title: Frequency and predictors of inappropriate management of recurrent gout attacks in a longitudinal study.
abstract: OBJECTIVE
  To evaluate the patterns and determinants of medication use during recurrent gout attacks.
  
  
  METHODS
  We followed participants with documented gout in an online prospective case-crossover study. During an attack, subjects were asked if they had consulted a physician for the attack and what medications they were using. Definitely inappropriate therapy was defined as use of allopurinol or a uricosuric agent acutely without having used it as a prophylactic. Potentially inappropriate therapy was defined as use of analgesics alone, alternative remedies, or no medications. We estimated the risk of having >or= 1 attack in 1 year using life table methods. We examined the relation of various risk factors to the risk of inappropriate therapy using Poisson regression.
  
  
  RESULTS
  Among 232 participants (mean age 52 yrs, 81% male) with documented gout, the risk of having >or= 1 attack in a year was 69%. One hundred ten participants consulted a physician for each attack, 49 did so for only some attacks, while 43 never consulted a physician for any attack. Fifty-three participants had definitely (n = 10) or potentially (n = 43) inappropriate therapy for their recurrent attacks. Physician consultation for an attack was associated with increased risk of inappropriate therapy (risk ratio, RR, 2.5, p = 0.006), whereas an increasing number of gout attacks was associated with lower risk of inappropriate therapy (RR 0.8, p = 0.01).
  
  
  CONCLUSIONS
  Given the high risk of recurrent attacks and the substantial number of persons whose attacks are not appropriately managed, further education about management of gout attacks for both patients and physicians may be warranted.
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts 02118, USA. tneogi@bu.edu
authors.forename: Tuhina
authors.initials: T
authors.lastname: Neogi
authors.forename: David J
authors.initials: DJ
authors.lastname: Hunter
authors.forename: Christine E
authors.initials: CE
authors.lastname: Chaisson
authors.forename: Donald
authors.initials: D
authors.lastname: Allensworth-Davies
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use; D015331:Cohort Studies; D018592:Cross-Over Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006073:Gout / Q000503:physiopathology / Q000517:prevention & control*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D020407:Internet; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012008:Recurrence; D012307:Risk Factors
chemical_list: D006074:Gout Suppressants; D000493:Allopurinol