Background/Purpose: Gout is the most common inflammatory arthropathy worldwide. Despite having evidence-based guidelines, inconsistent management approaches remain a significant barrier to adequate treatment and prevention. As a result, recurrent gout flares lead to increased utilization of the healthcare system. The aim of this project was to assess inpatient gout management patterns at our health center with a focus on presence of urate lowering therapy (ULT), patient education, and follow-up. We hypothesized that patients admitted to the hospital with a gout flare had indications for ULT and should receive adequate discharge instructions or follow-up regarding gout.

Methods: We conducted a retrospective chart review of inpatients admitted to our tertiary care academic medical center between January 2017 and December 2019 using ICD-10 codes for gout flare (M10.9), as well as a serum uric acid (SUA) level greater than 7.0 mg/dL. Patients who either did not have a documented gout flare or died during their admission were excluded. Patient demographics, comorbidities, laboratory values including mean SUA, treatment modalities, discharge instructions, and follow-up plans were recorded. Continuous variables were summarized by means and standard deviations while categorical variables were summarized with frequencies and percentages. Simple logistic regression models were fit for each potential predictor to determine if an individual relationship existed with whether urate lowering therapy was given. A multivariable model was fit with appropriate predictors and control variables.

Results: Of 205 charts reviewed, 149 (73%) were analyzed. More than 50% of the patients had chronic kidney disease, congestive heart failure, dyslipidemia, or hypertension. 59 (40%) patients had ULT prescribed at time of discharge. Of those prescribed ULT, 47 (80%) were prescribed allopurinol at a dose less than 300 mg/day. The mean (SD) SUA of patients was 10.4 mg/dL (2.6) with a median of 10.2 mg/dL. Amongst all patients included in the study, 46 (31%) had discharge instructions regarding gout and 85 (57%) were recommended to follow-up with their primary care physician or a rheumatologist. A univariate regression model suggested that both the number of flares (p=0.0039) and age (p=0.0012) were associated with whether ULT was prescribed. While controlling for age, the multiple logistic regression model demonstrated the odds of being prescribed ULT are 1.69, 95% CI (1.085, 2.629) for each additional gout flare after the first.

Conclusion: Only 40% of our studied patients received ULT despite all being at least conditionally recommended for ULT per the ACR 2020 gout guidelines. Of those prescribed ULT, 80% were on allopurinol dose less than 300 mg/day. We suspect ULT is both under prescribed and under dosed. ULT was more likely to be prescribed to patients who suffered from more than one gout flare during the study period, though these patients may have benefitted from earlier pharmacologic intervention. Furthermore, very few patients received discharge plans including education and follow up to reduce further gout flares. Our study reflects a significant opportunity to improve management of gout in the inpatient setting and upon hospital discharge.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-patterns-of-inpatient-gout-management-pathway-for-optimal-patient-treatment-outcomes/