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GPs warned to avoid high dose colchicine in gout patients

GPs should avoid using high doses of colchicine in patients with acute gout, according to the results of two audits of the implementation of current gout guidance.

The audits - both carried out last year - have highlighted many GPs are unaware of the guidance published in 2007 by the British Society for Rheumatology.

The BSR guidance recommends NSAIDs at maximum doses - plus a gastro-protectant - as a first-line treatment. It also recommended colchicine in patients who cannot take NSAIDs, but only in doses of up to 500 mcg four times a day to avoid diarrhoea and other adverse side effects.

The guidance also ruled out starting patients on allopurinol during an acute attack.

The first audit - of records from 583 consultations in patients with acute gout at ten general practices in north Staffordshire - found two thirds of patients who were prescribed colchicine were prescribed high dose regimens of more than 500 mcg four times daily. And 19% of patients were prescribed allopurinol at the time of their first acute attack.

Only 17 % - fewer than one in every five patients – who were prescribed an NSAID were given a gastroprotectant to take with it. Seven per cent of patients received no treatment at all.

One of the study authors, Dr Christian Mallen a GP in Newcastle-under-Lyme in Staffordshire, said: ‘Primary care acute gout management appears to be suboptimal.

‘Education of GPs about management strategies for acute gout and the importance of cardiovascular screening in this group of patients is a priority.'

A second study, of questionnaires from 415 patients with gout managed by GPs in Norfolk, also found their care was ‘not consistent with current guidelines.'

54% of GPs did not routinely measure serum uric acid levels to optimise the allopurinol dose as recommended in BSR guidance, and 30% were unsure of the target uric acid levels to prevent recurrent attacks of gout.

Both studies were both presented at the British Society for Rheumatology conference in Glasgow earlier this month.

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