Rheumatoid arthritis and gout hospitalization trends have reversed, according to new research. In the last two decades, there has been a switch in hospital admission trends, with more gout patients being hospitalized than rheumatoid arthritis patients. Researcher Sian Yik Lim said, “The findings may reflect suboptimal care received by gout patients and its increasing prevalence. Furthermore, the findings provide a benchmark for rheumatoid arthritis care over the past two decades, including the reduced frequency of joint replacements and other major joint operations related to rheumatoid arthritis.”

Gout and rheumatoid arthritis are two of the most common forms of inflammatory arthritis.

The researchers evaluated trends using data from the Nationwide Inpatient Sample for 1993 through 2011. They then calculated annual population rates of hospitalizations and relevant surgeries.

During the studied time period, there were 254,982 hospitalizations for gout and 323,649 for rheumatoid arthritis.

The annual rate of hospitalizations for rheumatoid arthritis declined from 13.9 to 4.6, whereas the rate of gout hospitalizations rose from 4.4 to 8.8.

The authors concluded, “The gout findings suggest the need to improve care and prevention.”

Inadequate clinical care led to unnecessary hospitalizations in 89 percent of patients with gout: Previous study

A previous study found that inadequate clinical care has led to unnecessary hospitalizations in 89 percent of gout patients. Researchers analyzed a retrospective study of 56 patients admitted to hospital with gout. The researchers’ goal was to determine how many of the hospitalizations could have been prevented with better interventions and clinical management.

Lead author of the study Thomas Olenginski said, “Because rheumatology sees these patients in hospital consultation, we hypothesized that many of these gout admissions were unnecessary. Because the patient presented so often to the emergency room rather than their doctor’s office and were in pain with other comorbidities, admission seemed the correct medical care decision. We felt that the results might spur interest in a system-wide effort to create a gout initiative or a multipronged approach to better address this perceived problem within our healthcare system.”

Of the 56 admissions, 50 (89 percent) met the definition of preventable admission. The authors noted several gaps in clinical care including failure to follow ACR/EULAR guidelines, lack of crystal-confirmed diagnoses, patient visits to the emergency room for care, and medication non-compliance.

Dr. Olenginski concluded, “Too many of these admissions were indeed preventable, but most of the time, the rheumatology department was called in after the patient had already been admitted to the hospital. To effectively deal with this problem in a busy emergency room, a collaborative approach between the ER, rheumatology, orthopedics, and internal medicine is necessary. The solution is quick assessment of the patient, prompt diagnostic aspiration of affected joints (to make a diagnosis of gout and/or consider the possibility of joint infection), prompt initiation of systemic anti-inflammatory therapy, and then adequate and close outpatient follow-up. Additionally, a patient with gout needs definitive uric acid-lowering therapy as long-term maintenance therapy. We can and will address this problem and fix it.”

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Sources:
http://jama.jamanetwork.com/article.aspx?articleid=2526626
http://www.medscape.com/viewarticle/864539
http://www.newswise.com/articles/most-gout-hospitalizations-are-preventable-with-better-clinical-care