Acute gout management during hospitalization: a need for a protocol
Internal Medicine Journal, 08/15/2011 Clinical Article
Gnanenthiran 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, 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 ...read more