New research led by doctors at King’s College Hospital NHS Foundation Trust, which reviews current treatments for gout, has revealed that only one in three patients in the UK received preventative medication within a year of diagnosis.
Gout is caused by a build-up in the blood of a substance called urate and is the most common form of inflammatory arthritis in the UK, affecting around 1 in 40 people. Those affected experience recurrent flare-ups of severe joint pain and swelling, which can lead to joint damage and impairment if undertreated or not treated at all. However, these flare-ups can be prevented with highly effective, low-cost medications which lower urate, and recent guidelines were introduced in 2016 and 2017 to encourage their prescription by doctors.
In light of the update to guidelines, King’s College Hospital researchers - Dr Mark Russell and Dr James Galloway - led a team of colleagues at the Trust, and researchers from Imperial College NHS Foundation Trust and King’s College London to evaluate the progress of care since its introduction.
Using the Clinical Practice Research Datalink, a health database of people registered at over 2,000 GP surgeries in the UK, the team found that prior to the guideline update just over a quarter of people with gout received urate-lowering medication to prevent future flare-ups. However, the guideline update resulted in only a modest improvement in prescription levels, with just over a third of people with gout receiving urate-lowering medication in 2020. The team also found that just one in six patients achieved the target blood urate level recommended by the British Society for Rheumatology.
The findings, published today in The Lancet Regional Health, suggest that gout care in the UK remains poor despite the updated guidelines. Other studies in this area have found that this problem is not just localised to primary care settings such as GP surgeries. Patients attending specialist clinics did not achieve the urate levels needed to prevent gout flare-ups and associated damage.
Lead author and rheumatology speciality registrar at King’s College Hospital, Dr Mark Russell said: “These results were quite surprising as the initiation of treatment is straightforward, and the medications we use to treat and prevent gout have been around for decades, and are inexpensive. Our data indicate that we have a lot more work to do. Strategies are needed to encourage the prescription of preventative medications in people with gout. For example, educational programmes could help to raise awareness about the importance of medications such as allopurinol in the prevention of recurrent flares and disability due to gout”.
Senior author and consultant rheumatologist at the Trust, Dr James Galloway added: “This study highlights the value of large datasets from primary care, and how applying analytical tools can uncover major challenges with the treatment of what are, in essence, very common inflammatory diseases. Reassuringly, these challenges are not so difficult to fix, and could have a huge impact on tens of thousands of people suffering from this condition across the country.”