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AB1083 Audit of best practice in gout management, dept of rheuamtology, new cross hospital wolverhampton
  1. H. Alobaidi,
  2. S. Fazal,
  3. A.W. Al-Allaf,
  4. S. Wood
  1. Rheumatology, Royal Wolverhampton Hospital Trust, Wolverhampton, United Kingdom

Abstract

Background Gout is a condition characterised by the deposition of urate crystals in joint spaces. Prevalence is rising and affecting more than 1% of the western population.A study has shown an incidence of 14/10,000 patient years from 1990-1999, with more men affected than women. Hyperuricaemia risk increases with high alcohol intake, hypertension, obesity, the use of diuretics, high red meat and sea food intake. Patients with gout are also more likely to suffer from coronary artery disease, diabetes, and chronic renal failure. Thus correct management of gout is vital, and evidence indicates the treatment of gout is often suboptimal. In 2010 we audited management of gout in the Rheumatology department of New Cross Hospital and compared the practice with the BSR guidelines. Main changes brought about as result of 2010 audit were establishing gout clinic and use of clerking proforma to standardise the practice

Objectives The aim was to reasses and improve the management of gout in the Rheumatology department of New Cross Hospital, wolverhampton, in line with the BSR and EULAR guidelines.

Methods Criteria were set as EULAR 2006 and BSR 2007 guidelines for gout management and standards were set as 100% adherence. We performed a retrospective audit and patients were identified from the Gout clinic register. Notes were reviewed and data were collected using a Data collection sheet. Some data, such as blood values, were obtained using the online Trust intranet. Data was analysed using an Excel spread sheet

Results Out of a total of 71 gout patients selected, 66 patients’ notes were available to review. 71% were male and 29% were female with an average age of 62 (range 28-88). Risk factors were hypertension (60.6%), alcohol intake (34.8%) and obesity (31.8%), 21% were on loop diuretics while 12.1% were on thiazide. The commonest co-morbidity was CRF 22.7% then CHD 18.2% and diabetes 15.2%. Colchicine was used in 60% of cases and NSAIDs in 31.3% during acute attacks. Lifestyle modification advice was given regarding alcohol (92.4%), diet (90.9%) and exercise/weight reduction (84.8%) as compared to 100%, 21% and 9%, respectively, in 2010 auidt. Most commonly used Urate Lowering Drugs (ULD) were allopurinol (84.8%) and Febuxostat (15.2%). ULD were used appropriately in 98.5% cases as opposed to 86.0% in 2010. In 90% of patients the allopurinol dose was titrated appropriately according to response. In 81% patients colchicine was used appropriately as prophylaxis while starting ULD. 21 patients were on diuretics and only in 14.3% cases diuretics were stopped. The uric acid target of ≤360mmol/l was achieved in 60% of cases as per EULAR guidelines and the target of ≤300mmol/l was achieved in 29.3% of cases as per BSR guidelines, as opposed to 9.3% of cases achieved the target of ≤300mmol/l in 2010 audit

Conclusions We showed improvements in many areas of practice and achieved better urate levels in patients as compared to our 2010 audit which could be attributed to establishing a specialist nurse led gout clinic and the use of a Gout clerking proforma, but still more work is needed to be done to achieve the 100% target. Urate levels were reduced in 60% of patients to ≤360mmol/l but one of the possible biases of this audit was that the inclusion of new patients who were not on ULD long enough which perhaps skewed our results in a negative way

Disclosure of Interest None Declared

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