11 steps to becoming a gout master

Thursday, 23 Apr 2015

A panel of local gout experts have interpreted international guidelines to come up with 11 key recommendations for the diagnosis and management of gout.

Dr Scott Graf from Royal Adelaide Hospital said a key strength of the national guidelines was that they were based on international evidence yet reflected an awareness of local issues.

In particular the guidelines are tailored to the medications available in Australia and New Zealand, which Graf says is important in the treatment of gout.

“It comes down to availability and funding and that’s why interpretation of the available evidence by Australian and New Zealand  rheumatologists — all of whom were picked because they have an interest or sub speciality in gout– it becomes quite useful,” he said.

“For example we don’t have easy access to febuxostat so recommendations that list drugs that we don’t have easy access to is of less use”, he added.

Key recommendations:

1. For a definitive diagnosis urate crystals must be demonstrated in synovial fluid or in the tophus.

2. Synovial fluid should be analysed by polarized light microscopy as soon as possible.

3. NSAIDs, low-dose colchicine and oral / intramuscular /intra-articular glucocorticoids are all effective in management of acute gout.

4. Allopurinol is the first-line urate-lowering therapy. Probencid, benzbromarone or febuxostat can be used as second-line urate-lowering therapy according to the clinical context.

5. In patients with renal impairment allopurinol should be started at a low dose and escalated to achieve target urate.

6. A target serum uric acid of <0.30mmol/L is recommended when tophi are present, otherwise <0.36 mmol/L is sufficient.

7. Prophylaxsis should be used routinely to reduce the risk of flare when urate-lowering therapy is initiated.

8. Tophi are a definite indication for intensive urate-lowering therapy. Surgery is not necessary in most cases.

9. There is insufficient evidence to recommend treatment of asymptomatic hyperuricemia with or without baseline renal impairment.

10. Healthy lifestyle advice should include maintenance of ideal body weight and avoidance of excess alcohol, sugar sweetened drinks and other known triggers.

11. Screening for cardiovascular risk factors, diabetes and renal disease should be undertaken.

For more information and level of evidence access the full recommendations here. 

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