Inpatient management of gout in a New Zealand hospital: a retrospective audit

AimTo review inpatient management of acute gout in a New Zealand hospital. MethodsA retrospective file review of all acute episodes of gout at Hutt Hospital, Wellington, New Zealand over a 1year period. ResultsIn the course of a year, there were 90 admissions for, or complicated by, acute gout. In 31 cases, gout was the primary diagnosis. Median length of stay was 5days and readmissions were common. The majority of patients (87%) were known to have gout before admission, yet only 50% of these patients were on uric acid lowering treatment. Serum urate was measured in only 60% of patients with a mean level of 0.471mmol/L. Treatment for the acute attack was evenly split between monotherapy (49%) and polytherapy (49%). Treatment modalities used were: prednisone (61%), non-steroidal anti-inflammatories (40%), colchicine (40%), adrenocorticotrophic hormone (ACTH) (15%) and intrarticular steroids (7%). Patients were generally treated in a timely manner with few patients experiencing delays. Patients seen by the Rheumatology Department were more likely to receive polytherapy, be treated with intra-articular steroids or ACTH and to start allopurinol. The treat-to-target' approach to the management of elevated serum urate was mentioned in only 9% of cases. ConclusionThere was considerable variability in the investigation and management of acute gout, with significant deviation from published protocols. The treat-to-target' approach to the management of elevated urate has not yet been widely adopted by the physicians in this New Zealand hospital.