In the Hospital, Your Joints Also Need Care

Hospitalization increases risk of having a gout attack

(RxWiki News) You've just started feeling better after your hospitalization, but then realize you’re having a gout attack.  Up until now, your symptoms were well controlled.  Why?

Gout is a type of arthritis that causes pain, tenderness, and inflammation of the joints, usually in the big toe. Accumulation of uric acid (a waste residue from the body) in the joint causes the inflammation.  

A recent study found that gout patients hospitalized for other reasons are at higher risk of developing a gout attack while in the hospital. The findings suggest that many patients with gout may benefit from the use of preventive medications such as colchicine or nonsteroidal anti-inflammatory drugs.

"Always give your doctors a complete medical history."

This recent study, which examined whether recurrent gout attacks were more frequent during hospitalization, was conducted by Maureen Dubreuil, MD, of the Boston Medical Center, Department of Medicine, and colleagues.

The study included 724 adult individuals that had been diagnosed with gout by a medical provider and who had had a gout attack within the previous 12 months. Participants were from across the US with an average age of 54 (21-88 years), of which 78 percent were men, and 89 percent Caucasian.

The participants provided information on the number, and date of their gout attacks; symptoms; medications in use; and the number, cause, and date of hospitalizations. Participants also answered questions that described whether or not they were exposed to well-known risk factors – hospitalization, diet, and medication - 2 days before a gout attack, and 2 days before other assigned dates by researchers (for control purposes).

The study recounted a total of 35 hospitalizations over one year, during which 24 patients developed a gout attack within two days of being in the hospital, and the remaining 11 patients did not.

From the 35 hospitalizations, only two patients were hospitalized because of gout attacks, and the rest of the patients were hospitalized for other reasons.

The researchers found that the odds of a participant having had a gout attack after being hospitalized for unrelated gout reasons were 4 times higher compared to those participants that had not been hospitalized. The study adjusted for other known factors associated with gout attacks that could contribute to higher odds, specifically alcohol, food high in purines (food that is converted to uric acid) and diuretics use.

In this study, the association between gout attacks and hospitalization appeared to decrease when the patients were taking gout medications such as allopurinol, colchicine, or nonsteroidal anti-inflammatory drugs. However, in this study, there weren't enough cases to see major effects. The authors suggested that more studies are needed to address whether or not the use of gout medications while in the hospital may decrease the risk of gout attacks.

The authors commented, “The reasons why some gout patients develop gout attacks while others do not depends on the condition that prompted hospitalization and the events and treatments that occurred during the hospitalization.” They explained that the shift of fluids or volume depletion — which frequently occur in the body tissues during hospitalization  may be the cause of uric acid accumulation.

Another limitation of this analysis is that most of the data came from Caucasian males and the rest of the population wasn’t represented.

Researchers emphasized the importance of preventive treatment in patients with gout who are hospitalized. They estimated that around 18 percent of gout patients will undergo hospitalization each year for different causes and medical providers need to be prepared.

This work was published on September 19 in The American Journal of Medicine. The study was funded by the Arthritis Foundation, American College Rheumatology Research and Education Fund, and National Institute of Health. The authors had no disclosures to make.

Review Date: 
October 3, 2013