Gout
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Unit Supplement 2
November 2024
This edition of check considers the diagnosis and management of gout in general practice.
Gout is a chronic condition characterised by sudden and severe pain, swelling, redness and tenderness in one or more joints. It most commonly affects the first metatarsophalangeal joint, although other joints, including the ankle, knee, fingers and wrist, can also be involved.
As one of the most prevalent inflammatory joint diseases globally and within Australia, gout imposes a significant health burden through the pain, limitations on activity and disability associated with it. Self-reported prevalence rates in Australian adults range from 4.5% to 6.8%. It is more commonly found among males and specific ethnic groups, including M膩ori and Pacific Islander peoples. There is a lack of data regarding the prevalence of gout in Aboriginal and Torres Strait Islander peoples; current figures are likely to be underestimates because of underdiagnosis and low rates of self-reporting.
Despite the high occurrence, gout remains significantly undertreated. The stigma surrounding it discourages patients from seeking or adhering to treatment. This undertreatment results in unnecessary pain, disability and a diminished quality of life for many patients.
Australian general practice data report that fewer than 60% of patients diagnosed with gout receive urate-lowering therapy. Another local study has observed that fewer than 10% of patients prescribed allopurinol for gout are co-prescribed colchicine on initiation for flare prophylaxis. Furthermore, fewer than 50% of Australian patients on therapy appear to achieve target serum uric acid levels.
Current Australian guidelines recommend a treat-to-target approach for urate-lowering therapy, with a target of <0.36 mmol/L for non-tophaceous and <0.30 mmol/L for tophaceous gout.
For Australian general practitioners, conducting a comprehensive review of gout management is critical to improving patient care outcomes. The impact on patients and their families is substantial, underscoring the need for an evidence-based approach in primary care settings. It is essential for healthcare providers to bridge these gaps in practice and ensure that gout is treated effectively, alleviating the burden on individuals and the healthcare system.
At the end of this activity, participants will be able to:
Jeffrey, aged 42 years, presents with intense pain in his right big toe. You diagnosed gout, using joint aspiration, at a similar presentation 12 months ago and explained possible treatment options. At that time, he was not open to starting urate-lowering therapy as a lifelong treatment.
Irene, an Elder aged 66 years from a regional town approximately a one-hour drive away, attends your clinic. She has intense pain and swelling in her left knee and reports that it is interfering with her ability to sleep, walk and drive. She thinks the pain is from her existing osteoarthritis and requests a cortisone injection, which has successfully controlled this type of pain in the past.
Marvin, aged 53 years, comes to see you today because of persistent pain in his right ankle and right large toe over the past three days. He has been a patient at your practice for the past five years, and his notes show that he emigrated from China 15 years ago. Marvin does not require an interpreter.
Tama, a M膩ori man aged 28 years, has come to your practice with acute pain in his left big toe. He has an antalgic gait pattern and is wearing thongs. He explains that the pain is so bad he cannot put on a sock. Tama is worried about missing his rugby league semi-finals, which are being played this coming weekend.
Brian, a retired bricklayer aged 68 years, presents to the practice with an antalgic gait. He is experiencing severe pain in his right knee and is finding it difficult to move about.
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Each unit of check comprises approximately five clinical cases, and the choice of cases will cover the broad spectrum of the unit’s topic. Each unit will be led by a GP with an interest and capability in the topic, and they will scope the five different cases for that unit in collaboration with the check team.