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Practice From Drug and Therapeutics Bulletin

Latest guidance on the management of gout

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2893 (Published 18 July 2018) Cite this as: BMJ 2018;362:k2893

Rapid Response:

Re: Latest guidance on the management of gout

Thank you for publishing this useful review of the management of gout.

I am a GP and have seen patients present with acute gout shortly after bariatric (gastric sleeve) surgery, which, it seems, is not uncommon (1). In all cases the patient had achieved substantial, rapid weight loss following the surgery. What would be the optimal management of an acute episode of gout in such a setting? Is there a substantial increase in the risk of a gastric perforation, ulcer or bleed with oral NSAIDs or oral/parenteral/intra-articular corticosteroids in the presence of a fresh/healing large surgical scar even with the co-administration of a PPI? Giving colchicine (a mitotic poison) also sounds unappealing to someone with a fresh, healing visceral scar who is also accommodating to the change in gastrointestinal function following reductive stomach surgery.

Anticipating such a possibility in patients with a known history of gout and optimising serum urate levels prior to surgery sounds sensible, but I am unable to find any supporting evidence.

1. Friedman JE, Dallal RM, Lord JE. Gouty attacks occur frequently in postoperative gastric bypass patients. Surg Obes Relat Dis 2008;4(1):11-3

Competing interests: No competing interests

04 August 2018
Stephen Longworth
GP
The CY O’Connor Village Medical Centre, 2/11 Erade Drive, Piara Waters, 6122 Western Australia