Treatment and management of gout

Gout can be controlled with early and ongoing treatment, including:

  • establishing a definitive diagnosis
  • providing rapid pain relief for flares
  • preventing flares and complications.

Flares and complications can be managed by reducing risk factors for hyperuricaemia (dehydration, obesity and alcohol intake), taking urate-lowering medications to keep uric acid levels low, and managing comorbid conditions, such as high blood pressure, chronic kidney disease, diabetes and heart disease.

Guidelines for the treatment and prevention of gout, including the American College of Rheumatology, European League Against Rheumatism, and the 3e Initiative (Multinational Evidence, Expertise, Exchange) suggest early treatment, use of pharmacological and non-pharmacological treatment, and patient education, including advice on diet and lifestyle [1,2,5].

The use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose colchicine and oral/intra-muscular/intra-articular glucocorticoids has also been found to be effective in managing acute gout. It has been recommended that people with gout should continue urate-lowering therapy for the rest of their lives [4].

Hospitalisations

Data from the AIHW National Hospital Morbidity Database (NHMD) show that, in 2014–15:

  • 6,724 hospitalisations had a principal diagnosis of gout (25 per 100,000 population)
  • 80% of all hospitalisations for gout were for males (5,359 hospitalisations), compared to 20% for females (1,365 hospitalisations)
  • hospitalisation rates increased with age and was highest for people aged 85 and over (237 per 100,000 population).

Figure 1: Rate of hospitalisation for gout, by sex and age, 2014–15

The vertical bar chart shows that the hospitalisation rates for the principal diagnosis of gout increased with age and was highest for people aged 85 and over.

Source: AIHW National Hospital Morbidity Database (Data table).

The age-standardised hospitalisation rate for Australians with gout increased in the 10 years from 2005–06 to 2014–15: from 20 hospitalisations per 100,000 population to 25 per 100,000 population. There was a slightly larger increase for females (29%, from 7 to 9 per 100,000 population) compared with males (26%, from 34 to 43 per 100,000 population).

References

  1. Graf SW, Whittle SL, Wechalekar MD, Moi JHY, Barrett C, Hill CL et al. 2015. Australian and New Zealand recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion in the 3e Initiative. International Journal of Rheumatic Diseases 18:341–351.
  2. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T et al. 2012. American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care & Research 64(10):1431–1446.
  3. NCCH (National Centre for Classification in Health) 2012. The international statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM), Australian Classification of Health Interventions (ACHI) and Australian Coding Standards (ACS), 8th edn. Wollongong: University of University of Wollongong.
  4. Perez-Ruiz F, Herrero-Beites AM & Carmona L 2011. A two-stage approach to the treatment of hyperuricemia in gout: the “dirty dish” hypothesis. Arthritis & Rheumatism 63(12):4002–4006.
  5. Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda-Sanabria J et al. 2016. 2016 updated EULAR ecidence-based recommendation for the management of gout. Annals of the Rheumatic Diseases. doi:10.1136/annrheumdis-2016-209707.