Table 1.
Summary of characteristics of studies included within the systematic review, highlighting key outcome measures and study findings
| Study author/year/country | Study design | Participants | Intervention | Comparator | Outcomes measures | Findings |
|---|---|---|---|---|---|---|
| Rainer et al., 2016, Hong Kong [14] | RCT | 416 patients presenting to EDs (four centres) with gout flares | Prednisolone 30 mg OD orally for 5 days | Indomethacin 50 mg TDS orally for 2 days then 25 mg TDS for 3 days | Improvement in pain (VAS); adverse events; time to resolution of symptoms; length of ED stay; return visits to ED | Equivalent reductions in pain at rest and on activity for prednisolone and indomethacin; no major adverse events; more minor adverse events with indomethacin than prednisolone (P <0.001); no differences in length of ED stay or return visits to ED within 14 days |
| Man et al., 2007, Hong Kong [15] | RCT | 90 patients presenting to ED (single centre) with suspected gout flares | Prednisolone 30 mg OD orally for 5 days | Indomethacin 50 mg TDS orally for 2 days then 25 mg TDS for 3 days | Improvement in pain (VAS); adverse events | Rate of decrease in pain on activity greater for prednisolone than indomethacin (P =0.0026); more adverse events with indomethacin than prednisolone (P < 0.05) |
| Shrestha et al., 1995, USA [13] | RCT | 20 patients presenting to EDs (two centres) with gout flares | Indomethacin 50 mg OD orally single dose | Ketorolac 60 mg i.m. single dose | Improvement in pain (Wong-Baker FACES® Rating Scale); adverse events | Equivalent reductions in pain between the study arms at 2 h; more rebound increases in pain with ketorolac at 6 h (P <0.05); no adverse events |
| Ghosh et al., 2013, USA [18] | Retrospective | 26 patients hospitalized for gout flares; flares resistant to standard treatments and/or contraindications to these treatments | Anakinra, multiple dosing regimens | None | Pain response (VAS <3/10 and able to weight bear); time to resolution of flare; adverse events | Pain response observed in 67% of patients within 24 h and 85% within 48 h; complete resolution of presenting symptoms in 73% by day 5; no attributable adverse events |
| Daoussiset et al., 2012, Greece [19] | Retrospective | 181 patients hospitalized for gout flares (primary or secondary admission diagnoses) | ACTH 1 mg i.m. single dose, followed by repeat dose if indicated | None | Response to treatment (attenuation of inflammation and no requirement for acute gout medications for 2 days); adverse events | 78% of patients responded to the initial ACTH dose; 83% responded to a further dose; few attributable adverse events |
| Pattanaik et al., 2019, USA [20] | Retrospective | 250 patients (US veterans) attending ED with gout flares | ULT | No ULT | Frequency of ED visits | Use of ULT associated with fewer ED visits than no use of ULT (P =0.02) |
| Hutton et al., 2009, New Zealand [21] | Case–control | 48 patients hospitalized for gout at least twice in the preceding year (cases); 48 matched patients with gout but without hospital admissions (controls) | Allopurinol; colchicine prophylaxis | No allopurinol; no colchicine prophylaxis | Hospital admissions | Patients who had been hospitalized were less likely to be on allopurinol than non-hospitalized patients (OR 0.06; P <0.0001) and less likely to have been prescribed colchicine prophylaxis (OR 0.39; P =0.039) |
| Huang et al., 2020, USA [22] | Retrospective | 59 patients with active prescriptions for allopurinol who had been admitted for gout flares | Continuation of ULT/dose increase | Discontinuation of ULT/dose reduction | Frequency of gout flares in the 3 months post-discharge | Dose reduction/discontinuation of allopurinol associated with more repeat gout flares within 3 months of discharge (P =0.03) |
| Hill et al., 2015, USA [16] | RCT | 31 patients with gout meeting ACR criteria for ULT commencement, recruited from EDs and rheumatology clinics within 72 h of initial therapy for gout flares | Allopurinol 100 mg OD orally (days 0–14) then 200 mg daily (days 15–28) | Placebo | Time to resolution of acute flare | No significant difference between allopurinol arm (15.4 days) or placebo arm (13.4 days) (P =0.50) |
| Taylor et al., 2012, USA [17] | RCT | 57 patients with crystal-proven gout flares, recruited from EDs, wards and outpatient clinics within 7 days of flare onset | Allopurinol 300 mg OD orally from day 0 onwards | Placebo (days 0–10) then allopurinol 300 mg OD orally (days 11–30) | Improvement in pain (VAS) by day 10; new or recurrent flares by day 30 | Rapid decrease in pain in both study arms, with no significant differences; flares reported in 7.7% of early initiation group and 12.0% of delayed initiation group (P =0.61); rapid decreases in SU levels by day 10 in the early initiation group |
| Feng et al., 2015, China [23] | Retrospective | 123 patients with gout initiating ULT during acute flares in ward and outpatient settings vs 457 patients initiating ULT after flares | ULT initiation during acute flares | Delayed ULT initiation after flare resolution | Proportion attaining target SU levels; time to attainment of SU target; flare rates | No difference in SU attainment rates (66.7% vs 65.6%); quicker attainment of target SU with immediate ULT (2.5 months vs 3.8 months; P =0.004); numerically more flares with immediate ULT vs delayed ULT in first 12 weeks but not subsequently |
| Kamalaraj et al., 2012, Australia [24] | Retrospective | Patients with gout flares in hospital before (n = 118) and after (n = 89) the introduction of management protocol | Introduction of a gout management protocol | No gout management protocol | Length of stay; treatment delays; proportion continuing ULT on admission | After introduction of protocol, more patients continued baseline allopurinol (P =0.01), treatment delays reduced (P <0.001), length of stay non-significantly shorter (10 vs 11.5 days; P =0.3) |
| Kapadia and Abhishek, 2019, UK [25] | Retrospective | 55 patients with crystal-proven gout flares admitted to a single centre | Inpatient rheumatology consultation | No rheumatology consultation | Proportion with discharge plan to initiate ULT | More patients receiving rheumatology consultation had a discharge plan to initiate ULT (OR 22.25; P =0.007) |
| Teichtahl et al., 2014, Australia [26] | Prospective cohort | 58 patients hospitalized with gout flares (primary or secondary admission diagnoses) in a single centre | Inpatient rheumatology consultation | No rheumatology consultation | Proportion on ULT at discharge; proportion receiving gout discharge plans or outpatient follow-up | Rheumatology consultation associated with non-significantly more ULT on discharge (42% vs 27%; P =0.27); more gout discharge planning (92% vs 24%; P <0.001); more rheumatology outpatient follow-up (42% vs 0%; P <0.001) |
| Sen, 2019, USA [27] | Retrospective | 200 hospitalized patients with diagnoses of gout in a single centre, 27% of whom flared during admission | Inpatient rheumatology consultation | No rheumatology consultation | Length of stay; proportion discharged on ULT or colchicine; proportion with outpatient follow-up | No difference in length of stay (4.7 days vs 5.8 days); more patients with rheumatology input were discharged on ULT or colchicine (100% vs 79%; P <0.04); more patients received outpatient follow-up (62% vs 12%; P <0.002) |
| Gnanenthiran et al., 2011, Australia [28] | Retrospective | 134 patients admitted for gout flares (primary or secondary admission diagnoses) in a single centre | Inpatient rheumatology consultation | No rheumatology consultation | Length of stay; treatment delays; proportion with outpatient follow-up | Length of stay not significantly different (19 vs 17 days; P =0.6); treatment delay not significantly different (2.0 vs 1.7 days; P =0.05); more rheumatology follow-up for those with inpatient rheumatology consultation (53% vs 0%; P <0.001) |
| Kennedy et al., 2015, New Zealand [29] | Retrospective | 90 admissions for gout flares (primary or secondary admission diagnoses) in a single centre | Inpatient rheumatology consultation | No rheumatology consultation | Length of stay; proportion initiating ULT +/– treat-to-target therapy | Length of stay not significantly different (7.1 vs 7.6 days; P =0.81); more patients with rheumatology input commenced allopurinol (53% vs 23%; P =0.04); no difference in treat-to-target therapy (17% vs 7%; P =0.15) |
| Wright et al., 2017, New Zealand [30] | Retrospective | 235 admissions for gout flares (primary or secondary admission diagnoses) in a single centre | Inpatient rheumatology consultation | No rheumatology consultation | Length of stay; proportion undergoing joint aspiration, SU measurement or ULT dose adjustment | Length of stay not significantly different (5.3 vs 6.7 days; P =0.44); more joint aspirations, SU measurement and ULT adjustment with rheumatology input (all P <0.001) |
| Barber et al., 2009, Canada [31] | Retrospective | 138 patients hospitalized with gout flares (primary or secondary admission diagnoses) in a single centre | Inpatient rheumatology consultation | No rheumatology consultation | Proportion initiating ULT +/– treat-to-target therapy; proportion receiving prophylaxis while initiating ULT | Non‐significantly more patients who were consulted by a rheumatologist commenced ULT during/after admission (81% vs 65%; P =0.08); non-significantly more patients received a treat-to-target approach (53% vs 30%; P =0.06); more patients received prophylaxis while initiating ULT (61% vs 29%; P =0.03) |
ACTH: adrenocorticotropic hormone; ED: emergency department; OD: once daily; OR: odds ratio; RCT: randomized controlled trial; SU: serum urate; TDS: three times daily; ULT: urate-lowering therapy; VAS: visual analogue scale for pain.