Factors associated with recurrent hospital admissions for gout: a case-control study.

OBJECTIVE Although gout has recognized prevention and treatment options, some patients have recurrent unplanned hospital admissions with gout flares. The aim of this study was to identify factors associated with recurrent hospital admissions with gout. METHODS A 1:1 case-control study was designed; cases were patients with 2 or more gout-related hospital admissions during any 12-month period between 2002 and 2007 (n = 48). Each case was matched with an age, sex and ethnicity-matched control patient with gout but without hospital admission, identified from the rheumatology clinic (n = 48). RESULTS Patients with recurrent hospital admissions had a higher number of comorbid medical conditions, particularly higher rates of heart disease (odds ratio 2.9, P = 0.013). Cases also had more hospital admissions for other medical problems (mean number of admissions in the preceding year 5.8 vs. 0.6, P < 0.0001). Although cases had higher rates of tophaceous disease and higher serum urate concentrations, there was no difference in gout disease duration. Cases were less likely to be on allopurinol (odds ratio 0.06, P < 0.0001), and those on allopurinol were on lower doses (median dose 200 mg/d vs. 300 mg/d, P = 0.0019). CONCLUSION Medical comorbidity, hyperuricemia, and inadequate allopurinol use are associated with repeated unplanned hospitalization for gout. These data suggest that the use of intensive urate-lowering therapy may prevent such admissions.