Session Title: Metabolic and Crystal Arthropathies II
Session Type: Abstract Submissions (ACR)
Acute gout attacks account for a substantial number of emergency department (ED) visits. Our aim was to record acute gout treatment in the ED and evaluate the treatment according to the 2012 American College of Rheumatology (ACR) guidelines (Khanna D et al. Arthritis Care Res. 2012; 64:1447-61).
Retrospective chart review of consecutive patients with acute gout seen in the ED 1/01/2004 – 12/31/2010. Patients included if their diagnosis field included the word gout. Variables included: age, years of gout, number of attacks/year, comorbidities, medications and involved joints.
Descriptive and summary statistics were performed on all variables. Subgroup analysis, sensitivity analysis and exploratory data performed where applicable.
541 acute gout patient visits recorded in the ED over 7 years. Mean patient age: 54 (range 20-96); 79% were men. 118 (22%): first attack. 75%: attack duration ≤ 3 days. Most commonly affected: lower extremity joints.
Of the 541 visits, 355 (66%) given drug treatment in the ED; 186 (34%) not given a medication during their visit. Medications given: NSAIDs: 56 % (n=198): (toradol 19% (n=69); indomethacin 19% (n=66); Ibuprofen 14% (n=49); naproxen 3% (n=11)); opiates 54% (n=190); colchicine 9% (n= 32); prednisone 9% (n=32). 154 (28%) not given drugs during visit received prescriptions. 6% (n=32) given no drugs during visit nor did they receive a prescription.
An anti-inflammatory drug given during 44% (n=239) of visits. 75% (n=408) given an anti-inflammatory drug prescription. 40% (n=216) given an anti-inflammatory drug during visit and a prescription. 110 (20%) not given an anti-inflammatory drug during visit nor a prescription.
35% (n=190) given an opiate (oxycodone/acetaminophen) during the ED visit and 52% (n=282) a prescription.
Monotherapy given during 74% (n=262) of visits.
During 13.4% (n=72) of visits patient reported being on colchicine prophylaxis. Patients on colchicine prophylaxis significantly more likely to receive colchicine for their acute attack than those not on prophylaxis (p=0.005).
According to the ACR guidelines, first-line anti-inflammatory drugs for the treatment of acute gout include oral colchicine, NSAIDs and corticosteroids, yet during 56% of acute gout ED visits, anti-inflammatory drugs not given. The ACR guidelines propose treatment be continued for 7-10 days yet only 40% given anti-inflammatory drugs in the ED and prescriptions. We suggest that 60% did not receive optimal treatment for acute gout. The ACR guidelines suggest that colchicine is not recommended when attack occurred in a patient on colchicine prophylaxis yet patients on chronic prophylaxis significantly more likely to receive colchicine for their acute attack. Opiates commonly given in the ED for acute gout; however, analgesia alone does not treat gouty inflammation (not addressed in guidelines). Combination of colchicine and NSAIDs suggested for severe and unresponsive attacks by ACR guidelines, yet in 76% of patient visits receiving combination therapy, an opiate was combined with an NSAID or prednisone.
Further studies are needed for development of evidence-based guidelines tailored to the ED to help improve treatment of acute gout in the ED.
Novartis Pharmaceutical Corporation,
Novartis Pharmaceutical Corporation,Sobi,
Novartis Pharmaceutical Corporation; Takeda, Savient,
Novartis Pharmaceutical Corporation, Takeda, Savient, Sobi,
T. Chang Young,
D. C. Radvanski,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-acute-gout-in-the-emergency-department-evaluated-according-to-the-2012-american-college-of-rheumatology-guidelines/