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Practical tips and information for managing patients with Gout
During an acute gout attack
- The recommended first-line treatment in an acute attack is a nonsteroidal anti-inflammatory drug (NSAID) you should
begin this as soon as possible. A recommended regimen is naproxen 500 mg, repeated after 8 – 12 hours, then twice daily
on the following day, tapering the dose as the attack resolves.1
- A corticosteroid or colchicine are second-line options if NSAIDS are contraindicated/ not tolerated. 2,3
- Drug treatment to prevent recurrent attacks of gout (e.g. allopurinol) should never be started during an acute attack;
they are usually started with NSAID cover 1–2 weeks after complete resolution of the attack.2 Allopurinol
should be continued during an acute attack if the person is already established on this treatment. Please see BPJ
issue 51 for further information on allopurinol dosing.
NB: Serum urate levels can be misleadingly low during an acute attack so this is not a good time to measure.
People with gout should be encouraged to: maintain an ideal weight, exercise moderately (but rest, elevate and cool
joints during an attack), include low fat dairy, soy, vegetable sources of protein and foods high in vitamin C in their
Gout in New Zealand
Gout is a common form of inflammatory arthritis that is caused by an inflammatory response to monosodium urate (MSU)
crystals, which form in the presence of high urate concentrations.
Many factors contribute to hyperuricemia (high levels of serum urate), including: genetics, insulin resistance, hypertension,
renal insufficiency, obesity, diet, use of diuretics and consumption of alcohol. The prevalence of gout in New Zealand
is approximately 4% in adults ≥20 years, with higher rates in Māori (6%) and Pacific peoples (8%).1,5
Table one below shows the estimated prevalence rates in New Zealand adults (those aged ≥ 20 years) in 2013.
Table 1. Prevalence rates of Gout in New Zealand adults, 2013
||Estimated prevalence of gout in NZ population (%)4,5
|NZ population ≥ 20 years
Urate lowering treatment is beneficial in people who experience recurrent attacks of gout, e.g. two or more attacks
in one year, and people who have tophi, renal impairment or changes characteristic of gout on x-ray.5 Treating
to achieve a target serum urate level of 0.36 mmol/L (or lower if clinically indicated) is associated with improved clinical
outcomes for people with recurrent gout.1
Sample practice data
Measuring serum urate levels when initiating anti-gout therapy
NICE guidelines recommended that serum uric acid levels are monitored every three months while establishing new long
term anti-gout treatments, then annually thereafter.3 For most patients aim for a serum uric acid level below
< 0.36 mmol/L.1
Sample Medical Centre had 14 patients initiate a new anti-gout medicine in 2013,
i.e. a dispensing of allopurinol, benzbromarone or probenecid and no long term anti-gout therapy in the preceding four
months. N.B. Data not available for febuxostat, as this is not funded.
of these patients had their serum uric acid levels checked within four months of starting this medicine.