Review of the management of gout in a primary care clinic

Abstract

Objective: To review the current management of gout in primary care with particular attention to lifestyle advice and drug management. Design: A retrospective non-interventional study of gout management. Subjects: Patients attending the Family Medicine Training Centre (FMTC) of the Prince of Wales Hospital between 1st July 2003 to 30th September 2003 with the diagnosis of gout. Main outcome measures: Baseline demographic data, frequency and quality of lifestyle advice given, serum urate levels and type of antihyperuricaemic drug used. Results: 279 patients were identified in the study. 53% were given lifestyle advice. Amongst the 67% patients given medications for acute gout control: 52% had NSAIDs alone for acute attacks, 29% colchicine alone, and 19% both colchicine and NSAIDs. 70% of patients were given allopurinol as antihyperuricaemic agent. None of our patients was prescribed uricosurics. 34% had no obvious cause for the use of allopurinol. 19% had multiple indications, the commonest being hyperuricaemia (49%). The majority of those on allopurinol had urate levels of more than 0.36mmol/L. Different allopurinol doses had no different effect on urate levels. Conclusion: The current management of gout in terms of lifestyle advice and drug treatment for acute and chronic gout varied widely within our FMTC. Areas for improvement include the appropriate use of medications in the acute attack, the appropriate initiation of antihyperuricaemic agent, and the quality of message given in terms of lifestyle modification. Further auditing in gout management and the development of guidelines will provide additional benefits to our patients.