Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 24;61(1):90-102.
doi: 10.1093/rheumatology/keab539.

Improving outcomes for patients hospitalized with gout: a systematic review

Mark D Russell  1 , Benjamin D Clarke  1 , Edward Roddy  2   3 , James B Galloway  1
Affiliations

Improving outcomes for patients hospitalized with gout: a systematic review

Mark D Russell et al. Rheumatology (Oxford). .

Abstract

Objectives: Hospital admissions for gout flares have increased dramatically in recent years, despite widely available, effective medications for the treatment and prevention of flares. We conducted a systematic review to evaluate the effectiveness and implementation of interventions in patients hospitalized for gout flares.

Methods: A search was conducted in MEDLINE, Embase and the Cochrane library, from database inception to 8 April 2021, using the terms 'gout' and 'hospital' and their synonyms. Studies were included if they evaluated the effectiveness and/or implementation of interventions during hospital admissions or emergency department attendances for gout flares. Risk of bias assessments were performed for included studies.

Results: Nineteen articles were included. Most studies were small, retrospective analyses performed in single centres, with concerns for bias. Eleven studies (including five randomized controlled trials) reported improved patient outcomes following pharmacological interventions with known efficacy in gout, including allopurinol, prednisolone, NSAIDs and anakinra. Eight studies reported improved outcomes associated with non-pharmacological interventions: inpatient rheumatology consultation and a hospital gout management protocol. No studies to date have prospectively evaluated strategies designed to prevent re-admissions of patients hospitalized for gout flares.

Conclusion: There is an urgent need for high-quality, prospective studies of strategies for improving uptake of urate-lowering therapies in hospitalized patients, incorporating prophylaxis against flares and treat-to-target optimization of serum urate levels. Such studies are essential if the epidemic of hospital admissions from this treatable condition is to be countered.

Keywords: admission; allopurinol; emergency; febuxostat; gout; hospital; inpatient; prevention; urate-lowering therapy.

PubMed Disclaimer

Figures

<sc>Fig</sc>. 1
Fig. 1
PRISMA flowchart of studies identified from the systematic literature search. Adapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009;6:e1000097. ED: emergency department
See this image and copyright information in PMC

References

    1. Hui M, Carr A, Cameron S. et al.; British Society for Rheumatology Standards, Audit and Guidelines Working Group. The British Society for Rheumatology guideline for the management of gout. Rheumatology 2017;56:1246. - PubMed
    1. Richette P, Doherty M, Pascual E. et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017;76:29–42. - PubMed
    1. FitzGerald JD, Dalbeth N, Mikuls T. et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res 2020;72:744–60. - PMC - PubMed
    1. Lim SY, Lu N, Oza A. et al. Trends in gout and rheumatoid arthritis hospitalizations in the United States, 1993–2011. JAMA 2016;315:2345–7. - PMC - PubMed
    1. Rai SK, Avina-Zubieta JA, McCormick N. et al. Trends in gout and rheumatoid arthritis hospitalizations in Canada from 2000 to 2011. Arthritis Care Res 2017;69:758–62. - PMC - PubMed

Publication types

Substances