Intended for healthcare professionals

Rapid response to:

Practice From Drug and Therapeutics Bulletin

Latest guidance on the management of gout

BMJ 2018; 362 doi: (Published 18 July 2018) Cite this as: BMJ 2018;362:k2893

Rapid Response:

Re: Latest guidance on the management of gout

As with the response from Dr Charkin, as a GP I frequently see patients with gout who have cardiovascular risk factors. As mentioned in the article some drugs increase the risk of gout, and at a population level the commonest are low dose aspirin and diuretics. Often these can reduced or stopped, or changed to alternatives that do not increase urate levels such as clopidogrel (instead of aspirin), or are known to uricosuric such as amlodipine or losartan (typically instead of thiazide diuretics.

Also it has been shown that atorvastatin 40mg will lower uric acid levels by 12.5% whereas simvastatin 40mg did not.(1)

I believe that we should offer these simple therapeutic options to our patients rather than adding in specific uric acid lowering therapy.

1. Am Heart J. 2004 Oct;148(4):635-40.
Effects of statin treatment on uric acid homeostasis in patients with primary hyperlipidemia.
Milionis HJ1, Kakafika AI, Tsouli SG, Athyros VG, Bairaktari ET, Seferiadis KI, Elisaf MS.

Competing interests: No competing interests

11 August 2018
john s ashcroft
Old Station Surgery Ilkeston