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Gout - Management
What follow up is needed in someone with recurrent episodes of gout?

  • If the person is taking allopurinol, check the serum uric acid (SUA) level and renal function every 3 months in the first year, then annually, and aim for a SUA level below 300 micromol/L.
  • If the person is taking febuxostat, use clinical judgement to decide if liver function tests need to be retested periodically after starting treatment.
  • If the person is still having frequent attacks of gout despite achieving the target SUA level:
    • Assess compliance with prophylactic medication and increase the dose appropriately.
    • Review any trigger factors such as medication (e.g. diuretics), trauma, diet, weight gain, and excess alcohol consumption.
    • Provide a home supply of medication to use during an acute attack to minimize the impact on the person's functioning.
  • Review cardiovascular risk factors and provide ongoing lifestyle advice. For more information, see the CKS topic on CVD risk assessment and management.
    • In a person with hypertension, stop diuretics during an acute attack and change to an alternative antihypertensive. For more information, see the CKS topic on Hypertension - not diabetic.
    • In a person with heart failure, continue diuretics during an acute attack. If using a nonsteroidal anti-inflammatory drug (NSAID) for pain relief, monitor renal function closely. For more information, see the CKS topic on Heart failure - chronic.
  • Consider referral to secondary care, if the person is still having attacks despite all these measures.
Basis for recommendation

The recommendations regarding allopurinol recommendations are based on the best available evidence and a guideline produced by expert representatives of the British Society for Rheumatology (BSR). The evidence supporting the BSR recommendations is based on a systematic review of literature [Jordan et al, 2007]. The recommendations regarding febuxostat are based on the Summary of Product Characteristics [ABPI Medicines Compendium, 2010].

  • If a person is still symptomatic despite optimum management in primary care, refer for specialist advice as other urate-lowering agents (sulfinpyrazone, benzbromarone, or probenecid) may be tried or combined by a specialist.

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