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Gout on the front pages

Issue 40 Synovium (Spring 2014)

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Gout hit the national headlines in January, with the BBC reporting ‘Rates of gout in UK soaring’. This was based on new evidence from Kuo et al. published in the Annals of Rheumatic Diseases.1 The prevalence of gout in UK adults was found to be 2.49%, a 63.9% increase since 1997. In 2012 only 48% of prevalent gout patients consulted, and of those only 38% received urate-lowering therapy (ULT). Only 18.6% of incident gout patients received ULT within 6 months of diagnosis. This work reinforces the conclusions reached by previous authors: gout tends to be managed as a series of acute attacks rather than a curable metabolic disease;2 we have relatively cheap, safe and effective drugs3 yet they remain under-prescribed.4 We should ask ourselves, ‘Why is gout undertreated?’.

Both patient factors and physician factors are likely responsible. Patients may believe that gout is self-inflicted, painful yet harmless and will settle given time. Doctors may lack undergraduate teaching, underestimate the long-term impact and may not be aware of treat-to-target guidance. UK GPs manage some complex chronic diseases extremely well; thus we must ask ourselves why gout continues to be sidelined in this way?

Audit suggestion: How many of your patients on allopurinol have had a serum urate measured in the last 24 months which reaches target (<0.30 mmol/L)? 

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