SLR - April 2020 - Aman Fatima

Rising Incidence of Acute Hospital Admissions Due to Gout 

Reference: Mark D. Russell, Mark Yates, Katie Bechman, Andrew I. Rutherford, Sujith Subesinghe, Peter Lanyon and James B. Galloway Rising Incidence of Acute Hospital Admissions Due to Gout. The Journal of Rheumatology September 2019, jrheum.190257

Reviewed By: Aman Fatima, DPM 
Residency Program: Northwell Long Island Jewish Forest Hills Hospital – Queens, NY 

Podiatric Relevance: As foot and ankle surgeons we often get consulted for a gout flare in the emergency department. Classically these patients complain of a “red, hot, swollen joint,” and after taking a through history, performing a joint aspirate, running uric acid levels, getting x-ray imaging studies; we treat them with NSAIDS, colchicine or a possible injection. However, this is a metabolic disorder secondary to the build-up of monosodium urate crystals and hyperuricemic extracellular fluids around the joints; the long term prevention for it is by attacking the underlying pathophysiology. This study examines the inpatient burden of gout in England between 2006 to 2017 using rheumatoid arthritis (RA) as a comparator. Additionally, they examined prescribing trends in England for three common gout medications (allopurinol, colchicine and febuxostat). 

Methods: A descriptive ecological study was done to ascertain admission and prescription trends. Hospital admission data was obtained nationwide in England from April 1 2006 to March 31 2017 for unplanned admissions of person’s ages 20 years and older. Figures for mean and median lengths of stay in the hospital were calculated. Additionally, prescription data for allopurinol, colchicine and febuxostat as obtained from prescriptions dispensed in the England community database from January 1 2006 to December 31 2016 were obtained. Chi squared tests were performed for statistical significance or various trends. 

Results: Over the study period, hospitalization where gout was the primary admission diagnosis increased by 58.4 percent. In contrast, unplanned admissions with a primary diagnosis of RA decreased by 50.2 percent. The changes in mean and medial lengths of stay for gout admissions were not statistically significant; seven days of stay in 2006-2007 and six days of stay in 2016-2017, median length of stay was four days in 2006-2007 and three days in 2016-2017.Prescriptions for allopurinol increased by 71.4 percent over the study period, colchicine increased by 165.5 percent and febuxstat increased nearly 20-fold. 

Conclusions: It was found that gout admissions in England increased by 58.4 percent over 11 years. It is believed that the key driving force behind the increase is ageing, multi morbid population, changing lifestyle and dietary factors and a growing epidemic of metabolic syndrome. Management of gout also remains suboptimal; fewer than a third of gout patients received ULT (urate lowering therapy) within 12 months by a primary care physician. It is vital to set up a system where this treatable disease does not contribute to the inpatient burden. 

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