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.