Treatment of gout 

 Summary points 
 What is gout 
 Treatment of gout 
 Indications for Uric acid lowering therapy 
 Lifestyle interventions 
 Pharmacists have a key role in the care of people with gout 
 Prevalence and impact of gout 
 References 
 Issue 8 Contents  		  PDF
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KEY ADVISER
Dr Nicola Dalbeth, Rheumatologist and Senior Lecturer, Department of Medicine, University of Auckland
ACKNOWLEDGEMENTS
We are grateful to Dr Peter Gow and Dr Doone Winnard for their review of this article.

Summary points

  1. Gout is a major cause of arthritis in New Zealand, with high rates of severe disease in Māori and Pacific patients
  2. Gout causes significant disability in Māori and Pacific men of working age
  3. All patients with gout should have cardiovascular disease (CVD) risk assessment, and intensive management of modifiable risk factors
  4. Long-term preventive therapy with allopurinol is critical for effective gout management:
    • Prescribe early, before development of tophi
    • Monitor serum uric acid levels
    • Aim for target serum uric acid <0.36 mmol/L
    • Introduce gradually: ‘start low and go slow’
    • Use colchicine prophylaxis
  5. Minimise diuretic therapy in patients with gout
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Comments recieved about this article

12 September 2008
Comment from:
Stephen Hoskin		We are often told that diuretic therapy is a risk factor for gout and stop treatment in patients with gout. However there is evidence to suggest the association may be confounded by cardiovascular risk. [http://ard.bmj.com/cgi/content/full/65/8/1080] I find I often have patients with poorly controlled hypertension who 'cannot' take bendrofluazide because of previous gout. I especially wonder about such a contraindication in patients who have successfully lowered their uric acid using allopurinol. Could we not restart bendrofluazide and check their uric acid does not rise above 0.36mmol/L?

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