Date: Monday, November 9, 2020
Session Title: Measures & Measurement of Healthcare Quality Poster
Session Type: Poster Session D
Session Time: 9:00AM-11:00AM
Background/Purpose: Gout is the most prevalent inflammatory arthritis globally. Despite treatment advances, the prevalence of gout has continued to increase over the last several decades. There has also been increasing evidence that gout has a strong association with the metabolic syndrome. This suggests that gout is likely both an inflammatory and a metabolic disease that has a significant effect on quality of life and healthcare costs. While current recommendations support aggressive medical therapy for gout treatment, dietary counseling is less emphasized. We hypothesize that emphasis on nonpharmacological therapy will likely improve management and the metabolic syndrome in gout patients.
Methods: A retrospective cohort study was created from 2009-2016 involving Long Beach Veterans Affairs Hospital gout patients (n= 130) based on International Classification of Disease version 9 or 10. Patients were then stratified into two cohorts: received diet counseling (n=100) and no diet counseling (n=30). Data was reviewed for 24 months following initial gout diagnosis or intervention. Management was evaluated based on frequency of flares and related ED visits, change in creatinine clearance, serum uric acid levels (sUA), and changes to risk factors for metabolic syndrome including blood pressure, body mass index (BMI), cholesterol panel and hemoglobin A1c levels (HA1c) at six-month intervals.
Results: Although patients in both cohorts had a trend of fewer gout attacks with time, those who received diet counseling had a significant decrease in number of attacks by 12 months (p = 0.002), and more so in 18 months (p = 0.001). After diet counseling, more patients reached their target sUA (sUA< 6 for nontophaceous gout and sUA< 5 for tophaceous gout) (p = 0.002) in 6 months and remained at goal at 24 months (p < 0.001), with improved creatinine clearance (p = 0.06) and HDL (p = 0.08). Patients with improved LDL and HDL values were more likely to have improved sUA levels (R2=0.4, slope 0.03 and R2=0.4, slope 0.16, respectively) by 6 months. Patients with improved HA1c and LDL values had fewer ED visits within the first 6 months (R2=0.4, slope 0.14 and R2=0.4, slope 0.05, respectively). Patients with improved HA1c were associated with decreased sUA at18 months (R2=0.5, slope 0.2).
Conclusion: Gout patients who receive diet counseling had better control of sUA and a lower rate of future attacks and ED visits. Risk factors associated with metabolic syndrome improved in these patients, with better control of their HA1c, LDL and HDL, and they achieved lower sUA levels. This implies that controlling diabetes and hyperlipidemia in patients may help improve gout management. Given the serious complications and increased cardiovascular risks that can be associated with metabolic syndrome, optimization of gout through a nonpharmacologic intervention such as diet counseling can enhance clinical outcomes and optimize healthcare resources.
To cite this abstract in AMA style:Chang J, Tsui J, Wong M. Effectiveness of Dietary Counseling on Gout Management and Risk Factors for Metabolic Syndrome in Gout Patients [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/effectiveness-of-dietary-counseling-on-gout-management-and-risk-factors-for-metabolic-syndrome-in-gout-patients/. Accessed October 21, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-dietary-counseling-on-gout-management-and-risk-factors-for-metabolic-syndrome-in-gout-patients/