Ankli B1, Kyburz D2, Hirschmann A3, Studler U4, Heijnen I5, Daikeler T6.
1,2,6 University Hospital Basel, Switzerland, Department of Rheumatology; 3,4 Department of Radiology Medical Immunology, 5 Laboratory Medicine.
Introduction: With age morbidity and the use of medications increase. Hence hyperuricemia and gout may develop. We here aim to describe epidemiology of gout in a tertiary hospital in Northwestern Switzerland.
Methods: We analyzed all patients with gout included between 01/2013 and 12/2014 in our single center prospective gout cohort (Basel university hospital). Within the cohort patients are followed at 3 and 12 months. At each visit we assessed number of flares, dietary inhabits, treatment, comorbidities, synovitis, tophi, blood pressure, weight, laboratory findings.
Results: 83 patients (pat) (72 men) with a mean age of 69 (range 23 – 99) years were consecutively included (69 with a flare at inclusion). Mean creatinine at presentation was 132, (range 66 -389) mmol/l, mean serum UA concentration was 470 (range 245 – 899) umol/l, mean CRP was 62 (range 1 – 290) mg/l. 54 pat suffered from hypertension, 20 had diabetes, 24 were obese. 54 pat were hospitalized at the time of inclusion and reason for hospitalization was: acute gout (24), infection (11), cardiac failure (8), malignoma (4). Treatment consisted of prednisone (14), colchicine (25), NSAID (11) or a combination (10) pat. At 3 months FU 32/65 scheduled pat attended the follow-up and 16/26 the 12 months follow-up. Reasons for not attending the FU visits were: death (8), no interest in participating in the FU study and not known (33) or hospitalization (2) pats. At 3 months FU 14/32 pat reported at least one flare and 18 did not, 10 pat had chronic active gout and 6 had tophi. Mean UA serum level at three months was 398 (range 180 - 623) umol/l. At 12 months 10/16 pat reported that they had flares since the last control, 3 had chronic gout and 2 had tophi, mean UA serum level was 358 (range 157 – 342) umol/l. At 12 months 8 of 16 pat reached the UA target level. Pat having experienced flares at 3 and 12 months FU were older and suffered from a higher number of comorbidities. Discussion: Gout is a disease of the elderly, the mean age of our patients at inclusion was 69 years and 8 patients died before FU. Despite adequate treatment and instruction of patients flares were frequent after inclusion. There is a high drop out rate in our cohort and more than half of patients did not show up for the FU appointments. Serum UA target levels are not reached by a majority of patients. This data show that there is an urgent need for better care of these patients.