Optimal gout treatment requires ongoing monitoring for urate lowering therapy

Managing gout as a chronic, rather than an acute, condition could help prevent recurrences. A new study of more than 8,000 medical records found a positive association between starting treatment with allopurinol, a medication that helps prevent gout by lowering production of uric acid, and recurring doctor visits for the condition. Clinicians may therefore be more likely to offer allopurinol, or patients may be more likely to accept it, after multiple acute gout attacks. Specifically, while patients eligible for allopurinol at baseline were more likely to receive it than ineligible patients, time-varying covariates indicate a change in the strength of the association with each additional unit of time; for every additional month of follow up, the hazard ratio for allopurinol initiation in men increased by 0.007 (0.004-0.01). The authors suggest that more frequent chronic disease reviews to evaluate patients' preferences and eligibility for allopurinol could reduce barriers to successfully treating gout.

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Factors Influencing Allopurinol Initiation in Primary Care

Lorna E. Clarson, MBChB, MS, PhD, et al

Keele University, Keele, Staffordshire, UK

http://www.annfammed.org/content/15/6/557.full