Background/Purpose: We previously examined management of gout attacks in the community in 2003-4. Since then, new agents have become available and gout publications have increased, potentially raising awareness about appropriate gout attack management. We therefore re-evaluated these patterns in a large community sample.

Methods: We conducted an internet-based prospective cohort study of gout (2003-2012). Subjects with gout who had ≥1 attack in the prior year were recruited online from 49 states and D.C., with their gout diagnosis verified through medical records review.  Subjects provided information about comorbidities, baseline medications, treatment of their gout attacks and whether they consulted a healthcare professional (HCP) for attacks that occurred during one year of follow-up. We estimated the risk of having ≥1 and ≥2 attacks in one year using life table methods. We determined the frequency and predictors of definitely inappropriate (use of urate-lowering therapy (ULT) acutely in absence of prophylactic use) and potentially inappropriate (use of analgesics alone, alternative remedies alone, or no medications) management of gout attacks.

Results: 1015 subjects with gout were followed for one year (78% male, mean age 53.6, mean BMI 31.9). Since 2005 (N=783), 63.5% had ≥1 self-reported comorbidity (hypertension 56%, kidney disease 19%, kidney stones 14%, diabetes 14%, CHF 7%, peptic ulcer disease 4%). ULT was used by 45%: allopurinol 42%, probenecid 2%, febuxostat 0.9%, sulfinpyrazone 0.1%. Colchicine was used for prophylaxis by 23%; 5% used it without ULT. Similarly, 23% used NSAIDs for prophylaxis; 8% used it without ULT.

The risk of having ≥1 attack and of ≥2 attacks in 1 year was 74.4% and 50.6%, respectively. Medications used to manage gout attacks, either alone or in combination were NSAIDs (52%), colchicine (34%), analgesics (27%), oral glucocorticoids (13%), alternative remedies (0.4%), and ULT acutely (without prior prophylactic use) (0.7%). No medications were used in 12%. Potentially and definitely inappropriate attack treatment occurred in 17.7% and 0.7%, respectively, an improvement from 2003-4 (Table 1). 53% never consulted a HCP for any attack, 25% only did so sometimes, and 22% did so for each attack, a substantial change from 2003-4. The most common HCP consulted for an attack were primary care (51%), ER (10%), rheumatologist (8%), podiatry (5%), and nurse practitioner (5%). In contrast to our previous study, consulting a HCP resulted in lower chance of inappropriate attack management. Age, gender, and disease durationwere also associated with inappropriate management (Table 2).

Conclusion: In this large cohort of gout patients recruited from across the US, overall management of gout attacks appears to have improved over the past 8 years. Gout management education efforts still need to be focused on primary care, ER and particularly patients themselves as they are the most likely to manage gout attacks.