Emergency Department Prescribe Opioids For Acute Gout

More than a quarter of patients with acute gout received a prescription for opioids at discharge from the emergency department, according to study results published in Arthritis Care & Research. Previous studies have reported that, although steroids, nonsteroidal anti-inflammatory drugs, and colchicine are effective for reducing the inflammation and pain associated with acute gout, opioid analgesics are commonly used in these cases.

The emergency department

In light of the ongoing opioid epidemic, the goal of the current study was to assess the burden of prescription opioid use in patients discharge from the emergency department with acute gout. The researchers use the electronic health records system of Lifespan; so the largest provider of health care in the state of Rhode Island; hence providing care to more than 2.2 million patients; so to identify patients discharge with an acute gout event. They include adult patients discharge between March 30, 2015, and September 30, 2017.

The goal of treatment during an acute gout attack; which is suppression of inflammation and control of pain. It is important to note, that if a patient is not on uric acid lowering therapy at the time of an acute attack; so then this is not the time to initiate such therapy. However, if a patient ison uric acid lowering therapy at the time of an acute attack, it should not be discontinued.

Only the first visit to the emergency department was include in the analysis. A total of 456 patients (mean age, 58.7±16.4 years; 79% men) were include in this retrospective study. Of these, 129 patients (28.3%) received an opioid prescription at discharge, including 102 patients (79%) who were not using these medications at the time of presentation to the emergency department.

Patient with acute gout

The opioids most commonly prescribe to patients discharge with acute gout; which were oxycodone or oxycodone combinations (81%). The median duration of opioid prescription was 8 days and the average daily dose; hence was 37.9±17.2 morphine milligram equivalents. Patients prescribe vs not prescribe opioids at discharge were younger. Most were men and had hypertension, substance abuse, and opioid use at admission.

The presence of diabetes (adjust odds ratio, 2.04; 95% CI, 1.15-3.60) and polyarticular gout attack (adjust odds ratio, 2.02; 95% CI, 1.05-3.90)  with an increase risk for being prescribe opioid medications at discharge. Study limitations include the retrospective design, the use of an administrative database; also the lack of data regarding long-term opioid use after discharge.

“Increasing coordination of care between [emergency department] physicians; and also outpatient doctors could mitigate the fears of using conventional gout therapies by [emergency department] providers as well as reduce the risk [for] readmission to the [emergency department], which could ultimately lead to less use of prescription of opioids,” concluded the investigators.