title: Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations.
abstract: OBJECTIVE
  To assess concordance of the management of chronic gout in UK primary care with the European League Against Rheumatism (EULAR) gout recommendations.
  
  
  METHODS
  A postal questionnaire was sent to all adults aged >30 years registered with two general practices. Patients with possible gout attended for clinical assessment, at which the diagnosis was verified clinically. Aspects of chronic gout management, including provision of lifestyle modification advice, use of urate-lowering therapies (ULT) including dose titration to serum urate (SUA) level, prophylaxis against acute attacks, and diuretic cessation were assessed in accordance with the EULAR recommendations.
  
  
  RESULTS
  Of 4249 (32%) completed questionnaires returned, 488 reported gout or acute attacks and were invited for clinical assessment. Of 359 attendees, 164 clinically confirmed cases of gout were identified. Advice regarding alcohol consumption was recalled by 59 (41%), weight loss by 36 (25%) and diet by 42 (29%). Allopurinol was the only ULT used and was taken by 44 (30%); 31 (70%) were taking 300 mg daily. Mean SUA was lower in allopurinol users than non-users (318 vs 434 micromol/l) and was less often >360 micromol/l in allopurinol users (23% vs 75%). Eight patients had recently commenced allopurinol; two of these also were taking prophylactic colchicine or non-steroidal anti-inflammatory drugs. Of 25 patients with diuretic-induced gout, 16 (64%) were still taking a diuretic.
  
  
  CONCLUSIONS
  Treatment of chronic gout is often suboptimal and poorly concordant with EULAR recommendations. Lifestyle advice is infrequently offered, and allopurinol is restricted to a minority. Persistent hyperuricaemia was often seen in allopurinol non-users, but was also in allopurinol users, suggesting that doses >300 mg are often necessary.
authors.affiliation: Academic Rheumatology, University of Nottingham, UK. e.roddy@cphc.keele.ac.uk
authors.forename: Edward
authors.initials: E
authors.lastname: Roddy
authors.forename: Weiya
authors.initials: W
authors.lastname: Zhang
authors.forename: Michael
authors.initials: M
authors.lastname: Doherty
mesh_terms: D000328:Adult; D000493:Allopurinol / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002908:Chronic Disease; D003078:Colchicine / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004739:England / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D006073:Gout / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006074:Gout Suppressants / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014527:Uric Acid / Q000097:blood; D014528:Uricosuric Agents / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004232:Diuretics; D006074:Gout Suppressants; D014528:Uricosuric Agents; D014527:Uric Acid; D000493:Allopurinol; D003078:Colchicine