Gout flare in people in hospital can be predicted

Hospitalisation increases the risk of gout flare, but risks can be assessed and steps taken to prevent it.

Introduction
Gout is one of the most common inflammatory conditions, affecting up to 2% of adults in developed countries. It is caused by long-standing deposits of crystals of a substance called uric acid (urate) in the joints. This leads to inflammation and tends to flare-up often, causing severe joint pain.

What did the authors hope to find?
The authors wanted to find out how to predict gout flares-ups in people with gout who are admitted to hospital for other reasons, or who also have other conditions. Using this knowledge, they planned to suggest a simple checklist to help doctors identify people who were at risk of developing gout flare-ups during their stay in hospital.

Who was studied?
The study took place in New Zealand and looked at 625 adults who already had gout and who were admitted to hospital for other reasons. Most people were of European descent, followed by Maori and Pacific people.

How was the study conducted?
This was a retrospective observational study, which means that the authors used existing databases of patients’ previous records to find people with gout. There was no specific treatment given. The authors went through the medical history of those people with gout who were admitted to one of the hospitals in Wellington, New Zealand, in 2017. They then used statistical models to work out a set of points that would help predict if someone would have a gout flare during their hospital stay.

What are the main findings of the review?
The authors found 9 predictors that were linked to a gout flare in people in hospital. These are listed below.

1. You have not been taking a medicine to lower your urate levels.
2. Your urate-lowering medicine was changed while you were in hospital.
3. You were not using a medicine to prevent gout before your admission to hospital.
4. Your doctor decides to increase or start you on a gout-preventing medicine while you are in hospital.
5. If any diuretic medicines you are on are changed.
6. You have a tophus.
7. You had a new kidney problem while you are in hospital.
8. If you have had surgery.
9. If your blood urate level was higher than 0.36 mmol/L before admission.

Are these findings new?
No, doctors already knew that many of the proposed predictors were associated with gout flare. But this study has helped provide scientific evidence to support the theory.

What are the limitations of the study?
The set of predictors was developed using people with gout from New Zealand. Therefore, it is not known if
these predictors will be as useful in people from a different country

What do the authors plan on doing with this information?
The authors will share their findings with doctors working in the field. They are currently running a separate study to test whether the predictors work in Asian people, and from information collected in real-time rather than from hospital records.

What does this mean for me?
If you have gout and you are admitted to hospital for some reason, you may have a higher chance of having a gout flare-up while in hospital. This study may help your doctors assess your risk of having gout flare and take the right action to prevent it. Therefore, it is very important that you let your doctor know that you have gout as soon as you are admitted to hospital.

If you have any concerns about your disease or its treatment, you should speak to your doctor.

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Date prepared: February 2020
Summary based on research article published on: 6 December 2019
From: Jatuworapruk K, et al. Development of a prediction model for inpatient gout flares in people with comorbid gout. Ann Rheum Dis 2019;79:418–423. doi:10.1136/annrheumdis-2019-216277

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