Letters Suboptimal prescribing in gout

Patient related factors are also important in treating gout

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e191 (Published 10 January 2012) Cite this as: BMJ 2012;344:e191
  1. Priyanka Chandratre, clinical research training fellow and honorary specialist registrar in rheumatology1,
  2. Edward Roddy, clinical senior lecturer in rheumatology and honorary consultant rheumatologist1,
  3. Christian Mallen, professor of general practice1
  1. 1Arthritis Research UK Primary Care Centre, Keele University, Keele ST5 5BG, UK
  1. p.chandratre{at}cphc.keele.ac.uk

The treatment of gout remains suboptimal—only 30% of primary care patients take urate lowering drugs.1 Lipworth and colleagues note that important reasons for this underuse include drug toxicity and poor patient adherence owing to the introduction of these drugs provoking gout attacks.2

However, the views and beliefs of patients about gout and urate lowering drugs also explain this poor uptake. From our experience of treating gout in primary and secondary care, patients are often reluctant to start taking this potentially lifelong treatment if they have access to non-steroidal anti-inflammatory drugs (NSAIDs) or colchicine to treat acute attacks when they arise. This behaviour may stem from a lack of understanding that urate lowering drugs prevent both recurrent attacks and long term irreversible joint damage.3 Clinicians should explain to patients the impact of these drugs on all aspects of gout, not simply prevention of acute attacks.

Our experience suggests that patients rarely re-consult after an acute attack of gout has been treated. Further acute attacks are often treated with NSAIDs (often purchased over the counter) or colchicine available on repeat prescription. The stigma attached to the condition may also deter patients from re-consultation.4 GPs may not be aware that patients are having recurrent acute attacks, denying them the opportunity to consider urate lowering drugs, tackle adverse lifestyle factors, and screen for cardiovascular risk factors in these high risk patients.5 After consultation in primary care with an acute attack of gout, we recommend that a further review is scheduled to consider these matters and explain the rationale for urate lowering treatment.

Irrational prescribing is one factor that leads to suboptimal management of gout but patient related factors should not be overlooked.

Notes

Cite this as: BMJ 2012;344:e191

Footnotes

  • Competing interests: None declared.

References

View Abstract