Review in Brief: Optimizing Gout Management

May 15, 2015

Expert rheumatologists examine patterns of treatment failure in gout, in light of six recent guidelines on the condition. This brief slide show based on their review summarizes basics about the guidelines and the clues to optimal treatment, linking to the review itself.

In a recent review, expert rheumatologists examine patterns of treatment failure in gout, in light of six recent guidelines on the condition. Here, basics about the guidelines and the clues to optimal treatment are summarized in a few slides.Links to the published review and other resources appear in the slide captions.

No fewer than six recent guidelines exist to describe optimal treatment for gout. Yet a high proportion of patients fail to reach target uric acid levels? Why? These authors examine the question and review the guidelines.Eric Wise and Puja P. Khanna. The impact of gout guidelines. Current Opinion in Rheumatology. 2015;27:225â230 doi:10.1097/BOR.0000000000000168

Six guidelines for gout care have been issued since 2002, from the Dutch general practitioners, EULAR, ACR, British and Japanese societies, and a multinational effort. These are reviewed in the next slide.Eric Wise and Puja P. Khanna. The impact of gout guidelines. Current Opinion in Rheumatology. 2015;27:225â230 doi:10.1097/BOR.0000000000000168

As this slide shows, the guidelines agree on some major issues in management, and there are many points of commonality among most of them on matters of medication and even dosage.Eric Wise and Puja P. Khanna. The impact of gout guidelines. Current Opinion in Rheumatology. 2015;27:225â230 doi:10.1097/BOR.0000000000000168

Differences between the guidelines center around the best use of various treatments: COX-2 inhibitors, pegloticase, and febuxostat.Eric Wise and Puja P. Khanna. The impact of gout guidelines. Current Opinion in Rheumatology. 2015;27:225â230 doi:10.1097/BOR.0000000000000168

Despite the general consistency among guidelines, many patients are not treated optimally. A survey in the UK showed that only a third of people with gout had ever received urate-lowering therapy.Cottrell E, Crabtree V, Edwards JJ, Roddy E. Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice. BMC Family Practice; 2013;14:170. doi: 10.1186/1471-2296-14-170.

A similar survey showed comparable results in the United States.Harrold LR, Mazor KM, Negron A, et al. Rheumatology (Oxford); 2013 Sep;52(9):1623-9. doi: 10.1093/rheumatology/ket158. Epub 2013 Apr 25.

Almost no gout patients are fully adherent with guideline recommendations, according to one study. Rheumatologists are more adherent than primary care doctors in their own adherence to guideline recommendations. But still they are far from perfect.Oderda GM, Shiozawa A, Walsh M et al. Postgraduate Medicine. 2014 May;126(3):257-67. doi: 10.3810/pgm.2014.05.2774. erm=24918810

Why do so many patients not meet gout treatment standards? They're overwhelmed, says this review, and under-counseled. Also, many physicians are not consistent themselves in monitoring and treatment.Eric Wise and Puja P. Khanna. The impact of gout guidelines. Current Opinion in Rheumatology. 2015;27:225â230 doi:10.1097/BOR.0000000000000168

Strategies for optimizing treatment: Monitor until the patient meets target urate levels, use febuxostat as first-line therapy, and use prophylaxis to avoid flares during treatment start-up.Eric Wise and Puja P. Khanna. The impact of gout guidelines. Current Opinion in Rheumatology. 2015;27:225â230 doi:10.1097/BOR.0000000000000168

Febuxostat is as effective as allopurinol, less expensive, and avoids allopurinol's safety risks.Eric Wise and Puja P. Khanna. The impact of gout guidelines. Current Opinion in Rheumatology. 2015;27:225â230 doi:10.1097/BOR.0000000000000168

The bottom line: Both doctors and patients must understand that gout is a chronic condition, not just a series of acute problems that need to be managed as they arise.