Feature Article

Gout – the pivotal role of primary care

Feature Article

Gout – the pivotal role of primary care

KYLAN PATHMANATHAN, KIMBERLY LOH, KELLY MORGAN, HELEN I. KEEN

Figures

© steven needell/spl
© steven needell/spl

Abstract

Gout is common and increasing in prevalence in Australia and worldwide. It is associated with multiple significant comorbidities and functional disability. Despite widely available and effective pharmacotherapy, management remains suboptimal with low rates of urate-lowering therapy initiation and target uric acid levels being achieved. GPs play an important role in primary care-led management of gout and in helping to improve patient outcomes.

Key Points

  • Gout is a common inflammatory condition with increasing prevalence in Australia and globally.
  • Diagnostic assessment modalities for gout have expanded to include ultrasonography and dual-energy CT.
  • Urate-lowering therapy (ULT) is the cornerstone of management and allopurinol remains first-line therapy due to its effectiveness, tolerability and low cost.
  • Lower starting doses are required for patients with moderate to severe renal impairment.
  • Prophylaxis with anti-inflammatories (for three to six months) is recommended during up-titration of ULT.
  • Gout management is based on a ‘treat to target’ approach focused on uric acid levels. However, suboptimal therapy is common due to lack of patient and physician education, poor adherence to therapy and infrequent uric acid monitoring.
  • Patient education is paramount for adherence to ULT.
  • The use of nurse- and pharmacy-led care, technology and increasing primary care awareness have been shown to improve patient outcomes.