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Updated gout guidelines

Issue 38 Synovium (Spring 2013)

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There is much comment and discussion in the journals and online about the update to the ACR guidelines for the management of gout published in October 2012.1 Gout is one of the commonest inflammatory arthropathies, affecting 3.9% of the adult population in the US and 1.4% in the UK. Worryingly the prevalence of gout is increasing in many populations, due mainly to lifestyle issues, co-morbidities and longevity. Gout is, however, controllable and although it is not a simple disease it is well understood and effective treatments are available. Disappointingly the delivery and uptake of medical care for gout remains poor in many places – hence the need for a guideline update.

Key messages for primary care include:

  1. the importance of initiating urate-lowering therapy – usually with allopurinol – starting at 100 mg/day and increasing the dose slowly until the target urate level (0.3 mmol/l) is reached, and monitoring thereafter regularly
  2. the importance of intensive patient education with respect to the aims of treating gout and also optimising diet and lifestyle
  3. treating episodes of acute gout promptly and effectively
  4. tackling co-morbidities to improve cardiovascular risk
  5. reducing the unnecessary use of urate-raising drugs such as thiazides and loop diuretics.

The UK is some way behind the US in terms of obesity, inactivity and adverse dietary factors but the trajectory is very similar and continuing increase in the prevalence of gout is anticipated. All the more work for the primary care practitioner to do. 

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