GP management of gout is at odds with UK and European guidance according to a new primary care audit.
Audit criteria for the study – published in BMC Family Practice – were derived from the European League Against Rheumatism (EULAR) and the British Society for Rheumatology (BSR)/British Health Professionals in Rheumatology (BHPR) guidelines. Both guidelines encourage urate-lowering therapy (ULT) if patients have two or more attacks of acute gout. Current guidance regarding initiation of allopurinol recommends a starting dose of 100mg every few weeks until the target level (≤360 μmol/l) for serum uric acid is achieved.
Adults with a diagnosis of gout were identified from the records of a practice with almost 9,000 adult patients. A medical record review assessed the extent to which medical management adhered to the predefined standards.
Three per cent of the patient records included a diagnosis of gout. Only 62% of patients were started on allopurinol at a dose recommended in the guidelines. When SUA among patients prescribed allopurinol was examined, only 34% of patients on ULT had a SUA recorded in the last year and only 38% of patients had their latest SUA ≤360 μmol/l.
The researchers note that the primary care management of gout in this practice ‘was not concordant with national and international guidance, a finding consistent with previous studies’. The researchers say that the results demonstrated that ‘the provision of guidelines alone is not sufficient to improve the quality of gout management’ and that further work to understand the link between gout and cardiovascular disease is needed’.