Korean J Med.  2023 Jun;98(3):137-143. 10.3904/kjm.2023.98.3.137.

Missed Opportunities for Urate Lowering Therapy after Gout Flares in Frail Patients Living Alone

• Jang YM
• Kim MJ
• Ryu B
• Sun JY
• Moon KW
• Shin K

• KMID: 2542691
• DOI: http://doi.org/10.3904/kjm.2023.98.3.137

Abstract

Background/Aims
Irrespective of socioeconomic status, urate lowering therapy (ULT) is crucial for all chronic gout patients. We investigated the presence of missed opportunities for ULT among underprivileged patients treated at a major public hospital in Korea after a severe gout flare.
Methods
We first collected information on patients admitted under the diagnosis of gout (International Classification of Diseases 10th Revision code M10) at a major public hospital from March 2011 to February 2022. De-identified patient data, including sociodemographic status, uric acid levels, list of medications, and outpatient follow-up data, were extracted. The patients were grouped into frail patients, who were living alone and were admitted to the specialized ward (SPE), and those who were admitted to the general ward (GEN). Primary endpoints were the outpatient visit rate immediately after discharge and the rate of ULT maintenance after a year.
Results
Acute gouty arthritis was the chief event during admission in 136 cases. The mean (± standard deviation) age was 60.1 (± 16.1) years, and 95% of the patients were male. Only 18% of the patients were on ULT before admission. The patients were divided into the SPE (n = 25) and GEN (n = 111) groups. Body mass index in the SPE group was lower than in the GEN group (23.4 [± 4.4] and 25.1 [± 3.7], respectively, p = 0.082). The uric acid levels at admissio in the SPE and GEN groups were 9.6 (± 2.7) and 7.6 (± 2.3), respectively (p = 0.0023). After discharge, 80% and 95.5% of the SPE and GEN group participants presented to the outpatient department within 1 month, respectively (p = 0.019). ULT was continued or initiated in 85% of the patients. However, fewer patients continued colchicine for at least 3 months in the SPE group compared to the GEN group (25.0% and 43.4%, respectively). After 1 year, the SPE group had a higher rate of loss to follow-up (32.0% vs. 23.4%), higher uric acid levels (7.4 [± 3.8] vs. 6.2 [± 2.1]), and fewer ULT users (41.2% vs. 50.6%) compared to the GEN group, but the differences were not statistically significant.
Conclusions
Frail patients who lived alone, even in the metropolitan area, missed opportunities for ULT and long-term gout care. Joint efforts on the part of health authorities and social workers are necessary to devise a strategy for better access and management among underprivileged gout patients.

Keyword

Gout; Ill-housed persons; Social class; Urate lowering therapy