bpj-sce-august-2020

MUSCULOSKELETAL
RHEUMATOLOGY
Managing gout in primary care
For many people, gout is a debilitating condition associated with poor health and reduced life expectancy.
However, it can be effectively managed with appropriate and prompt use of urate-lowering treatment. Too often,
management is focused on controlling the patient’s symptoms in the short-term, while their risk of irreversible
joint damage and negative health outcomes continues to grow, particularly among Māori and Pacific peoples.
It’s time for a re-think.
KEY PRACTICE POINTS:
Gout flares can be treated with a NSAID, prednisone or
low-dose colchicine, depending on individual clinical
circumstances; all are considered to be equally effective
Following the first flare, lifestyle changes are important
but alone are generally insufficient for the management
of gout; discuss urate-lowering treatment at the first
presentation and recommend initiation if indicated
Allopurinol is the first-line urate-lowering treatment and
can be initiated during a flare; the starting dose is based on
renal function, followed by gradual up-titration
– Probenecid can be used second-line either as
monotherapy or in combination with allopurinol
– Febuxostat is a third-line option
Prophylactic medicines should be routinely prescribed
alongside urate-lowering medicines, usually for at least six
months or longer if symptoms are ongoing
Patients should aim for a target serum urate level below
0.36 mmol/L or below 0.30 mmol/L if there are features
of severe disease, e.g. tophi; regular review of treatment is
required to achieve these levels
Patients with gout require consistent ongoing management
of cardiovascular risk, as well as monitoring for comorbidities,
e.g. chronic kidney disease and diabetes
www.bpac.org.nz
Best Practice Journal – SCE Issue 1 27