Background/Purpose: Patients with gout frequently have multiple serious co-morbidities, take concomitant medications, and have complex clinical profiles, making treatment of acute flares in hospital settings difficult. We evaluated the current management of inpatient acute gout in an academic tertiary-care hospital.

Methods: Retrospective data review of acute gout flares occurring during hospitalization at the University of Chicago Medical Center in the period 01/01/2013 to 10/01/2015 was undertaken. To be included, a rheumatology consulting service had to have confirmed acute gout (ICD-9 code 274.xx) as a primary or secondary diagnosis. We reviewed demographics, comorbidities, gout flare characteristics, serum uric acid and creatinine levels, and treatment of gout flare. Multivariate logistic regression was performed to determine factors associated with discontinuation or dose reduction of baseline XOI therapy.

Results: 112 patients were included in the study. Mean patient age was 63.8 ± 13.7 (SD) years, and 75% were male. Baseline characteristics included a prior history of gout (70%), chronic kidney disease (58%), heart failure (47%), and diabetes mellitus (37%). Active infection (34%) and acute kidney injury (43%) were common preceding the acute gout attack. Mean serum urate levels during flares were 8.2 ± 2.7 (SD) mg/dL, but 29 % of values were ≤ 6.0 mg/dL. Treatments for acute attacks included non-steroidal anti-inflammatory drugs (2%), colchicine (18%), intra-articular steroids (49%), and systemic steroids (64%). 79% of systemic steroid administration were administered to patients at high risk for steroid-induced complications, including heart failure, diabetes, active infection, or immediate post-operative status. In patients on baseline XOIs prior to admission, discontinuation or dose reduction occurred in 33% (18/54) of cases. Multivariate logistic regression analysis, when adjusted for age and sex, revealed discontinuation or dose reduction of baseline XOI therapy was more likely in patients with acute kidney injury (OR: 8.34, 95% CI [2.04, 43.22]), but less likely when acute gout was the primary reason for hospitalization (OR: 0.086, 95% CI [0.0038, 0.70]). 23% of patients with a prior history of gout were not on urate lowering therapy despite meeting ARA criteria for acute gout.

Conclusion: Acute gout treatment in hospitalized patients is complicated by a high prevalence of comorbidities, multiple concomitant medications, and acute organ dysfunction. Systemic steroids are ordered frequently for hospitalized patients with acute gout that are at risk for steroid-induced complications. Discontinuation or dosage reduction of XOIs during hospitalization commonly occurs during acute kidney injury, but the evidence basis for this remains to be established.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/management-of-acute-gout-in-hospitalized-patients-and-risk-factors-for-xanthine-oxidase-inhibitor-xoi-discontinuation-or-dose-reduction/