Clinical audit suggestions: gout

One of the most common causes of inflamed joints, gout affects approximately one in 100 adults in the UK. In contrast to other causes of inflamed joints such as rheumatoid arthritis, which are usually treated by hospital specialists, gout is largely managed in primary care.

Guidelines

The British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guidelines for the management of gout:

• executive summary (PDF, 99 kb)
• full guidelines (PDF, 261 kb)

These guidelines are under revision and updated versions are due for publication in 2016.

Guidelines written by Dr Louise Warburton, president of the Primary Care Rheumatology Society, which appeared in GP Magazine, in November 2012.

Clinical knowledge summary

National Institute for Health and Care Excellence (NICE) clinical knowledge summary for the management of gout.

Audit criteria

All patients with gout should have:

• screening for co-morbid disorders (BP, HbA1c and fasting lipids) recorded within the past five years
• documented advice on lifestyle modification (weight reduction, alcohol intake and dietary adjustment)
• been signposted to information about their condition and this should be documented in their notes.

All patients with >one documented attack of gout in the past 12 months should be taking (or have been offered) a uric acid-lowering drug.

All patients with gout should have a medication review performed in the past year.

Patients with gout should not be prescribed a thiazide or loop diuretic unless there is a documented rationale for doing so.

All patients on uric acid-lowering therapy (BNF section 10.1.4) should be treated to target levels of reduction in plasma urate levels (360μmol/L or 6mg/dl).

Other suggested audits

Search for patients on uric acid-lowering therapies (BNF section 10.1.4)

• Do they have gout documented as a diagnostic code?
• Are they being treated to target levels of reduction in plasma urate levels (360μmol/L or 6mg/dl)?

Resources

Read code: C34 Gout