Just 25% of suspected gout patients had arthrocentesis for crystal analysis, despite the fact that the procedure remains the “gold standard” for diagnosis of the disease, according to a report by Dr. Danielle Petersel and Dr. Naomi Schlesinger.
Furthermore, of the 184 patients diagnosed with gout in one 400-bed hospital over a 2-year period from 2002 to 2004, only 38% received a rheumatology consultation, reported Dr. Petersel and Dr. Schlesinger, of the Robert Wood Johnson Medical School at New Brunswick, N.J. “The diagnostician was likely to be the admitting physician for these patients,” they wrote.
Of the 184 patients, the average age was 71 years (with a range from 40 to 96 years). All were male.
Another important finding was that a combination of anti-inflammatory agents was taken by 52% of patients, despite a lack of evidence in the literature supporting the use of combination therapy.
In fact, wrote the authors, “Combination therapy potentially puts the patient at risk of increased morbidity/mortality due to the combined effects upon the kidney.” Indeed, renal failure was present in 65% of patients with acute gout. Nevertheless, prednisone and colchicine were given in 23% of cases; nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine were given in 16%; and a steroid with an NSAID was administered in 13% of patients. Indomethacin was the most commonly prescribed NSAID (J. Rheumatol. 2007;34:1566-8).
Additionally, despite evidence that using the urate-lowering drug allopurinol to cut serum urate levels to less than 6 mg/dL is beneficial and leads to the dissolution of urate crystals and regression of tophi, only 27% were treated with the drug. “Even when it was taken, [serum urate] was not lowered to [an] SU goal of 6 mg/dL,” reported the researchers.
Rather, in 60% of patients treated with allopurinol, SU level was greater than 6 mg/dL.
“Practice patterns vary widely and support the need for education of health care professionals taking care of patients with gout,” concluded the authors.
“In our study, all patients were male, which may suggest that the cohort was somewhat biased. Long-term prospective, placebo-controlled studies are needed to establish guidelines for the diagnosis and treatment of gout,” they added.