Acute gout management during hospitalization: A need for a protocol
Internal Medicine Journal, 08/15/2011Gnanenthiran SR et al.
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.
Case–file review of all episodes of acute gout occurring in a large tertiary hospital over a 20–month period
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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