long-term management for acute flares and urate-lowering is in agreement with international recommendations among gout patients. The study involved comorbidities, demographics, treatment of acute gout, urate lowering and concomitant medications. During the evaluation, gout was classified as a primary or secondary discharge diagnosis.
A total of 216 patients were identified with 235 acute gout admissions. Out of which, four patients were admitted three times, and 11 patients were admitted two times. The primary gout diagnosis was made among 95 admissions and the 75 admissions were diagnosed with acute gout. The management of acute gout was done among 170 patients with prednisone monotherapy. Further, the serum urate was diagnosed in 123 admissions out of 235. Out of 123, only 19 entries were identified with target urate level (< 0.36 mmol/l). By this time, the urate-lowering therapy was recommended to 60 admissions. A total of nine entries out of 175 did not initiate urate-lowering treatment at admission commenced allopurinol, whereas, 32 out of 174 admissions were treated with urate-lowering therapy which was prescribed in the discharge plan.
The
overall analysis illustrates that gout admission rates were identical to that
noticed in other studies.
J Rheumatol. 2017 Aug 1. pii: jrheum.170387
Management of Gout in a Hospital Setting: A Lost Opportunity
Sarah Wright et al.
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