Prevalence of Contraindications and Prescription of Pharmacologic Therapies for Gout

doi:10.1016/j.amjmed.2010.09.012

The American Journal of Medicine

Volume 124, Issue 2, February 2011, Pages 155-163

https://doi.org/10.1016/j.amjmed.2010.09.012 Get rights and content

Abstract

Background

Patients with gout have comorbidities, but the impact of these comorbidities on treatment has not been studied.

Methods

A total of 575 patients with gout were stratified according to certainty of diagnosis according to International Classification of Diseases, 9th Revision, Clinical Modification code alone (cohort I), American College of Radiology criteria (cohort II), and crystal diagnosis (cohort III). Comorbid conditions were defined according to International Classification of Diseases, 9th Revision, Clinical Modification codes, and stratified as either moderate or severe. Drug contraindications were defined as moderate or strong, based on Food and Drug Administration criteria and severity of disease.

Results

The most common comorbidity was hypertension (prevalence 0.89). The presence of comorbidities resulted in a high frequency of contraindications to approved gout medications. More than 90% of patients had at least 1 contraindication to nonsteroidal anti-inflammatory drugs. Many patients demonstrated multiple contraindications to 1 or more gout medications. Frequently, patients were prescribed medications to which they harbored contraindications. The prevalence of patients prescribed colchicine despite having at least 1 strong contraindication was 30% (cohort I), 37% (cohort II), and 39.6% (cohort III).

Conclusion

Patients with gout typically harbor multiple comorbidities that result in contraindications to many of the medications available to treat gout. Frequently, despite contraindications to gout therapies, patients are frequently prescribed these medications.

Section snippets

Patient Enrollment

Patients with gout were identified from all patients in the NY VA electronic medical record, ages 18 to 100 years, as having any International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code (274.xx) for gout. Patients from this initial screen were excluded from further analysis if their records lacked documentation of a clinic or hospital visit during the 18-month period of our review (July 2007 to December 2008) or if the patient had died within the first 6

Patients

From among 32,888 patients in the NY Harbor VA Medical Center electronic medical record, 807 individuals age ≥ 18 years (2.5%) were identified as having ≥ 1 ICD-9-CM code diagnosis of gout. Exclusion of individuals who failed to meet other entry criteria resulted in an initial cohort for analysis (cohort I) of 575 patients (1.7%). As expected, this cohort was almost exclusively male. Mean age was 72 ± 11.8 years. Mean and median serum urate levels for cohort I were 7.7 mg/dL and 7.6 mg/dL (range,

Discussion

To our knowledge, this observational study is the first formal investigation of contraindications to traditional gout medications and of the use of such agents in the setting of such contraindications. Our principal findings were as follows: Patients with gout typically have multiple comorbid conditions; patients with gout frequently harbor multiple, often strong contraindications to the drugs available for gout management; and many patients with gout are prescribed medications for their gout

Conclusions

Our study demonstrates that gout is associated with an increased risk for multiple comorbidities, that patients with gout typically harbor contraindications to multiple medications available to treat their condition, and that patients with gout frequently are prescribed medications despite contraindications. Collectively, these data illuminate the limitations of the currently available therapies for gout management.

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: Funding: Drs Keenan and Fisher were supported by National Institutes of Health T32 Training Grant 5T32AR007176. Dr Fisher also was the recipient of Fellowship Training Award from the Arthritis Foundation New York Chapter. No other external funding was used.

: Conflict of Interest: Dr Goldfarb is a consultant for Takeda. None of the other authors have any conflict of interest regarding this manuscript.

: Authorship: All authors had access to the data and played a role in writing this manuscript.

View full text

Clinical research studyPrevalence of Contraindications and Prescription of Pharmacologic Therapies for Gout

Abstract

Background

Methods

Results

Conclusion

Section snippets

Patient Enrollment

Patients

Discussion

Conclusions

Am J Kidney Dis

Am J Med

Mayo Clin Proc

Gout and mortality

Clin Exp Rheumatol

Epidemiology of hyperuricemia and gout

Am J Manag Care

Epidemiology of gout: is the incidence rising?

J Rheumatol

Estimates of the prevalence of arthritis and other rheumatic conditions in the United StatesPart II

Arthritis Rheum

Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population

J Rheumatol

Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey

Arthritis Rheum

The prevalence of hyperuricemia in a population of the coastal city of Qingdao, China

J Rheumatol

Quality of care for gout in the US needs improvement

Arthritis Rheum

Evaluation of allopurinol use in patients with gout

Am J Hosp Pharm

Medication errors with the use of allopurinol and colchicine: a retrospective study of a national, anonymous Internet-accessible error reporting system

J Rheumatol

Frequency and predictors of inappropriate management of recurrent gout attacks in a longitudinal study

J Rheumatol

Analgesic-Antipyretic Agents: Pharmacotherapy of Gout

The effectiveness of the xanthine oxidase inhibitor allopurinol in the treatment of gout

Ann Intern Med

Management of gout in older adults: barriers to optimal control

Drugs Aging

Renal effects of non-steroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors

Curr Pharm Des

Cardiovascular risk, hypertension, and NSAIDs

Curr Rheumatol Rep

Clinical research study
Prevalence of Contraindications and Prescription of Pharmacologic Therapies for Gout