Acute Gout in hospitalized patients in Sarawak …

1 This article was accepted: 5 May 2014 Corresponding Author: Cheng lay The, Rheumatologist Sarawak general hospital Medicine, Jalan hospital Kuching, Sarawak 93586, MalaysiaEmail: J Malaysia Vol 69 No 3 June 2014 ORIGINAL ARTICLEA cute Gout in hospitalized patients in Sarawak general hospitalTeh C L, Chew K F, Ling G RUnit of Rheumatology, Department of Medicine, Sarawak general hospital , Sarawak , Malaysia126 SUMMARYwe performed a prospective study of all hospitalized patientswith a diagnosis of Gout in Sarawak general hospital from 1stJuly 2011 to 1st July 2012. There were a total of 126 patientsin our study of which 112 ( ) were males. The majority ofour patients were from the indigenous populations ( ).They have a mean age of years.

2 Most of ourpatients were overweight (68%) with comorbities ofhypertension ( ), Chronic Kidney Failure ( ), Type IIdiabetes Mellitus ( ), dyslipidemia ( ) and Ischaemicheart disease ( ). Polyarticular gouty arthritis was themain presenting pattern during hospitalization ( ). Themean length of stay for our patients was days whichwas significantly longer than the mean length of stay for otherpatients without gout (p< ). Only 17 patients had gout onadmission and the majority developed gout duringhospitalizations. Our patients were admitted respectively formedical problems ( ), surgical problems ( ) andorthopaedic problems ( ). Colchicine ( ) and steroid( ) were the main stays of treatment for our patients . Ourhospitalized gout patients were complicated patients withmultiple wORdS:gout; hospitalizationsInTROdUCTIOnAcute gout is the most common inflammatory arthritisworldwide.

3 Acute gout is characterised by formation ofmonosodium urate (MSU) crystals in the synovial fluid of jointsand soft tissues. Recent epidemiological data showed thathospitalizations for Acute gout to be on the rising trends indeveloped countries1,2. Gout admissions rose at per yearin New Zealand and at per year in England from 1999-20092. This has been attributed to increased longevity, recentshifts in diet and lifestyle and improved medical care. Almostall data on hospitalized gout patients were from Westerncountries3-5. There are no published data on hospitalized goutpatients from Asia. Sarawak , located in the island of Borneo is the largest state ofMalaysia. Sarawak has a resident population recorded in theyear 2005 census6of million.

4 The majority are the nativepopulation ( ) which comprises of Iban ( ), Malay( ), Bidayuh ( ), Melanau ( ) and diverse smallerethnic groups ( ). The largest non-indigenous group is theChinese ( ). Less than 1% are from other ethnic general hospital is a 800-bed tertiary public hospitalwhich is located in Kuching, the capital city of Sarawak . It isthe biggest public hospital providing sole Rheumatology carein Sarawak . The aim of our study is to describe the profile ofacute gout in hospitalized patients in our conducted a prospective study of all hospitalized patientswith a diagnosis of Gout who received treatment in SarawakGeneral hospital . The diagnosis of Gout was based on the 1987revised American College of Rheumatology (ACR) criteria7. Thisstudy was conducted over a one-year period from 1st July 2011to 1st July 2012.

5 Demographics and clinical features of patients were collectedduring the study period. Causes of hospitalizations, length ofstays and treatment regimes were also collected. Treatmentregimes of Acute gout were based on the Malaysian ClinicalPractice Guideline of Management of Gout published in was performed using SPSS version , (SPSS, ChicagoIL, USA). Standard statistical methods were used to providedescriptive were a total of 126 patients in our study. Thedemographic data of our patients is shown in Table I. Themajority of our patients were male (112 [ ] malecompared to 14 [ ] female). Gout affects all ethnic groupsin Sarawak but showed preponderance towards the nativepopulation, which consisted of Malay ( ), Iban ( )and Bidayuh ( ).

6 Our patients have a mean age of years. They have amean duration of illness of years (0-30).The diagnosisof gout was made based on clinical criteria in 119 ( ) ofour cases. Only 7 cases were diagnosed based on crystalidentification. Thirty-six ( ) of our patients have familyhistory of gout in their first-degree majority of our patients ( ) were overweight and theyhave the following comorbidies: Hypertension (99 [ ]),Chronic Kidney Failure (61[ ]), Type II Diabetes Mellitus(38[ ]), Dyslipidemia (35[ ]) and Ischaemic HeartDisease (15[ ]). The main cause of chronic kidney failurein our patients was Diabetes Mellitus (50%). There were fourcases of hydronephrosis due to uric acid stones. The commoncomplications of gout in our patients were tophi (63 [ ]),joint deformities (40[ ]) and kidney stones (10[ ]).

7 Polyarticular gouty arthritis was the main presenting featureMed J Malaysia Vol 69 No 3 June 2014 Acute Gout in hospitalized patients127during the study period ( ). The main joints involved inour patients were ankles ( ) knees ( ) and firstmetatarsalphalageal joints ( ).The causes of hospitalization in our patients were as followed: Acute gouty arthritis (17[ ]), medical problems (54[ ]), surgical problems (34[ ]) and orthopaedicproblems (11[ ]). The common medical causes forhospitalizations were renal diseases (8 [ ]), heart diseases(7[ ]) and strokes (7[ ]). Upper GastrointestinalBleeding was the main cause of surgical admission in our study(12[ ]). Only two patients were admitted for management ofrenal stones. Four patients were admitted for infected tophi inorthopaedic wards.

8 The mean length of stay for our patients was dayswhich was significantly longer than the mean length of stayfor other patients without gout (p< ). The mean length ofstay differed according to causes of hospitalizations: Acute gout( ), medical causes ( ), surgical causes ( ) andorthopaedic causes ( ). As shown in , patients withacute gout stayed longer than the average patients withoutgout in almost all disciples. As for medications for treatment of gout, the followingmedications were used in our patients : colchicine (111[ ]),steroids (25[ ]), NSAIDS (20[ ]) and Cox-2 inhibitors(9[4%]). As for hypouricemic treatment, only of ourpatients were on allopurinol. The mean uric acid level of ourpatients was + described the clinical features of Acute gout amonghospitalized patients over a one-year period in a tertiaryRheumatology centre in Sarawak .

9 Sarawak is the largest statein Malaysia with a widely dispersed population over an areaof 124, km2. Our annual infant mortality rate is per1000 live births and the doctor to population ratio is 1:3,707compared to the national rate of per 1000 live births andthe doctor to population ratio of 1:1, reflected thelimitations in terms of access to healthcare and resourceconstraints in our patients are predominantly the native population wherebyMalay ( ), Iban ( ) and Bidayuh ( ). They madeup more than 50% of our cohort. This is most probably due togenetic factors in uric acid metabolism in Melanesian peopleas our native populations shared genetic profiles with theMaori and Pacific Islanders2,3. This is further supported by thefact that of our patients have a positive family historyof gout.

10 The majority of our patients are male and all thefemale patients were postmenopausal. This is consistent withworldwide findings of gout, which affects predominantly diagnosis of gout was made based on clinical criteria inthe majority of our cases. Only 7 cases were diagnosed basedon crystal identification. More than half of our patients were obese. They also have ahigh incidence of hypertension, chronic kidney failure,hypercholesterolaemia and diabetes mellitus. This findingmirrored worldwide data on gout, which showed that gout isstrongly associated with multiple comorbidites and metabolicdisorders9-10. The presence of multiple comorbidites complicatedthe management of gout in our patients as reflected by thelimitations in using NSAIDs and Cox-2 inhibitors in of our patients have tophi formation and one third ofthem have joint deformities.