EXTENDED REPORTS

Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations

Edward Roddy, Weiya Zhang, Michael Doherty

Academic Rheumatology, University of Nottingham, UK

Dr Edward Roddy, Clinical Research Fellow & Consultant Rheumatologist, Primary Care Musculoskeletal Research Centre, Keele University, Staffordshire, ST5 5BG; e.roddy{at}cphc.keele.ac.uk

Objectives: To assess concordance of the management of chronic gout in UK primary care with the European League Against Rheumatism (EULAR) gout recommendations.

Methods: A postal questionnaire was sent to all adults aged >30 years registered with two general practices. Patients with possible gout attended for clinical assessment, at which the diagnosis was verified clinically. Aspects of chronic gout management, including provision of lifestyle modification advice, use of urate-lowering therapies (ULT) including dose titration to serum urate (SUA) level, prophylaxis against acute attacks, and diuretic cessation were assessed in accordance with the EULAR recommendations.

Results: Of 4249 (32%) completed questionnaires returned, 488 reported gout or acute attacks and were invited for clinical assessment. Of 359 attendees, 164 clinically confirmed cases of gout were identified. Advice regarding alcohol consumption was recalled by 59 (41%), weight loss by 36 (25%) and diet by 42 (29%). Allopurinol was the only ULT used and was taken by 44 (30%); 31 (70%) were taking 300 mg daily. Mean SUA was lower in allopurinol users than non-users (318 vs 434 µmol/l) and was less often >360 µmol/l in allopurinol users (23% vs 75%). Eight patients had recently commenced allopurinol; two of these also were taking prophylactic colchicine or non-steroidal anti-inflammatory drugs. Of 25 patients with diuretic-induced gout, 16 (64%) were still taking a diuretic.

Conclusion: Treatment of chronic gout is often suboptimal and poorly concordant with EULAR recommendations. Lifestyle advice is infrequently offered, and allopurinol is restricted to a minority. Persistent hyperuricaemia was often seen in allopurinol non-users, but was also in allopurinol users, suggesting that doses >300 mg are often necessary.

Abbreviations: ARA, American Rheumatism Association; EULAR, European League Against Rheumatism; GFR, glomerular filtration rate; NSAID, non-steroidal anti-inflammatory drug; SUA, serum urate; ULT, urate-lowering therapies

Keywords: gout; primary health care; lifestyle risk reduction; allopurinol; EULAR recommendations

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Why is gout so poorly managed?

Eliseo Pascual and Francisca Sivera
Ann Rheum Dis 2007 66: 1269-1270. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Roddy, E., Mallen, C. D., Hider, S. L., Jordan, K. P. (2009). Prescription and comorbidity screening following consultation for acute gout in primary care. Rheumatology (Oxford) 0: kep332v1-kep332 [Abstract] [Full Text]  
• Riches, P. L., Wright, A. F., Ralston, S. H. (2009). Recent insights into the pathogenesis of hyperuricaemia and gout. Hum Mol Genet 18: R177-R184 [Abstract] [Full Text]  
• Rider, T. G., Jordan, K. M. (2009). The modern management of gout. Rheumatology (Oxford) 0: kep306v1-kep306 [Abstract] [Full Text]  
• BARBER, C., THOMPSON, K., HANLY, J. G. (2009). Impact of a Rheumatology Consultation Service on the Diagnostic Accuracy and Management of Gout in Hospitalized Patients. The Journal of Rheumatology 36: 1699-1704 [Abstract] [Full Text]  
• Lee, S. J., Hirsch, J. D., Terkeltaub, R., Khanna, D., Singh, J. A., Sarkin, A., Kavanaugh, A. (2009). Perceptions of disease and health-related quality of life among patients with gout. Rheumatology (Oxford) 48: 582-586 [Abstract] [Full Text]  
• HANLY, J. G., SKEDGEL, C., SKETRIS, I., COOKE, C., LINEHAN, T., THOMPSON, K., van ZANTEN, S. V. (2009). Gout in the Elderly -- A Population Health Study. The Journal of Rheumatology 36: 822-830 [Abstract] [Full Text]  
• Schumacher, H. R. Jr, Becker, M. A., Lloyd, E., MacDonald, P. A., Lademacher, C. (2009). Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study. Rheumatology (Oxford) 48: 188-194 [Abstract] [Full Text]  
• Roddy, E., Zhang, W., Doherty, M. (2008). Gout and nodal osteoarthritis: a case-control study. Rheumatology (Oxford) 47: 732-733 [Full Text]