Acute gout management during hospitalization: A need for a protocol

Internal Medicine Journal, 08/15/2011

Acute gout episodes in hospital are variably investigated and treated with frequent suboptimal management. The authors recommend establishment of a hospital–wide protocol to support decision–making regarding investigations, treatment and follow up.

Methods

  • Case–file review of all episodes of acute gout occurring in a large tertiary hospital over a 20–month period

Results

  • Of 134 acute gout episodes identified, large majority (118) occurred in patients not admitted under rheumatology unit
  • Baseline anti–gout medications were frequently ceased on admission and in 9% of episodes, no pharmacotherapy was prescribed
  • Delays in initiation of treatment occurred in up to 29% of patients
  • Acute management included anti–inflammatory monotherapy, or combinations of colchicine, NSAIDs and corticosteroids
  • Of patients prescribed colchicine, 26% received >1.5 mg/day and strong correlation found between colchicine dose and occurrence of diarrhoea
  • NSAIDs prescribed in 29% of patients with pre–existing renal impairment
  • 25% of patients received inappropriate pharmacological management
  • In patients not under direct care of rheumatology unit in–hospital rheumatology consultation was sought by treating unit in 34% of episodes
  • Consultation was sought more frequently in patients with multiple joint involvement, but there were no other obvious differences in baseline clinical characteristics between cases with or without rheumatology involvement
  • In cases with rheumatology involvement, patients were investigated more frequently, they received more pharmacotherapeutic intervention, in particular combination anti–inflammatory therapy, and they achieved better symptomatic relief and long–term follow up

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