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Frequency and Predictors of Inappropriate Management of Recurrent Gout Attacks in a Longitudinal Study
TUHINA NEOGI, DAVID J. HUNTER, CHRISTINE E. CHAISSON, DONALD ALLENSWORTH-DAVIES, and YUQING ZHANG
ABSTRACT. Methods. We followed participants with documented gout in an online prospective case-crossover study. During an attack, subjects were asked if they had consulted a physician for the attack and what medications they were using. Definitely inappropriate therapy was defined as use of allopurinol or a uricosuric agent acutely without having used it as a prophylactic. Potentially inappropriate therapy was defined as use of analgesics alone, alternative remedies, or no medications. We estimated the risk of having ≥ 1 attack in 1 year using life table methods. We examined the relation of various risk factors to the risk of inappropriate therapy using Poisson regression. Results. Among 232 participants (mean age 52 yrs, 81% male) with documented gout, the risk of having ≥ 1 attack in a year was 69%. One hundred ten participants consulted a physician for each attack, 49 did so for only some attacks, while 43 never consulted a physician for any attack. Fifty-three participants had definitely (n = 10) or potentially (n = 43) inappropriate therapy for their recurrent attacks. Physician consultation for an attack was associated with increased risk of inappropriate therapy (risk ratio, RR, 2.5, p = 0.006), whereas an increasing number of gout attacks was associated with lower risk of inappropriate therapy (RR 0.8, p = 0.01). Conclusion. Given the high risk of recurrent attacks and the substantial number of persons whose attacks are not appropriately managed, further education about management of gout attacks for both patients and physicians may be warranted. (J Rheumatol 2006;33:104-9; First Release Nov 1, 2005) Key Indexing Terms:
GOUT From the Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, and the Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, USA. Supported in part by a Clinical Science Grant from the Arthritis Foundation, and a grant from the National Institutes of Health (AR47785). Dr. Neogi is supported by the Arthritis Foundation Postdoctoral Fellowship Award and the Abbott Scholar Award in Rheumatology. Dr. Zhang is supported in part by TAP Pharmaceuticals. T. Neogi, MD, FRCPC; D.J. Hunter, MBBS, PhD, FRACP, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine; C.E. Chaisson, MPH; D. Allensworth-Davies, MSc, Data Coordinating Center, Boston University School of Public Health; Y. Zhang, DSc, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine. Address reprint requests to Dr. T. Neogi, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118. E-mail: tneogi@bu.edu Accepted for publication August 25, 2005. |
