Evaluating the Treatment of Acute Gout Flares in the Emergency Department

With the rise in number of opioid addictions, alternative long-term care and acute flare management for gout should be further addressed, according to a letter to the editor published in Arthritis Care & Research.¹

Researchers previously reported on the diagnosis and treatment of acute gout flares in a 541 consecutive emergency department (ED) visits over a 7-year period.² They indicated that among patients who visited the ED for an acute gout flare, 35% received an opioid (oxycodone/acetaminophen) and 52% received a prescription for an opioid. According to another study, opioids were prescribed more than 50% of the time in the ED for acute gout flares³; however, the researchers pointed out that the use of analgesia alone does not treat gouty inflammation.

Researchers of this study noted that treatment programs need to consider that gout is a long-term, chronic disease that requires continuous management; the possibility that acute flare-ups can occur must be considered. Research is necessary to address if the use of opioids for acute gout flares in the ED is warranted as well as to establish evidence-based guidelines for treating gout flares.

“[T]he clinical importance of this study is that it will increase discussion about the treatment of acute gout flares in the ED and beyond,” the investigators concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

1. Schlesinger N, Brunetti L. Treatment of acute gout flares in the emergency department [published online February 14, 2020]. Arthritis Care Res (Hoboken). doi:10.1002/acr.24166

2. Oster A, Bindman AB. Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations. Med Care. 2003;41:198-207.

3. Dalal DS, Mbuyi N, Shah I, Reinert S, Hilliard R, Reginato A. Prescription opioid use among acute gout patients discharged from the emergency department [published July 2, 2019]. Arthritis Care Res. doi:10.1002/acr.23928