2. Abstract 2557
The Relation of Colchicine to Knee/Hip Replacement Among People with Gout. Wang et al.2
Current guidelines recommend anti-inflammatory prophylaxis for people with gout starting urate-lowering therapy for three to six months.3,4 An exploratory post hoc analysis of the LoDoCo2 trial reported a lower incidence of total hip or knee joint replacement in people with cardiovascular disease who received colchicine than among those who received placebo.5 On the basis of this, Wang et al. undertook a propensity score-matched, population-based cohort study of people with gout to examine the effect of colchicine on joint replacement using data from the U.K. IMRD General Practice database.
The study identified ~32,000 incident colchicine users with gout and compared the risk of hip/knee replacement with ~32,000 propensity score-matched people with gout not starting colchicine. The authors reported a modest lower risk of hip/knee replacement in those who initiated colchicine, which remained similar after adjustment (HRadj 0.87 [95%CI 0.80 to 0.95]).
These data are of interest given previous negative trials of colchicine for treatment of osteoarthritis and suggest there may be some benefit for the use of colchicine in people with gout beyond prevention and treatment of gout flares.
3. Abstract 1071
Rapid Access Microscopy & Real-Time Case Discussion via a Secure Messaging App. Anouchka Lewis6
Acute crystal arthritidies including gout and calcium pyrophosphate deposition disease (CPPD) typically present as a painful, red, hot, swollen joint. Septic arthritis, which is considered a medical emergency given the risk of joint destruction, can also present as a painful, red, hot, swollen joint.
Synovial fluid analysis is the gold standard for diagnosis of both crystal arthritidies and septic arthritis. Visualization of monosodium urate or calcium pyrophosphate crystals in synovial fluid is operator dependent. A false-negative result for crystals in synovial fluid may result in a diagnosis of culture-negative septic arthritis, leading to patients being admitted to hospital, undergoing joint washout and receiving antibiotics unnecessarily.
In this abstract, Lewis et al. noted a high rate of culture-negative septic arthritis in their institution, suggesting a high rate of misdiagnosis. A hot-joint pathway providing a structured assessment for patients presenting with an acutely swollen joint included indications for joint aspiration, rapid access to rheumatology-led polarized light microscopy and a secure messaging app for coordination between ED physicians, rheumatologists and orthopedic surgeons.
With the introduction of the pathway cases of culture-positive septic arthritis increased, culture-negative arthritis cases were reduced and the diagnosis of crystal arthritis went up. Importantly, there was an increase in the number of people able to be discharged without the need for hospital admission and the average length of stay reduced by three days.
