In 2017, the British Society of Rheumatology published clinical guidelines designed to assist clinicians in the management of gout in primary care settings.
Gout is a common condition wherein a joint becomes inflamed due to precipitation of uric acid crystals. This condition is due to overproduction or underexcretion of uric acid.
In 2017, the British Society for Rheumatology published revised and updated guidelines for the management of gout. These patient-focused and evidence-based guidelines were developed to assist doctors and allied health professionals in the management of gout in primary care settings. The following are the components of the updated guidelines:
- Educating patients to understand that attacks should be treated as soon as an attack occurs and ensure that they are aware of the importance of continuing urate-lowering therapy (ULT) during attacks
- Affected joints should be rested, elevated, and exposed in a cool environment
- Using non-steroidal anti-inflammatory drugs (NSAIDS) at maximum dose of 500 mg bd-qds and colchicine as the first-line medications for acute attacks
- Using a short course of an oral corticosteroid or a single injection of intramuscular corticosteroid if the patient cannot tolerate NSAIDs
- Using interleukin-1 inhibitors if the patient is not responsive to the standard treatment
- Considering alternative medications for hypertension if the patient is taking a thiazide or loop diuretic
- Explaining the pathophysiology of gout to patients and educating them about the role of lifestyle modification in its management
- Encouraging patients with gout and a history of renal stones to consume at least 2 liters of water per day
- Explaining the importance of urate-lowering therapy and stressing the importance of adherence to prescribed medications even if the patient is asymptomatic
- Using allopurinol, a xanthine oxidase inhibitor, as a first-line medication for urate-lowering therapy
- Using febuxostat as an alternative if the patient cannot tolerate allopurinol
- Using uricosuric agents such as probenecid for patients resistant to xanthine oxidase inhibitor
- Using colchicine as prophylaxis against acute attacks.
Overall, the British Society of Rheumatology provided very detailed guidelines for the management of gout. This can help clinicians to effectively and efficiently manage this condition.
Written by Karla Sevilla
Hui, M., et al. (2017). The British Society of Rheumatology guideline for the management of gout. Rheumatology. Doi:10.1093/rheumatology/kex156