Management of Gout in Primary Care is Suboptimal- Audit

Abstract

Introduction: The soaring incidence of gout in the United Kingdom suggests that medical practitioners should be increasingly aware of optimizing management of gout, which is aimed at pain relief, preservation of joint function and preventing recurrent attacks. Recent guidelines published by the British Society of Rheumatology (BSR), have provided clinicians with a framework for achieving these aims. Aims : To evaluate the management of gout in a primary care centre in North West England against recognized standards. Methods : An electronic search on EMIS Web using the Read codes “gout” and “gouty arthritis”, with a specified period of 2010–2013, generated a cohort of patients who were categorized into 2 groups: those prescribed urate-lowering therapy (allopurinol) and those not. Patients on febuxostat were excluded. Clinical data from the patients were extracted and retrospectively audited. Results : A total of 112 patients were identified, of which only 46% ( n = 52) of patients were reviewed after an acute attack. Among those who were prescribed allopurinol, only 19% ( n = 12) achieved target serum urate levels while only 67% ( n = 42) had their serum urate levels checked regularly and 31% ( n = 20) had dosage adjustments. Comparatively, in patients not prescribed allopurinol, a few indications for initiating allopurinol were detected: 29% ( n = 12) had more than one attack of gout in a year, 27% ( n = 11) suffered from renal insufficiency, 2% ( n = 1) presented with tophi, and 17% ( n = 7) were on diuretics. Conclusion : Gout management in this primary care centre is not fully concordant to the BSR guidelines. Clearly, there is a need to improve adherence, particularly in the tight monitoring of serum uric acid levels, medications review, appropriate use of allopurinol, where indicated, and patient follow-up.