AB0117 FACTORS ASSOCIATED WITH POOR GOUT OUTCOME IN A REGIONAL HOSPITAL REGISTER
Authors: C. P. Buclin, D. Mongin, N. Bürgisser, O. Braillard, S. Mehouachi, P. Darbellay Farhoumand, D. S. Courvoisier, K. Lauper
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Gout has a heavy impact on quality of life and is associated with increased mortality [1]. It is often diagnosed and managed by internal medicine or primary care physicians. Despite long established treatment guidelines, it remains underdiagnosed, and poorly treated, with patients not always being referred to rheumatologists even in severe instances. <h3>Objectives:</h3> To examine the factors associated with rheumatology referrals, gout severity, and death in patients with gout. <h3>Methods:</h3> The Geneva University Hospitals gout register is an electronic-health records-based register including all gout patients in the last 10 years[2]. It identifies patients through ICD-10-GM Codes, joint aspiration results, drugs prescriptions, written documents, radiology reports and problem list with excellent predictive values (positive: 92.4%; negative: 94.3%). Data extracted include demographics date of diagnosis and severity of gout (severe gout being defined as hospitalization for gout or at least 2 flares in one year), presence of a rheumatology referral, Body Mass Index, age, alcohol use disorder, comorbidities (diabetes, hypertension, organ transplantation, presence of chronic kidney disease (≥ KDIGO 3a)), psychiatric disorder, nationality (Swiss/other). Associations of these factors with rheumatology referrals, gout severity, and death in patients with gout were assessed using multivariable logistic regression. <h3>Results:</h3> The study included 5,138 patients (1,320 outpatients, 3,818 inpatients), mostly male (76.5%), averaging 71.2 years old, with a mean BMI of 28.3 kg/m<sup>2</sup>. 6.7% of the patients were classified with severe gout, 34.5% died during follow-up. 78% of patients with severe gout saw a rheumatologist, compared to 30% with less severe gout (Figure 1). Gout severity was associated with chronic kidney disease (CKD) and alcohol use (Table 1). Rheumatology referrals were associated with being a woman, not being Swiss, having comorbidities (diabetes, CKD, psychiatric disorder) and a severe gout (strongest association). Mortality in gout patients was positively associated with male gender, older age, Swiss nationality, overall comorbidity, psychiatric disorder, CKD and rheumatology referrals, and negatively with years since diagnosis and higher BMI. <h3>Conclusion:</h3> In this register, 22% of patients with severe gout were not seen by a rheumatologist. Rheumatology referrals were higher among patients with severe gout, women, and non-Swiss nationals. Three associations were unexpected: first despite gout being both classically and, in our register, more frequent in men, gout severity wasn't associated with gender. Second, mortality was negatively associated with BMI, potentially reflecting weight loss in end-stage patients. Lastly, while there was no association between gout severity and mortality in adjusted analyses, rheumatology referrals remained associated with higher mortality. This is potentially due to gout-associated mortality often being of cardiovascular origin, and hence analyses adjusted for comorbidities found no association with mortality. Overall, these findings suggest that, while referrals to rheumatologists are crucial for managing severe gout, they may also indicate a subset of patients with more advanced disease and higher risk factors. This underscores the complexity of gout management and the need for not only early rheumatologist referral but also comprehensive care strategies for sever gout management. <h3>REFERENCES:</h3> [1] Dalbeth N, Choi HK, Joosten LAB, <i>et al.</i> Gout. <i>Nat Rev Dis Primers</i>. 2019;5:69. [2] Bürgisser N, Mongin D, Darbellay Farhoumand P, <i>et al.</i> POS0523 FEASIBILITY STUDY OF AN ELECTRONIC HEALTH RECORD-BASED GOUT REGISTRY. Annals of the Rheumatic Diseases. 2023;82:524–5. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>