Treatment of Acute Gout Flares in the Emergency Department: Comment on the Article by Dalal et al

Abstract

Treatment of acute gout flares in the emergency department: comment on the article by Dalal et al To the Editor: Acute gout flares account for a substantial number of visits to the emergency department (ED), and treatment of the acute gout flare in the ED was the subject of an interesting article by Dalal et al (1), recently published in Arthritis Care & Research. The authors reported that 28.3% of the 456 patients included in the study received an opioid at discharge. Furthermore, 80% of the opioid prescriptions were new, indicating that a large proportion of patients without previous exposure to an opioid were now exposed. We reported on the diagnosis and treatment of acute gout flares in a large series of 541 consecutive ED visits over a 7-year period (2). In our study 35% of patients were given an opiate (oxycodone/acetaminophen) during the ED visit, and 52% were given a prescription for an opiate. Opiates comprised over half of the medications given during the ED visit and as prescriptions (1,2); however, use of analgesia alone does not treat gouty inflammation. Health services research has shown that the number of ED visits due to disease exacerbations may be indicative of suboptimal chronic disease management and poor treatment adherence (3). Both the study by Dalal et al and our own study indicate that the treatment of gout flares in the ED warrants closer attention. Studies are urgently needed to assess the use of opiates in the treatment of gout flares. Previous studies suggest that opiate exposure in the ED precedes addiction (4,5), and the use of opioids for acute pain is associated with an increased risk for long-term use (6). In the current landscape of opioid abuse and addiction, prescription of these agents should be prudent. The importance of antiinflammatory drug treatment during acute flares should be emphasized, as well as the treatment of gout as a longitudinal disease and not just an acute flare. The clinical importance of this study is that it will increase discussion about the treatment of acute gout flares in the ED and beyond. Thus, the study has the potential of improving the treatment of gout flares and possibly leading to the development of evidence-based guidelines tailored to the ED.

Evaluation of inflammatory rheumatic diseases from an emergency medicine perspective

“…The high number of patients with familial Mediterranean fever who visited the ED may have been due to the commonality of the disease in Turkey and abdominal pain and chest pain during attacks. Gout presents commonly to the ED 6 . According to our study, gout is among the most common reasons for applying to the ED (Table 1).…”

Besonderheiten rheumatischer Erkrankungen im Alter

“…Die Anfallskontrolle mittels Glukokortikoid-Gabe ist wirksam und durch schrittweise Dosisreduktion gut steuerbar, nichtsdestotrotz bei häufigen und schweren Manifestationen ebenfalls komplikationsträchtig [44]. Die IL-1 Blockade ist diesbezüglich eine hocheffektive und sichere therapeutische Alternative bei schweren Verlaufsformen oder Patienten mit entsprechend hohem Risikoprofil [45]. Colchizin wird in der klinischen Praxis in der prophylaktischen Behandlung zu selten genutzt, obwohl aktuelle Studiendaten die gute Verträglichkeit und antiinflammatorisch-protektive Wirkung für kardio-und cerebrovaskuläre Ereignisse belegen.…”

Treatment of Acute Gout Flares in the Emergency Department: Prescribing Patterns and Revisit Rates

“…11 The inappropriate administration of opioids, which our group and others have highlighted, is of concern. 12-14 The objectives of this study were to identify pharmacotherapy related to gout treatment before, during hospital visit or stay, and on discharge in patients presenting to the ED with acute gout flares. Secondary end points included opioid use in specific subpopulations, revisit rates to the ED, and risk factors associated with revisits.…”