title: Prevalence of contraindications and prescription of pharmacologic therapies for gout.
abstract: BACKGROUND
  Patients with gout have comorbidities, but the impact of these comorbidities on treatment has not been studied.
  
  
  METHODS
  A total of 575 patients with gout were stratified according to certainty of diagnosis according to International Classification of Diseases, 9th Revision, Clinical Modification code alone (cohort I), American College of Radiology criteria (cohort II), and crystal diagnosis (cohort III). Comorbid conditions were defined according to International Classification of Diseases, 9th Revision, Clinical Modification codes, and stratified as either moderate or severe. Drug contraindications were defined as moderate or strong, based on Food and Drug Administration criteria and severity of disease.
  
  
  RESULTS
  The most common comorbidity was hypertension (prevalence 0.89). The presence of comorbidities resulted in a high frequency of contraindications to approved gout medications. More than 90% of patients had at least 1 contraindication to nonsteroidal anti-inflammatory drugs. Many patients demonstrated multiple contraindications to 1 or more gout medications. Frequently, patients were prescribed medications to which they harbored contraindications. The prevalence of patients prescribed colchicine despite having at least 1 strong contraindication was 30% (cohort I), 37% (cohort II), and 39.6% (cohort III).
  
  
  CONCLUSIONS
  Patients with gout typically harbor multiple comorbidities that result in contraindications to many of the medications available to treat gout. Frequently, despite contraindications to gout therapies, patients are frequently prescribed these medications.
authors.affiliation: Section of Rheumatology of the New York Harbor Health Care System, New York Campus of the US Department of Veterans Affairs, New York, USA. robert.keenan@duke.edu
authors.forename: Robert T
authors.initials: RT
authors.lastname: Keenan
authors.forename: William R
authors.initials: WR
authors.lastname: O'Brien
authors.forename: Kristen H
authors.initials: KH
authors.lastname: Lee
authors.forename: Daria B
authors.initials: DB
authors.lastname: Crittenden
authors.forename: Mark C
authors.initials: MC
authors.lastname: Fisher
authors.forename: David S
authors.initials: DS
authors.lastname: Goldfarb
authors.forename: Svetlana
authors.initials: S
authors.lastname: Krasnokutsky
authors.forename: Cheongeun
authors.initials: C
authors.lastname: Oh
authors.forename: Michael H
authors.initials: MH
authors.lastname: Pillinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000008:administration & dosage; D003078:Colchicine / Q000008:administration & dosage; D015897:Comorbidity; D000075202:Contraindications; D003920:Diabetes Mellitus / Q000453:epidemiology; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D005938:Glucocorticoids / Q000008:administration & dosage; D006073:Gout / Q000188:drug therapy* / Q000453:epidemiology*; D006074:Gout Suppressants / Q000008:administration & dosage*; D006521:Hepatitis, Chronic / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011339:Probenecid / Q000008:administration & dosage; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D012720:Severity of Illness Index; D014528:Uricosuric Agents / Q000008:administration & dosage*
chemical_list: D005938:Glucocorticoids; D006074:Gout Suppressants; D014528:Uricosuric Agents; D000493:Allopurinol; D011339:Probenecid; D003078:Colchicine