A poster presented at the 2013 ACR/ARHP Annual Meeting in San Diego that examined differences between women and men with gout found women were more likely to have contraindications to nonsteroidal antiinflammatory drugs (NSAIDs), probably due to a higher prevalence of kidney disease. In addition, among patients who were candidates for urate-lowering drugs (ULDs), women were less likely to receive them then men.
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The lead author on the study, “Sex Differences in Gout Evaluation and Management,” (Abstract #1195) says she hopes the data highlight that rheumatologists and others must work diligently to make sure that women receive optimal gout care.
“While we physicians and rheumatologists think we treat everyone the same and do everything we’re supposed to do, we need to explore if that’s truly the case,” says Leslie Harrold, MD, MPH, associate professor of orthopedics and medicine at the University of Massachusetts Medical School in Worcester. “The treatment differences are not necessarily due to poor care by providers … this is a preliminary study and we need to explore these results using a larger population.”
The report found that while women had similar clinical features in terms of acute gout presentation and gouty arthritis, they were more likely to have contraindications to treatment with NSAIDs (32% vs. 21%, p=0.02) or colchicine (14% vs. 6%, p=0.01). Among those patients with two or more attacks per year or those with tophi, women were also less likely to be on a ULD as compared to men (78% vs. 89%, p=0.02) in both unadjusted and adjusted (OR 0.42, 95% CI 0.19–0.92) analyses.
Dr. Harrold’s work was based on initial data from the Consortium of Rheumatology Researchers of North America (CORRONA). As the database offers more information, Dr. Harrold and colleagues plan to continue their analysis. For example, they’ve yet to tease out why the differences in care for men and women exist.
“For crystal-proven gout, we don’t know if the provider offered an aspiration to the patient and more women declined than men,” Dr. Harrold notes. “Same thing with medications. Were they offered the same medications, and women were more likely to decline them than men?
“We don’t know that, but once again, if you don’t identify problems, you can’t solve them.”
Richard Quinn is a freelance writer in New Jersey.