The British Society for Rheumatology Guideline for the Management of Gout

Abstract

Scope and purpose of the guideline Need for a revised management guidelineThe British Society for Rheumatology/British Health Professionals in Rheumatology guideline for the management of gout was published in 2007 1 . A revised and updated guideline is now required because of the availability of new pharmaceutical treatment options; recent increases in the incidence, prevalence and severity of gout 2 ; continuing suboptimal management in both primary and secondary care 2,3 ; and better understanding of patient and provider barriers to effective care. 4,5 Objectives of the guidelineTo offer revised and updated, concise, patient-focussed, evidence-based, expert recommendations for the management of gout in the UK.

An update on the management of gout

“…10 Although a definitive diagnosis of gout is made by the demonstration of monosodium urate crystals in synovial fluid, this is rarely undertaken in primary care. 2 …”

“…As a result, the BSR recommends that people presenting with gout are assessed for cardiovascular risk factors, including cigarette smoking, hypertension, diabetes, dyslipidaemia, obesity and renal disease. 2 …”

“…2,5,6 The choice of first-line agent should be guided by comorbidities, concurrent drug therapy, renal function and patient preference. 2 …”

“…5,6,14 The BSR guideline suggests a dose of colchicine 0.5mg two to four times daily, but recognises that higher doses are often associated with gastrointestinal adverse effects. 2 In the UK, the licensed dose of colchicine is 1mg followed by 0.5mg after 1 hour; 19 after 12 hours, treatment can resume with a maximum dose of 0.5mg every 8 hours until symptoms are relieved with no more than 6mg per course and at least 3 days between courses.…”

A Changing Landscape of Gout: Comorbidity Matters

“…First, the initial assessment of incident gout patients should include a comorbidity checklist. Currently, the European League Against Rheumatism recommendations 8 , the British Society for Rheumatology 9 , and the American College of Rheumatology guidelines 10 all recommend comorbidities that may contribute to or associate with hyperuricemia as part of an initial assessment of patients with gout. The comorbidity checklist, including obesity, metabolic syn drome, diabetes mellitus, hyperlipidemia, urolithiasis, and chronic kidney diseases, is roughly consistent with the comorbidities that occurred more commonly in newly diagnosed patients with gout, as reported by Elfishawi, et al 6 .…”