Gout Arthritis During Admission for Decompensated Heart Failure—A Descriptive Analysis of Risk Factors, Treatment and Prognosis

Abstract

BackgroundChronic heart failure and hospital admissions are well-known risk factors for acute gouty arthritis. However, in-depth analyses of patients admitted for decompensated heart failure (DHF) who subsequently developed a gout attack are sparse. This study aims to characterize DHF patients who developed a gout attack during their inpatient treatment and describe potential risk factors, its consequences, and its management in the setting of heart failure exacerbation.MethodsRetrospective chart review of 50 patients with an admission diagnosis of DHF who subsequently experienced a gout attack during admission at a Swiss tertiary care hospital between 2018 and 2020. Patients with a refusal of the general research consent were excluded (n = 10).ResultsA gout attack developed in 66/1,832 (3.6%) DHF admissions of whom 50 individual patients were analyzed. Patients were predominately male (76%), of advanced age (median 80.5 years), with several comorbidities including chronic kidney disease (74%), comorbid gout (70%, only 43% on urate lowering therapy) and hyperuricemia (median 547 μmol/l, IQR 434–667 μmol/l). Diuretics were intensified in all patients. Acute gout presented as polyarticular arthritis (62%) and was often accompanied by fever (30%). Joint aspiration was performed in 32%, and intra-articular steroid injections administered in 20% of patients. Median length of stay and 6-month mortality were 16 days (IQR 12–25) and 32%, respectively, compared to 9 days (IQR 6–14) and 16% for DHF patients without a gout attack.ConclusionOur study highlights features of gout attacks in the context of DHF including the absence of comorbid gout in a significant proportion of patients, the presence of polyarticular disease during the flare, and a poor prognosis. The present study identifies the necessity to better address gout as a comorbidity in DHF patients and may assist clinicians in identifying DHF patients at risk for a gout attack.

Association between Impella device support and elevated rates of gout flares: a retrospective propensity-matched study

“…The median hospital and ICU LOS of Impella-supported patients with gout flares was 24 days and 25 days longer, respectively, compared to those without gout flares. These findings align with previous research that has consistently reported similar trends in various medical contexts [ 23 – 25 ]. These observations could be attributed to the need for additional diagnostic studies, inpatient consultations, and therapies, which may result in extended hospital stays.…”

Association Between Impella Device Support and Elevated Rates of Gout Flares: A Retrospective Analysis

“…The median hospital and ICU LOS of Impella-supported patients with gout ares was 24 days and 25 days longer, respectively, compared to those without gout ares. These ndings align with previous research that has consistently reported similar trends in various medical contexts [20][21][22]. These observations could be attributed to the need for additional diagnostic studies, inpatient consultations, and therapies, which may result in extended hospital stays.…”

The role of interleukin 1 in the development of human diseases: focus on Anakinra (IL-1 receptor antagonist)

“…Другим потенциальным показанием для назначения анакинры при РА (и других ИВЗ) является развитие резистентного перикардита и плеврита [291]. Следует иметь в виду целесообразность применения анакинры у тяжелых пациентов с подагрическим артритом и другими микрокристаллическими артритами, частыми коморбидными патологиями при которых являются ЗСН, СД2 и хроническая болезнь почек [102, [292][293][294], затрудняющие применение стандартной терапии (НПВП, глюкокортикостероиды).…”

“…Научно-практическая ревматология. 2022;60(3):[280][281][282][283][284][285][286][287][288][289][290][291][292][293][294][295][296][297][298] …”