Most common errors in the treatment of gout

What are the most common errors in the treatment of gout?

George Nuki: I think that in general practice, first of all, the diagnosis is not always correct. And I think it is really quite important to try and make the diagnosis with some certainty. You do not want to put patients on a lifelong treatment with a drug which may have small possibility of side effects if they have not got gout. There are some suggestions that there are more people being treated with allopurinol who do not have gout than there are patients who actually have gout. This is because a lot of people maybe have an episode of back pain and they have a biochemical profile done, the only thing that shows up is a high urate level, and they are told that their back pain is due to gout. Of course, it was not due to gout at all. That is an important error.

I think another important error is that in general practice, one thinks of gout as being a recurring acute problem and does not think that it actually has an underlying chronic inflammatory disease associated with the deposition of crystals. We have to change our mindset about that.

I think the next problem is that the patients are often put in general practice on 300 mg of allopurinol and they go away. One study that we did looking at 2.5 million patient records in general practice in Germany and another 2.5 million in the United Kingdom showed that less than 10% of patients who were given allopurinol ever even had a second uric acid level measured. How can you treat to target if you do not actually measure the target? Measuring the target, treating to target is very, very important.