Background/Purpose: Knowing which diagnoses result in a high frequency of hospitalization in persons with inflammatory arthritis (IA) and gout can inform health system planning and interventions to reduce avoidable acute care use. This review sought to estimate the proportion (%) and/or rate (events per 100 person years) reported in the literature of specific reasons for hospitalization in those with IA or gout.

Methods: A systematic review was conducted in EMBASE and Medline online databases for the period of January 2000 to January 2024. Search terms were related to hospitalization and the inflammatory arthritis (IA) condition of interest (RA, PsA, AS, JIA, and/or gout). All stages of screening and review were completed independently by two researchers and discrepancies were solved by consensus. Specific reasons for hospitalization were assigned into 1 of 8 categories (arthritis condition-specific, ambulatory care sensitive conditions, infection, cardiac, respiratory, musculoskeletal, cancer, and psychiatric). A meta-analysis to determine the mean proportion (%) and rate (per 100 person years) of hospitalization for each type of IA by specific hospitalization category was conducted.

Results: From 8038 studies identified by the search terms, 165 studies met inclusion criteria, with two thirds (68%) reporting data from a RA cohorts, while JIA made up just 2% of the included cohorts. Meta-analysis of cohorts identified an overall mean age of participants of 58 years, and 64% were female.

Meta-analysis of the proportion of cohort members hospitalized for their IA condition, determined the highest frequencies were for RA (11.4%) and PsA (11.2%), followed by AS (9.0%), and Gout (7.0%). Proportion hospitalized for ambulatory care sensitive conditions was highest in PsA (11.6%) followed by gout and RA at 7.7% and 5.6% of cohort members respectively; an estimate for AS could not be made as there was only 1 study. Admissions for infection was also highest in PsA (8.2%), then for RA (7.8%), and AS (5.5%), with too few studies available for gout for estimation. Cardiac related hospitalizations were again highest in PsA (14.4%) compared to the other IA conditions (gout 6.6%, AS 3.8%, RA 3.4%).

Too few studies were available to complete meta-analysis for JIA, as well as for specific respiratory, musculoskeletal, cancer, and psychiatric admissions for all types of IA. Reporting of hospitalization rates for specific reasons was infrequent in the literature and therefore, also could not be reported on.

Conclusion: The available literature for specific causes of hospitalizations in patients with IA and gout conditions primarily described arthritis condition-specific flares, ambulatory care sensitive conditions, infections, and cardiac- related admissions. Overall, PsA cohorts had the highest proportion of admissions for these specific reasons and IA flares had the highest proportion of hospitalizations of the specific reasons examined.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/specific-causes-for-hospitalization-in-persons-with-inflammatory-arthritis-conditions-and-gout-a-systematic-review/