Objectives - To assess concordance of the management of chronic gout in UK primary care with the EULAR gout recommendations.
Methods - A postal questionnaire was sent to all adults aged over 30 years registered with two general practices. Possible cases of gout attended for clinical assessment where the diagnosis was verified clinically. Aspects of chronic gout management including provision of life-style 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 completed questionnaires returned (32%), 488 reported gout or acute attacks and were invited for clinical assessment. From 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 300mg daily. Mean SUA was lower in allopurinol-users than non-users (318 vs 434 µmol/l) and was less frequently > 360 µmol/l in allopurinol-users (23% vs 75%). Eight subjects had recently commenced allopurinol - 2 were taking prophylactic colchicine/NSAID. Sixteen (64%) of 25 subjects with diuretic-induced gout were still taking a diuretic.
Conclusion - Treatment of chronic gout is often suboptimal and poorly concordant with EULAR recommendations. Life-style advice is infrequently offered. Allopurinol is restricted to a minority. Persistent hyperuricaemia was often seen in allopurinol non-users but also in allopurinol-users suggesting that higher doses than 300mg of allopurinol are often necessary.
- EULAR recommendations
- life-style risk reduction
- primary health care