Improving outcomes for patients hospitalized with gout: a systematic review

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 hospitalised 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 randomised control trials) reported improved patient outcomes following pharmacological interventions with known efficacy in gout, including allopurinol, prednisolone, non-steroidal anti-inflammatory drugs 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 in patients hospitalised for gout flares. Conclusion There is an urgent need for high quality, prospective studies of strategies to improve uptake of urate-lowering therapies in hospitalised patients, incorporating prophylaxis against flares and treat-to-target optimisation of serum urate levels. Such studies are essential if the epidemic of hospital admissions from this treatable condition is to be countered.

Implementing treat-to-target urate-lowering therapy during hospitalizations for gout flares

“…The intervention was developed with extensive stakeholder input, following a systematic literature review [ 15 ], audit and process mapping of gout care at our hospital [ 16 ]. The management pathway was designed as a quick-reference guide on optimal gout care for use by frontline clinicians and rheumatologists.…”

“…For avoidable gout admissions to be prevented, strategies are needed to optimize care and increase uptake of treat-to-target ULT in hospitalized patients. A recent systematic review found a paucity of high-quality studies in people hospitalized for gout [ 15 ]. Specifically, no prospective studies to date had evaluated strategies designed to encourage ULT uptake and prevent re-admissions in hospitalized patients [ 15 ].…”

“…A recent systematic review found a paucity of high-quality studies in people hospitalized for gout [ 15 ]. Specifically, no prospective studies to date had evaluated strategies designed to encourage ULT uptake and prevent re-admissions in hospitalized patients [ 15 ]. We sought to address this knowledge gap.…”

Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England

“…Hospitalizations due to gout also doubled in the United States, Canada and Sweden, contrasting large decreases in admissions for rheumatoid arthritis [5][6][7]. Despite this, few studies have investigated strategies to prevent avoidable gout admissions [8].…”