Background Gout is well known old disease, with still increasing prevalence. We are not in short of well-established clear guidelines for its management. However, it is still not well managed even in developed countries.
Objectives We share our experience of auditing the gout management in our out-patient clinic with the completion of our audit cycle. The aim is to improve gout service in line with 2006 EULAR guidelines, using the ethos of treat-to-target approach.
Methods We audited randomly selected 101 patients seen in our well established gout clinic. All patients should be in that clinic for a minimum of 6 months, ensuring sufficient time for prophylactic therapy to take effect. Records from patients attending the gout clinic between 07/07/2014 and 29/06/2015 were accessed & information was collected on serum urate and the treating medications, gouty attacks & presence of tophi. Patients' comorbidities were recorded. Recent serum uric acid levels were specifically scrutinized against both BSR and EULAR targets of ≤300 and ≤360 mmol/L respectively
Results Female (27%), males (73%). Average age: 64. Acute attack management: NSAID (42%), Colchicine: (82%), Oral Steroid (10%), IA Steroid (27%).
42% and 69% of patients acieved the BSR & EULAR s. uric acid target as compared with 9.3% for BSR target in 2010 and 29% & 60% for 2012 audit respectively. 64% of patients were under the BSR target reported no acute gout episodes since their last appointment, which is almost the same (66%) of patients achieving EULAR target.
70%, 20% & 10% of patients in the sample were on allopurinol, Febuxostat and Benzbromarone respectively. For Allopurinol treated patients 36.6% & 67.6% were under BSR and EULAR targets respectively. For Febuxostat these figures were much better at: 61.9% and 85.7% and for Benzbromarone 54.5% achieved EULAR & BSR target. Patients on Febuxostat had a significantly lower average urate (290) than allopurinol (351) (P=0.015). Patients prescribed Febuxostat if they had experienced side-effects to allopurinol (in concordance with NICE guidelines) or if allopurinol found it to be ineffective (31%).
However, for patient with tophi s. uric acid target of <300 (BSR) was achieved in 33.3% and of <360 (EULAR) in 59.3%.
100% of patients received lifestyle advice on diet, exercise & alcohol (NICE recommendation) as compared to only 9% in 2010. In CHD patients, 71% reduced their Cholesterol/HDL ratio to <5.0. In hypertensive patients, 60% reduced systolic blood pressure to <160 & in obese patients 7.84% were able to significantly reduce their weight (>5 kg).
Conclusions The proportion of patients achieving BSR & EULAR targets, in comparison to 2010 and 2012 were increased significantly on adapting gout speciality clinic. A greater proportion of patients on Febuxostat reached their targets compared to other urate lowering agents. No significant benefit (in terms of stopping further acute attacks with the meeting of the BSR target of <300 over the EULAR target of <360 were seen. Tophaceous gout has not been treated well when compared to the rest of the cohort. The impact of the clinic on improving and managing other co-morbidities associated with gout has much improved. We recommend that all gout patients should be treated with target to treat stratigy & this will be best achieved in specialized gout clinic
Disclosure of Interest None declared