Chronic gout: Barriers to effective management

Gout is one of the most common inflammatory arthropathies, and the pathogenesis is well understood. In Australia, most patients with chronic tophaceous gout (CTG) are treated by general practitioners (GPs). Urate-lowering therapy, if adhered to continuously, can suppress the disease, reduce the likelihood of flares and prevent long-term complications such as disfiguring tophi and joint damage. Many rheumatology societies recommend a treat-to-target (T2T) approach, lowering serum urate to 0.35 mmol/L or below with urate lowering therapy.

The aim of this article is to discuss inconsistencies in treatment guidelines, identify patient and physician barriers to optimal gout care, explain why a T2T approach is appropriate and make a series of recommendations that are practical for GPs.

Despite an in-depth understanding of this controllable disease and the availability of simple, safe treatments, chronic gout remains poorly managed. The development of Australian gout guidelines that are easily implemented by GPs is vital and overdue.