Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: We describe patient characteristics, serum uric acid (sUA) levels while on allopurinol, and activities of daily living (ADL) in nursing home residents with gout.
Methods: On-site chart review of 14 nursing homes in Hawaii (Oct 2010-Mar 2011), including serum creatinine, sUA, the Minimum Data Set (MDS) and medication records. Eligible residents were >65 years of age, had been residents >30 days, and had recent sUA and ADL assessments. Cases (n=202) were eligible residents with gout using allopurinol. Controls (2 per case, n=404) without gout were identified by simple random sampling from the same time frame. A global ADL score was calculated [BMC Geriatr 2006, 6:7] from the most recent MDS. Multiple regression separately estimated the independent association of gout with ADL score and the use of any opiate medication, adjusting for potentially related factors (eg,demographics, body mass index (BMI), renal function, and comorbid conditions).
Results: Of residents with gout, 69% had sUA ≥6mg/dl, despite allopurinol treatment. Compared with controls, cases were younger (39% vs. 53% <85 years of age; p<0.001) and more likely to be of Hawaiian ancestry (OR=7.3, p<0.001). BMI was 2.3 points higher for cases vs controls (p<0.001). Cases were more likely to have coronary artery disease (OR=4.0, p<0.001), diabetes (OR=3.6, p<0.001), previous myocardial infarction (OR=7.3, p<0.001), and charted renal failure (OR=4.9, p<0.001). They had a mean Carpenter score of 25.2 (0-28; 28=total dependence) vs 17.1 for controls (p<0.001). Adjusted logistic regression models showed that gout was independently associated with a 7.26-point higher (worsened) Carpenter ADL score (p<0.001). Cases were more likely than controls to receive an opiate (adjusted OR=8.7, p<0.001).
Conclusion: In nursing home residents, gout is independently associated with worsened ADL scores and should be factored into pre-admission evaluation and considered in resident care management. In the institutionalized elderly, renal insufficiency is prevalent. Allopurinol, even when given at maximum renally-adjusted doses, may not be sufficient to achieve target sUA.
Disclosure:
J. Higa,
Takeda Pharmaceuticals America, Inc.,
2;
G. Reardon,
Informagenics, Inc.,
3;
G. Tong,
Takeda Pharmaceuticals America, Inc.,
3.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-retrospective-evaluation-of-the-clinical-and-economic-implications-of-gout-in-nursing-home-residents-in-hawaii-treated-with-allopurinol/