Background/Purpose: Despite advances in the management of inflammatory arthritis (IA) and gout, many patients still access acute care services. This may be related to their arthritis conditions, associated comorbidities, or other factors. The magnitude of this use, and the variations related to contextual factors such as health system or personal characteristics is unknown. This review sought to estimate the proportion (%) and/or rate (events per 100 person years) of all-cause emergency department (ED) visits or hospitalizations in IA or gout cohorts.

Methods: A systematic review was conducted in EMBASE and MedLine online databases for January 2000 to January 2024. Keywords for the search strategy were based on the types of arthritis conditions of interest (including RA, PsA, AS, JIA, and gout), as well as the type of acute care services of interest (ED visits and hospitalizations). Title and abstract screening, full-text review, and data extraction were completed independently by two researchers. Studies reporting either the proportion and/or rate of acute care use were included, with meta-analysis of the two outcomes conducted for each IA condition separately, and by available population membership strata were possible.

Results: From 8038 candidate studies, 1061 were selected for full-text review; 89 met inclusion criteria with data from 126 cohorts available. Studies focused largely on patients with RA (67% and 68% of studies reporting the proportion of ED visits or hospitalizations per year respectively, and 100% and 73% of studies reporting rate of ED visits or hospitalizations respectively) and no studies provided estimates for those with JIA. Over half (51%) of the cohorts reported estimates from American administrative datasets.

EDs were accessed by 20.4%, 24.4%, 25.4%, and 27.8% of individuals annually in PsA, AS, RA, and gout cohorts respectively. The proportion of cohort members requiring hospital admissions per year was similar in AS and RA at 15.2% and 15.7%, and in gout and PsA at 22.3% and 22.8% respectively. Hospitalization rates were similar across cohorts at 27.3 in PsA, 29.0 in Gout, 30.4 in RA, and 33.1 in AS cohorts per 100 person years.

Stratification of acute care use by PROGRESS+ characteristics was lacking. Out of 89 studies, 3 studies stratified by sex/gender, 2 by age, and 2 by First Nations status as well as rural/urban. Acknowledging the limited data, acute care use was higher for equity seeking groups in all available studies.

Conclusion: The proportions and rates of persons with IA conditions requiring acute care services were generally consistent across IA types, though the ranges seen within each IA type were large. Studies identified in this review reflected predominantly western health system structures. There is a paucity of data available for JIA, and for equity deserving group members in all IA conditions. Studies to understand the reasons for acute care use and possible interventions to reduce avoidable use is needed, as is further understanding of temporal trends in acute care use and needs to improve care models in equity-deserving groups.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/frequencies-and-rates-of-all-cause-emergency-visits-and-hospitalizations-in-persons-with-inflammatory-arthritis-conditions-and-gout-a-systematic-review/