Hospitalization for Gout Flares Needs More Attention, Study

Existing data on the effectiveness of treatment for patients hospitalized with flares of gout are lacking and speak to the need for more high quality, prospective research to shed light on an “epidemic” of inpatient admissions for gout, British researchers concluded.

“Hospital admissions for gout flares have increased dramatically in recent years, despite widely available, effective medications for the treatment and prevention of flares,” the investigators wrote. To shed light on the increase in hospitalizations for gout, they searched MEDLINE, Embase, and the Cochrane library, from database inception to April 8, 2021, for studies of admissions for gout. They included any studies that evaluated interventions conducted during hospital admissions or emergency department visits for effectiveness and/or implementation, and assessed the risk of bias for the included studies.

Most studies included in the analysis of 19 articles were small, single-center, retrospective analyses, which raised concerns for bias. Reports on 11 studies, which included 5 randomized controlled trials, noted that outcomes improved when patients received pharmacological therapies including allopurinol, prednisolone, nonsteroidal anti-inflammatory drugs, and anakinra—all with proven efficacy in the treatment of gout. In 8 studies, improved outcomes were also associated with nonpharmacological management strategies, such as inpatient rheumatology consultations and a gout management protocol.

However, the investigators found, “No studies to date have prospectively evaluated strategies designed to prevent re-admissions of patients hospitalized for gout flares.” Therefore, they concluded, “There is an urgent need for high-quality, prospective studies of strategies for improving uptake of urate-lowering therapies in hospitalized patients, incorporating prophylaxis against flares and treat-to-target optimization of serum urate levels. Such studies are essential if the epidemic of hospital admissions from this treatable condition is to be countered.”

—Rebecca Mashaw

References:
Russell MD, Clarke BD, Roddy E, Galloway JB. Improving outcomes for patients hospitalized with gout: a systematic review. Rheumatology. 2022;61(1): 90–102 https://doi.org/10.1093/rheumatology/keab539