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Patients with gout should be treated early, new guidelines say

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New clinical guidelines for the management of gout emphasise the benefits of early treatment.

Published by the British Society for Rheumatology (BSR), the updated guidance is intended to be used by all UK doctors and allied health professionals in primary and secondary care who look after and treat patients with the condition.

Gout is a form of arthritis which is caused by a build-up of uric acid in the blood. This leads to small crystals forming in and around the joints, causing them to become inflamed and painful.

Treatments are available to help relieve the symptoms and prevent further attacks, and the new guidelines recommend that urate-lowering drugs should be offered to all patients with gout early in the course of their disease rather than waiting for them to develop troublesome, disabling symptoms.

Other recommendations are aimed at helping health professionals support their patients in managing their own condition through information — on managing acute attacks; continuing any established urate-lowering therapy during an attack; the causes and consequences of gout and hyperuricaemia; on healthy lifestyle choices to tackle the risk factors of alcohol consumption and obesity; and the rationale, aims and use of urate-lowering therapy to target urate levels.

BSR also suggests that all patients with gout should be screened for cardiovascular risk factors and co-morbid conditions such as cigarette smoking, hypertension, diabetes mellitus, dyslipidaemia, obesity and renal disease.

The full guidelines — available at http://www.rheumatology.org.uk/goutguideline — include specific recommendations for management of gout in patients with renal sufficiency, severe refractory tophaceous gout, and in pregnancy.

BSR said that it updated the previous guidance in response to increases in the incidence, prevalence and severity of gout; the availability of new pharmaceutical treatment options; continuing suboptimal management in both primary and secondary care; and better understanding of the barriers to effective care experienced by patients and providers.