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

Agnes Kempny1, Jamie Martin1

  • 1Hartley Corner Surgery.

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|June 20, 2020
PubMed

Insights

This audit of gout management in UK general practice found that while most patients have risk factors, urate-lowering therapy (ULT) like allopurinol is underprescribed. Adherence to new guidelines for gout treatment requires improvement.

Area of Science:

  • Rheumatology
  • General Practice
  • Clinical Audit

Background:

  • Gout is a prevalent inflammatory joint disease managed in primary care.
  • Recent British Society for Rheumatology (BSR) guidelines (2017) updated recommendations for urate-lowering therapy (ULT), advising initiation after the first gout episode.
  • The updated guidelines also emphasize screening and managing gout risk factors.

Purpose of the Study:

  • To audit current gout management practices in a large UK general practice.
  • To assess adherence to the 2017 BSR guidelines for gout treatment and risk factor management.

Main Methods:

  • An audit was conducted on patients diagnosed with gout between July 2017 and May 2019.
  • Evaluated pharmacological gout management, lifestyle advice, and management of risk factors including body mass index (BMI), blood pressure (BP), and HbA1c.

Main Results:

  • The audit included 104 patients; 68% had abnormal BMI, and 20.2% were prescribed allopurinol.
  • While most patients had abnormal BMI, BP and HbA1c were normal in the majority, though only 17% had all parameters normal.
  • Lifestyle advice was provided to 44.2% of patients, with colchicine (40.2%) and naproxen (56.7%) being more commonly prescribed than allopurinol.

Conclusions:

  • The majority of patients diagnosed with gout, even after a first attack, present with risk factors requiring management.
  • Allopurinol is prescribed to only one-fifth of patients, potentially due to patient preference, lifestyle adherence, or contraindications.
  • Further assessment is needed to understand the reasons for the observed prescribing patterns and to improve adherence to updated gout management guidelines.
Abstract

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