Quality of care in patients with gout: why is management suboptimal and what can be done about it?

Gout is a common inflammatory arthritis. We know a great deal about its etiopathogenesis and have relatively safe and effective therapies for it. Gout, however, remains a poorly managed disease with mistakes made in securing an accurate diagnosis and in using appropriate therapies for acute and chronic stages of the disease. Synovial fluid analysis with polarizing microscopy is the "gold standard" for confirming the diagnosis of gout but has been used in fewer than 10% of all patients diagnosed with gout. The newly adopted European clinical guidelines offer a practical alternative to synovial fluid analysis, but primary care physicians are not well-versed in their use. Other serious errors in the management of gout are related to the use of medications to treat acute and chronic gout. Frequently, the anti-inflammatory drugs used to treat acute symptoms and urate-lowering drugs used to prevent long-term destruction are improperly dosed, leading to dissatisfaction on the part of patients and physicians. Widespread education about evidence-based diagnostic and treatment guidelines is desperately needed.