Sarah Wright1,2, Peter T Chapman1,2, Christopher Frampton1,2, John L O'Donnell1,2, Rafi Raja1,2, Lisa K Stamp3,4. 1. From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand. 2. S. Wright, MBChB, PhD, Registrar, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; P.T. Chapman, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; C. Frampton, PhD, Biostatistician, Department of Medicine, University of Otago, Christchurch; J.L. O'Donnell, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; L.K. Stamp, FRACP, PhD, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, and Department of Medicine, University of Otago, Christchurch. 3. From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand. lisa.stamp@cdhb.health.nz. 4. S. Wright, MBChB, PhD, Registrar, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; P.T. Chapman, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; C. Frampton, PhD, Biostatistician, Department of Medicine, University of Otago, Christchurch; J.L. O'Donnell, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; R. Raja, FRACP, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; L.K. Stamp, FRACP, PhD, Rheumatologist, Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, and Department of Medicine, University of Otago, Christchurch. lisa.stamp@cdhb.health.nz.
Abstract
OBJECTIVE: Management of gout is frequently suboptimal. The aim of this study was to determine the proportion of patients presenting to Christchurch Hospital for a gout flare and to determine whether management for both acute flares and urate lowering was in accordance with international recommendations. METHODS: A retrospective audit was undertaken of all admissions to Christchurch Hospital from June 1, 2013, to May 31, 2014, in which gout was coded as a primary or secondary discharge diagnosis. Information including demographics, comorbidities, concomitant medications, treatment of acute gout, and urate lowering was collected. RESULTS: A total of 235 acute admissions for gout in 216 individuals were identified. Eleven individuals had 2 admissions and 4 individuals had 3 admissions. In 95/235 admissions (40.4%), gout was the primary diagnosis. Gout accounted for 95/77,321 (0.12%) of acute admissions. The treatment of acute gout was prednisone monotherapy in 170/235 (72.3%) of admissions. Serum urate was measured at some point during 123/235 (52.3%) of admissions, with only 19/123 (15.4%) at target urate level (< 0.36 mmol/l). At 60 of the 235 admissions, urate-lowering therapy was already being prescribed. Nine out of 175 patients (5.1%) not treated with urate-lowering therapy at admission commenced allopurinol and 32/174 (18.4%) had commencement of urate-lowering therapy recommended in the discharge plan. CONCLUSION: Rates of admission for gout are similar to that observed in other studies. Failure to initiate, change, or recommend alterations in urate-lowering therapy to achieve target urate in people with gout admitted to hospital represents a significant lost opportunity to improve longterm gout management.
OBJECTIVE: Management of gout is frequently suboptimal. The aim of this study was to determine the proportion of patients presenting to Christchurch Hospital for a gout flare and to determine whether management for both acute flares and urate lowering was in accordance with international recommendations. METHODS: A retrospective audit was undertaken of all admissions to Christchurch Hospital from June 1, 2013, to May 31, 2014, in which gout was coded as a primary or secondary discharge diagnosis. Information including demographics, comorbidities, concomitant medications, treatment of acute gout, and urate lowering was collected. RESULTS: A total of 235 acute admissions for gout in 216 individuals were identified. Eleven individuals had 2 admissions and 4 individuals had 3 admissions. In 95/235 admissions (40.4%), gout was the primary diagnosis. Gout accounted for 95/77,321 (0.12%) of acute admissions. The treatment of acute gout was prednisone monotherapy in 170/235 (72.3%) of admissions. Serum urate was measured at some point during 123/235 (52.3%) of admissions, with only 19/123 (15.4%) at target urate level (< 0.36 mmol/l). At 60 of the 235 admissions, urate-lowering therapy was already being prescribed. Nine out of 175 patients (5.1%) not treated with urate-lowering therapy at admission commenced allopurinol and 32/174 (18.4%) had commencement of urate-lowering therapy recommended in the discharge plan. CONCLUSION: Rates of admission for gout are similar to that observed in other studies. Failure to initiate, change, or recommend alterations in urate-lowering therapy to achieve target urate in people with gout admitted to hospital represents a significant lost opportunity to improve longterm gout management.
Authors: Huai Leng Pisaniello; Mark C Fisher; Hamish Farquhar; Ana Beatriz Vargas-Santos; Catherine L Hill; Lisa K Stamp; Angelo L Gaffo Journal: Arthritis Res Ther Date: 2021-04-28 Impact factor: 5.156