Management of gout and adherence to current guidelines in general practice surgery

Background Gout is one of the most common inflammatory joint diseases in the UK managed by GPs. The recent (2017) guideline of the British Society for Rheumatology (BSR) changed the recommendation for urate-lowering therapy (ULT) and now advises it after the first episode of gout, whereas it previously recommended after the second one. Moreover, the BSR now also recommends screening and management of risk factors of gout.

Aim To audit contemporary management of gout and adherence to the new BSR guideline in a large GP practice.

Method The audit identified all patients diagnosed with gout between 1 July 2017 and 1 May 2019. Pharmacological gout management, lifestyle advice, and management of risk factors were assessed, including body mass index (BMI), systemic blood pressure (BP), and HbA1c.

Results The audit included 104 patients, 26.9% female, mean age 63.8 years at the age of diagnosis. Uric acid was raised in all patients (mean 469 um/L). Most patients (68%) had abnormal BMI (mean 30.4), whereas BP, cholesterol, and HbA1C were normal in the majority of patients (in 78%, 75%, and 90%, respectively); however, all of these parameters were normal in just 17% of patients. Lifestyle advice was given to 46 (44.2%) patients while allopurinol was prescribed, and overall in 21 (20.2%) patients. More patients were managed with colchicine (40.2%) and naproxen (56.7%).

Conclusion Most patients diagnosed with a first gout attack have risk factors of gout and require their management. Overall, allopurinol is prescribed in a fifth of patients, which may be related to patients’ preferences, strict adherence to lifestyle modification only, or presence of contraindications to allopurinol. This requires, however, further assessment.