AB0863\u2005AN AUDIT OF MANAGEMENT OF GOUT ACCORDING TO THE BRITISH SOCIETY FOR RHEUMATOLOGY GUIDELINES,2017 IN A TEACHING HOSPITAL RHEUMATOLOGY UNIT

Abstract

Background Gout is the most common form of inflammatory arthritis worldwide. Its prevalence is 2.49% in UK general practice. In spite of the availability of effective treatments in the UK, the incidence of gout has increased in the last decade, the reasons for which are many.There is also evidence that gout is being sub-optimally treated in primary and secondary care. (1) Fewer than 50% of patients receive urate lowering therapy (ULT), and many patients on ULT do not achieve the target serum urate level of 300 µmol/l or lower. which is essential to prevent further attacks of gout. This target has been proposed by the British Society for Rheumatology(BSR), in the latest guideline from 2017. (2) Objectives To asess the compliance of gout management with the BSR 2017 guideline in our unit (a teaching hospital rheumatology department): a) Urate lowering therapy should be discussed with all patients diagnosed with Gout. b)ULT is strongly advised in patients with recurrent attacks (>2 over 12 months), chronic gouty arthritis, tophi, renal impairment (eGFR <60), patients on diuretics and primary gout at an early age. c)Aim of urate lowering to reduce serum urate to <300µmol/l. (2) Methods Inclusion criteria: All patients being treated for gout in the department of rheumatology, between 1st October 2016 to 31st September 2017, were included in this retrospective study. Demographics, treatment details obtained from electronic patient records. Adherence to the BSR guidelines was expressed as percentage. Results Total number of patients with gout was 113. Among these, 83 patients remain under rheumatology follow up, 30 were discharged within the 1 year period. 113 were considered were audit standard 1 and 2, and 83 were considered for standard 3. Audit standard Expected Achieved Urate lowering therapy should be discussed with all patients diagnosed with Gout. 100% 100% (113/113) Strongly advised in patients with recurrent attacks (>2 over 12 months), chronic gouty arthritis, tophi, renal impairment (eGFR <60), patients on diuretics and primary gout at an early age 90% 92.9% ( 105/113) Aim of urate lowering to reduce serum urate to <300µmol/l 80% 36% (30/83) Among the 113 patients being followed up in Rheumatology, 83% were on Allopurinol, 19 were on Febuxostat, 1 patient was on Benzbromarone. 10 patients were not on Urate lowering therapy. However, 2 among them had first attack of gout without any sign of chronicity, organ damage or tophi, so not started on ULT. Median Allopurinol dose was 300mg. ( IQR 200mg–700mg). 25 patients among the 113 had topheaceous gout, and 5 of them achieved BSR treatment target 22/83 (26.5%) patients on Allopurinol achieved BSR treatment target of <300µmol/l. 7/19 (37%) patients on Febuxostat achieved BSR treatment target of <300µmol/l Conclusion It is clear that a “treat to target” approach have not been adopted for x% of the patients. Gout has been shown to have better outcomes with treat to target approach. (3) Adequate escalation of ULT is essential to achieve target serum urate level, where as the median dose of Allopurinol here is 300mg. Gout remains inadequately treated, even in secondary care A consistent “Treat to target “approach needed for treatment of gout. Annual gout review clinic may be an effective strategy and is now being implemented as a result of this audit. References [1] Kuo C, Grainge MJ, Mallen C, Zhang W, Doherty M. Eligibility for and Prescription of Urate-Lowering Treatment in Patients With Incident Gout in England. JAMA2014Dec24,;312(24):2684-2686. [2] Hui M, Carr A, Cameron S, Davenport G, Doherty M, Forrester H, et al. The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology (Oxford, England) 2017 Jul 1,;56(7):e20. [3] Perez-Ruiz F, Moreno-Lledó A, Urionagüena I, Dickson AJ. Treat to target in gout. Rheumatology (Oxford, England) 2018 Jan 1,;57(suppl_1):i26.. Disclosure of Interests None declared