A Philippine Tertiary Hospital Cross-sectional and Registry Feasibility Study: Gout Clinical Case Scenario

Abstract

Background. Gout is one of the most common arthritides affecting Filipinos; yet, there is a lack of updated local data and Clinical Practice Guidelines. Objective. To describe Clinical Case Scenario (CCS) of Filipino patients with gout in a tertiary referral hospital seen over a year. Design. Cross-sectional study. Methods. Patients' characteristics, risk factors, disease course, management, and CCS were obtained by a rheumatologist using a questionnaire. Descriptive statistics were used. Results. One hundred eight patients were included with a median age of 58 (range 26-80) years. 106 were male (98%); and, 2 were female (2%) who were menopause and had chronic kidney disease (CKD). Most prevalent CCS were stages 9 (29%), 1 (16%), and 2 (15%). The majority of cases had tophi and belonged to CCS 4-9 (62%). This signifies that most patients had advanced gout. Consistent with international and local data: Almost half had hypertension (46%), a third had CKD (36%). Most were ethanol drinkers (65%) and smokers (57%). Unexpectedly, not many were obese (10%) or had metabolic syndrome (2%). The initial joint involved was the ankle (52%) rather than the first metatarsophalangeal joint (40%). Almost half of the patients presented with two or more joint involvement (46%) than monoarthritis (54%). Patients with acute flare were most commonly prescribed NSAIDs (77%), followed by colchicine (62%). Most were prescribed allopurinol (44%) compared with febuxostat (37%) for urate-lowering therapy. Only 16% received patient education. Medication compliance was 65%, but followup compliance was less than 18%. Comparing the Filipino clinical profile to historical data suggests an increased incidence of gout in the young and an increase in comorbidity prevalence. Conclusion. This study reports a cohort of Filipino gout patients. Comorbidities are similar to world figures but differ in the low incidence of obesity and metabolic syndrome. It also differs from literature in having the ankle as the most common initial joint presentation. Management and compliance were also described. As a pilot study for a registry, this study can be implemented at different institutions to broaden and monitor the ever-changing Filipino gout profile. Recommendation. A larger sample size and a more extended observation period are recommended to estimate gout CCS prevalence, flare risk factors, and treatment response more accurately. Other outcomes that can be measured are mortality rates and etiologies for each CCS.