Impact of a Rheumatology Consultation Service on the Diagnostic Accuracy and Management of Gout in Hospitalized Patients

Objective. To determine if a hospital rheumatology Consultation service improves diagnostic accuracy and adherence to treatment recommendations for gout. Methods. This was a retrospective, single-center, case-control study of consecutive hospitalized patients with gout. Demographic, diagnostic, and treatment variables were compared in patients with and without a rheumatology consultation (controls). American College of Rheumatology (ACR) preliminary criteria for the classification of acute gout and the European League Against Rheumatism (EULAR) recommendations were used to determine diagnostic accuracy. Adherence to EULAR drug management recommendations and Quality Indicators for treatment were compared between groups. Results. In total, 138 patients were studied. The mean (SD) age was 71.3 (13.4) years and 70% were men. Forty-eight (35%) patients had gout on admission, 90 (65%) during their hospital stay, and 8 (6%) had multiple attacks. A total of 79 (57%) patients had a rheumatology consultation. These patients had more joints involved (p < 0.001), more frequent synovial fluid analysis (p < 0.001), and fulfilled ACR classification criteria more frequently than those who did not have a rheumatology consultation (65% vs 37%; p = 0.002). Intraarticular corticosteroid use was more common (44% vs 12%; p < 0.001) in patients who were seen by rheumatology. In contrast, colchicine Was used more frequently in controls (63% vs 40%; p = 0.006). Patients seen by rheumatology were more likely to use nonsteroidal anti inflammatory drugs or colchicine for (gout prophylaxis while titrating allopurinol to target (p = 0.033). Conclusion. A rheumatology consultation service for hospitalized patients with gout significantly improved the diagnostic accuracy and adherence to established guidelines for short and longterm treatment. (First Release July 1 2009; J Rheumatol 2009;36:1699-04; doi:10.3899/jrheum.081296)