CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Gout - Management
When is referral recommended in someone with gout?
- Admit the person if septic arthritis is suspected.
- Seek specialist advice when:
- The diagnosis is uncertain.
- There is a suspicion of an underlying systemic illness (e.g. rheumatoid arthritis or connective tissue disorder).
- Gout occurs during pregnancy or in a young person (under 25 years of age).
- Allopurinol or febuxostat is at maximum dose but a person is still having recurrent attacks of gout.
- A person has persistent symptoms during an acute attack despite maximum doses of anti-inflammatory medication (alone or in combination).
- An intra-articular steroid injection is indicated but the facilities or expertise are not available.
- Complications are present, including urate kidney stones, urate nephropathy, or troublesome tophi.
Basis for recommendation
These recommendations are based on published expert opinion, pragmatic advice 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 recommendation regarding febuxostat is based on the Summary of Product Characteristics [ABPI Medicines Compendium, 2010].
- Many people with gout have comorbidities, so close monitoring for adverse effects and deteriorating renal function is needed. A referral to secondary care or further specialist advice may be advisable if the person is inadequately controlled on routine medication or there are contraindications to starting treatment.
© NHS Institute for Innovation and Improvement