Improving management of gout in primary care: a new UK management guideline.

Abstract

Gout is the most prevalent inflammatory arthritis, affecting 2.5% of adults in the UK.1 Despite its prevalence and the availability of potentially ‘curative’ urate-lowering therapies (ULT) such as allopurinol, gout remains undertreated in both primary and secondary care. Under half of patients receive ULT and many do not have ULT escalated sufficiently to reduce serum uric acid (sUA) below recommended target levels.1 The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) have recently revised their evidence-based guideline for the management of gout,2 first published in 2007.3 The multidisciplinary guideline development group agreed key clinical management questions and undertook a systematic literature review and Delphi process to inform evidence-based consensus management recommendations. These were grouped into three categories: management of acute attacks ( n = 6), modification of lifestyle and risk factors ( n = 5), and optimal use of ULT ( n = 10). The guideline has been reviewed and endorsed by the Royal College of General Practitioners (RCGP). For acute attacks of gout, a non-steroidal anti-inflammatory drug (NSAID) (with gastro-protection) or low-dose colchicine 500 mcg two to four times daily are recommended as first-line treatment, depending on patient preference, renal function, and comorbidities. In patients who are intolerant of, or have contraindications to, NSAIDs and colchicine, intra-articular, intra-muscular, or oral corticosteroids are recommended (for example, oral prednisolone 35 mg daily for 5 days). Patients should be advised to treat attacks as soon as possible after onset to minimise severity and impact. Non-pharmacological …