Management of gout in general practice—a systematic review

Abstract

This systematic review aims to summarise published evidence that assessed the management of gout in regard to the following: prescription of urate lowering therapy (ULT), monitoring of serum urate levels (sUA) and allopurinol dosing in patients with renal impairment, lifestyle advice and acute management of gout. Studies investigating the management of gout in general practice (GP) were identified by searching PubMed and Scopus databases. To be eligible for inclusion, studies had to be focused on the GP setting alone. Studies were also excluded if they examined diagnosis without exploring management of gout. Editorials and reviews were excluded. A total of nine studies were identified. Eight studies explored the proportion of gout patients currently on ULT. Six out of the eight studies revealed that ULT was prescribed in less than 50 % of gout patients. Four studies considered the monitoring of sUA levels in gout patients. The results were generally similar throughout studies indicating sub-optimal management. Only two studies examined the monitoring of sUA levels specifically in patients who were prescribed ULT. The two studies showed 28 and 38 % of patients on ULT had their sUA levels monitored. Two studies examined the dosing of allopurinol in renally impaired patients and revealed that 74-78 % of renally impaired patients had an appropriate allopurinol dose of less than 300 mg. This systematic review suggests that gout is sub-optimally managed in general practice. However, more studies with a larger sample size focusing on active patients are required to provide more definitive evidence.

General practitioners' perspectives on the management of gout: a qualitative study

“…There were strong similarities between the findings from this study and the quantitative results present in the literature 4. The acute management of gout commonly involved indomethacin due to the gastrointestinal side effects from colchicine.…”

“…However, the percentage of patients on allopurinol in quantitative studies does not reflect this. Studies such as those by Kuo et al 15 and Singh et al 7 only revealed about 35–50% of the gout population on urate-lowering therapy 4. This could suggest that the suboptimal prescription of allopurinol in general practice could be as a result of patient's non-compliance to the medication and follow-up plans, rather than GP's non-adherence to guidelines.…”

Factors Influencing Allopurinol Initiation in Primary Care

“…[1][2][3] This study investigated factors influencing initiation of allopurinol for treatment of gout in primary care.…”

A survey on the beliefs and knowledge of gout management in new medical graduates ‐ New South Wales, Australia

“…This is mirrored in Australian outpatient studies, with only 57% of patients with known gout on allopurinol, 55% having their serum urate level checked and 22.4% achieving a serum urate of < 0.36 mmol/L . A systematic review article of general practitioner (GP) management in 2015 revealed less than 50% of gout patients were prescribed ULT and 28–38% had their serum urate monitored …”

“…10 A systematic review article of general practitioner (GP) management in 2015 revealed less than 50% of gout patients were prescribed ULT and 28-38% had their serum urate monitored. 11 Several theories are proposed as to why gout is poorly managed. Patient factors include a limited understanding of their condition, impacting their desire to be proactive and adhere to care.…”