Background/Purpose: While anecdotal evidence suggests that risk of recurrent gout attack increases during hospitalization and gout is one of the most common reasons for in-patient rheumatology consultations, to our knowledge no study has formally tested this hypothesis.  Understanding the magnitude of risk conferred by hospitalization on recurrent gout attacks would provide clinical guidance as to whether prophylactic therapy should be provided to prevent gout attacks in patients with existing gout during hospitalization, particularly since such attacks contribute to increased length of hospital stay.    

Methods: We conducted an online case-crossover study to assess putative risk factors, including hospitalization, for recurrent gout attacks among persons with pre-existing gout. Those who had experienced at least one gout attack within the previous year were recruited online and underwent verification of gout diagnosis through medical records review.  Participants logged onto the study website when they experienced a gout attack and provided exposure information (including hospitalization) over the two-day period prior to an acute gout attack (case period) using an online questionnaire. The same questionnaire was collected for a two-day period during an intercritical period (control period) in a 3-month interval for up to four times.  We examined the relation of hospitalization and reasons for hospitalization over a 2-day period to the risk of recurrent gout attacks using conditional logistic regression. 

Results: Our analysis included 724 subjects who experienced recurrent gout attacks during the study period (mean age 54.5, mean BMI 32.1, 78.5% male). Over the one-year follow-up period, 35 hospitalizations occurred. Of these, 3 hospitalizations were due to gout-related conditions and were excluded from the analysis. Of the remaining, 10 were for surgery, 9 for acute infections, and 13 for other conditions. The proportion of hospitalization was 5.2 and 15.4 per 1000 person-periods during the control and case periods, respectively.  Adjusting for alcohol consumption, purine intake, and use of diuretics, allopurinol, colchicine, and NSAIDs, the odds of recurrent gout attacks during hospitalization increased by more than 3-fold (odds ratio=3.86, 95% confidence interval: 1.69-8.84) compared with periods without hospitalization (Table).

Conclusion: Our study confirmed that the risk of gout attacks increases during hospitalization. These data support the consideration of the provision of appropriate prophylaxis to patients with pre-existing gout during hospitalization.

 Table.  Hospitalization and Risk of Recurrent Gout Attacks 

Hospitalization     Over 2 Days	No. Control   Periods	No. Hazard  Periods	Adjusted OR        (95% CI)
No	1931	1402	1.00 (referent)
Yes	10	22	3.86 (1.69-8.84)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-of-recurrent-gout-attacks-during-hospitalization/