104 The Journal of Rheumatology 2006; 33:1 Frequency and Predictors of Inappropriate Management of Recurrent Gout Attacks in a Longitudinal Study

ABSTRACT. Objective. To evaluate the patterns and determinants of medication use during recurrent gout attacks. Methods. We followed participants with documented gout in an online prospective case-crossover study. During an attack, subjects were asked if they had consulted a physician for the attack and what medications they were using. Definitely inappropriate therapy was defined as use of allopurinol or a uricosuric agent acutely without having used it as a prophylactic. Potentially inappropriate therapy was defined as use of analgesics alone, alternative remedies, or no medications. We estimated the risk of having ≥ 1 attack in 1 year using life table methods. We examined the relation of various risk factors to the risk of inappropriate therapy using Poisson regression. Results. Among 232 participants (mean age 52 yrs, 81 % male) with documented gout, the risk of having ≥ 1 attack in a year was 69%. One hundred ten participants consulted a physician for each attack, 49 did so for only some attacks, while 43 never consulted a physician for any attack. Fifty-three participants had definitely (n = 10) or potentially (n = 43) inappropriate therapy for their recur-rent attacks. Physician consultation for an attack was associated with increased risk of inappropriate therapy (risk ratio, RR, 2.5, p = 0.006), whereas an increasing number of gout attacks was associate