Treating Gout in the Primary Care Setting

JULY 24, 2015
MD Magazine staff

In the MD Insights program “The ‘Disease of Kings:’ Addressing Misperceptions and Treating Gout Effectively Now and in the Future,” Theodore R. Fields, MD, professor of clinical medicine at Weill-Cornell Medical College, and director of the Rheumatology Faculty Practice Plan at Hospital for Special Surgery, discusses gout diagnosis, misperceptions about the disease, and the consequences of undertreatment of this condition. He also reviews current gout treatment options and discusses potential future treatments.
There are several misconceptions about gout treatment commonly held by primary care physicians, including the tendency to manage gout attacks as intermittent episodes rather than as a chronic disease.
Dr. Fields said that it’s not uncommon for primary care providers to think that allopurinol shouldn’t be given in doses higher than 300 mg. “They may have learned that when they were residents, that it’s risky to raise allopurinol dose, but the reality is that we’re allowed to go up as high as 800 mg of allopurinol and if a patient is not getting to the uric acid goal with the 300 mg dose, they really should be raised,” he said,
Studies have shown that only 42 percent of patients get to goal with allopurinol 300 mg. Too many primary care physicians start their gout patients on allopurinol 300 mg and then never go back and recheck the uric acid levels. “It’s really important for doctors to feel that‑‑just like for hypertension where we have a blood pressure goal, for diabetes we have a hemoglobin A1C goal‑‑for gout we have a goal of uric acid of less than 6 or less than 5 with tophi, and you’ve got to push the medicine. And if they don’t get there with allopurinol you switch them to febuxostat.  But one way or another you need to get that patient to that uric acid goal.”

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