Acute gout management during hospitalization: a need for a protocol.
OBJECTIVE
To review systematically the management of acute gout during hospitalization.


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, the large majority (118) occurred in patients not admitted under the 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, non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. Of patients prescribed colchicine, 26% received >1.5 mg/day and a strong correlation was found between colchicine dose and the occurrence of diarrhoea. NSAIDs were prescribed in 29% of patients with pre-existing renal impairment. Overall, 25% of patients received inappropriate pharmacological management. In patients not under the direct care of the rheumatology unit, in-hospital rheumatology consultation was sought by the 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.


CONCLUSIONS
Acute gout episodes in hospital are variably investigated and treated with frequent suboptimal management. We recommend establishment of a hospital-wide protocol to support decision-making regarding investigations, treatment and follow up.
Gnanenthiran
S R
SR
South Western Sydney Clinical School, University of New South Wales, Australia.
Hassett
G M
GM
Gibson
K A
KA
McNeil
H P
HP
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols / Q000592:standards; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006073:Gout / Q000175:diagnosis* / Q000628:therapy*; D006074:Gout Suppressants / Q000627:therapeutic use; D006301:Health Services Needs and Demand / Q000592:standards / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D006074:Gout Suppressants