Gout management needs standard protocol

Sydney doctors are calling for protocols to help doctors treat gout after a study revealed there were wide gaps in how Australian hospitals manage the condition. Reviewing all episodes of acute gout over a 20-month period, the study authors from Sydney’s Liverpool Hospital noted significant variability in both hospital clinical practice and rheumatology unit involvement in nearly 140 patients who were identified with the condition. Patients received regular suboptimal management and treatment delays, and nearly 25% had inappropriate pharmacological management. Baseline anti-gout medications - such as allopurinol - were often ceased on admission, and nearly 10% of patients were not prescribed any pharmacotherapy. Furthermore, many patients received potentially inappropriate therapy from incorrect or conflicting treatments that may have exacerbated or triggered gout attack. Of note, patients who had rheumatology unit involvement received more pharmacotherapeutic intervention, were investigated more frequently, and had better symptomatic relief and long term follow-up. Conversely, those who did not were more likely to receive inappropriate pharmacologic treatment, though this finding was not significant. The study authors said their findings highlight the need for a hospital-wide protocol developed by rheumatologists to assist decision making to investigate, manage and treat acute gout. “This would promote standardised comprehensive patient care, particularly given that acute gout during hospitalisation is primarily managed by non-rheumatologists,” they concluded in the Internal Medicine Journal. Internal Medicine Journal, published ahead of print...