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Hospitalization and Flare Risk In Patients With Established Gout: A Population-Based Study

Zleik, Nour MD
Michet, Clement J. MD; Khun, Helen MS; Crowson, Cynthia S. MS; Matteson, Eric L. MD, MPH; Bongartz, Tim MD, MS
Tuesday, October 29, 2013
Presenter Available:
9:00 am - 11:00 am
Poster Available:
8:30 am - 4:00 pm
Exhibit Hall B2-C-D
Session Title:
Metabolic and Crystal Arthropathies II
Abstract Category:
Metabolic and Crystal Arthropathies


Hospitalization of patients with gout may be associated with an increased risk of arthritic flares, due to administration of IV fluids, discontinuation of established uric acid lowering therapies and other medication changes. While previous studies have suggested an association of gouty arthritis and hospitalization, the absolute flare risk has not been identified.We aimed to assemble a population based cohort of patients with newly diagnosed gout to determine the risk of flares with future hospitalizations and explore the role of various predictors that may be associated with an increased risk of in-hospital gout flares.


We examined a population-based incidence cohort of patients with gout, diagnosed according to the New York, Rome or ACR preliminary criteria between Jan 1st 1989 and Dec 31st 1992. All subjects were followed longitudinally through their complete community medical records, until death, migration or July 1st 2012. Hospitalizations of each subject were recorded and hospital records were evaluated for a possible flare of gouty arthritis.Person-year methods were used to calculate the rate of flares of gouty arthritis during hospitalizations and out-of-hospital. In addition, we utilized a conditional frailty model (accounting for multiple flares per subject) to explore risk factors of in-hospital gout flares.


159 patients with incident gout were identified within the 4 year time period. Subjects were followed for a mean (SD) of 13.4 (8.5) years. The majority of patients were male (73.4%) and the mean age (SD) at gout onset was 59.2.0 (17.8).  107 patients (67%) did have at least 1 hospitalization, with a total of 382 hospitalizations during the entire follow-up period. 12 of these 382 hospitalizations were complicated by a flare of gouty arthritis during a total of 1548 hospital days (4.2 total person-years) compared to 370 out-of hospital flares during 2117 person-years of follow-up. The rate of flares during hospitalization was 7.7 per 1000 person-years compared to 0.5 per 1000 person-years out-of-hospital. Hospitalization was associated with a significantly increased risk of gout flares (Rate Ratio: 16.8; 95% CI: 8.8, 27.7).Various possible predictors of gout flares during hospitalization were evaluated, including discontinuation of established uric acid lowering therapy, administration of IV fluids, ICU admission, use of diuretics and reason for admission. None of these factors could be identified as a statistically significant predictor of in-hospital flares.


Hospitalization does represent a significant risk factor for flares of gouty arthritis in patients with a prior diagnosis of gout. Future studies will have to clarify if there are patient subgroups that are at particular risk and if inpatient care related measures can help to prevent arthritic flares during hospitalization.


N. Zleik, None; C. J. Michet, None; H. Khun, None; C. S. Crowson, None; E. L. Matteson, Hoffmann-La Roche, Inc., 2, Pfizer Inc, 2, Novartis Pharmaceutical Corporation, 2, Mesoblast, 2, UCB Pharma, 2, Genentech and Biogen IDEC Inc., 2, Celegene, 2, Ardea Biosciences, 2; T. Bongartz, None.