Tuesday, 20 Mar 2018

You are here

Gouts' Increasing Hospitalizations and Poor Management

Numerous studies have shown that gout hospitalizations have increased in the last decade. Also worrisome is a new studiy showing that patients admitted to the hospital are less likely to have received recommended urate-lowering treatment (ULT). (Abstract OP0262 - http://buff.ly/2roN7SF)

Dehlin and Swedish researchers have analyzed the Western Swedish Health Care Region register to identify gout hospitalizations between 2000-2013. They found the annual hospitalization rate for gout increased from 12.2 to 16.7 per 100 000 adults, with a resultant 56% increase in healthcare costs.

Moreover, these patients were less likely to receive ULT -  only 19 to 27% had been on ULT in the 6 months preceding their hospitalization. This considerable lack of treatment is seen as yet another reason for the growth in gout hospitalizations in Sweden.

A second study, examined whether nurse-led management of gout using EULAR guidelines and treat to target principles significantly improved patient outcomes compared to standard general practitioner care (http://buff.ly/2sBCxvY).

Over 2 years, they studied 517 patients who received usual care by general practitioners (GP) or nurse-led care.  Nurse lead care were more likely to achieve SUA targets, more likely to be prescribed ULT (97% vs. 54%), more escalation of  allopurinol therapy (470 vs. 240 mg), fewer gout attacks, and a nearly 75% reduction in tophus size. 

The results of these studies have immediate applicability to gout populations and public welfare and healthcare costs. 




The author has received research/grant financial support on this subject

Add new comment

More Like This

Does Dose Escalation Help in Gout?

Contrary to expectations, dose escalation of allopurinol among patients with gout did not improve survival, a 10-year observational study found.

CARES Study- More CV Deaths with Febuxostat

The CARES study was presented Monday at the American College of Cardiology meeting in Orlando and finds that while the rates of all major cardiovascular (CV) events were comparable between febuxostat or allopurinol, there were more CV deaths with febuxostat. (Citation source bit.ly/2HtUEaz)

Gout Crystal Deposition is Deeper than its Measures

Dalbeth and colleagues have published that among gout patients without palpable tophic and despite long term allopurinol, nearly half have monosodium urate (MSU) as detected by Dual-energy CT (DECT).  The total body urate deposition is even greater in those with higher sUA and evidence of severe disease. 

Probenecid Benefits Heart Failure

In animal studies, probenecid was shown to have positive inotropic effects on the cardiomyocyte mediated by transient receptor potential vanilloid 2 activation. This concept was further studied in 20 patients with heart failure with reduced ejection fraction where probenecid was shown to improve cardiac function after just one week of probenecid treatment.

T2T Improves Primary Care Gout Management

Researchers from Geisinger Medical center tested a pilot primary care gout management improvement intervention, and demonstrated significantly improved primary care gout management metrics when a treat to target approach was implemented.