Persistent aim definition8/9/2023 Searches were performed on Medline and PubMed using the terms ‘gout’, ‘hyperuricaemia’, ‘hyperuricemia’, ‘tophi’, ‘monosodium urate’, ‘therapy’, ‘management’, ‘treatment’ and all possible synonyms. patient and physician barriers to optimal gout care, and suggested approaches practical for Australian GPs to overcome these barriers.inconsistencies in the levels of evidential support in current guidelines contributing to uncertainty in treatment.Patients with gout are typically managed longitudinally by general practitioners (GPs), 14 who are often underexposed to this literature. 12Įxcepting the American College of Physicians’ statement, 13 evidence-based guidelines for gout are rheumatologist-generated and disseminated in rheumatology journals. 11 Therapy is effective when adhered to however, adherence in chronic gout is the lowest among seven chronic diseases. Urate-lowering therapy optimally reduces serum uric acid levels below the solubility constant for urate (48 µmol/L or 6.8 mg/dL) and, with long-term adherence, may place the patient in remission from gout and resolve tophi. Treatments indicated in the management of chronic gout include education, diet and lifestyle changes, pharmacotherapy for acute flares and long-term urate-lowering therapy for repeated episodes and CTG. Hyperuricaemia and gout have been associated with increased risk of cardiovascular events in a variety of populations 3–9 urate-lowering therapy either has no increase in risk, 10 or may lower risk, 4 of cardiovascular events. Gout is associated with metabolic syndrome, nephrolithiasis, cardiovascular disease and chronic renal impairment. 2 Gout often recurs and, when inadequately treated, may progress to chronic tophaceous gout (CTG) and joint damage. Risk factors include increasing age, genetic factors, purine-rich foods, alcohol, diabetes and diuretic use. 1 The pathogenesis of gout is clearly understood. The prevalence of medically diagnosed gout in adult Australians may be as high as 5.2%.
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