17 Oct 2014 | Health Quality Intelligence
A new paper published in the New Zealand Medical Journal has examined treatments for gout in New Zealand and found only 23 percent of gout patients considered to require regular treatment were being treated according to best practice.
Gout is an extremely painful, potentially debilitating condition that affects over 4 percent of New Zealanders. Attacks of gout, caused by high blood urate levels, are readily preventable with regular use of the drug allopurinol, alongside frequent testing of blood urate levels.
The Atlas of Healthcare Variation (www.hqsc.govt.nz/atlas), published by the Health Quality & Safety Commission, looks for unwarranted differences in how New Zealand district health boards manage and treat gout. The new paper extends what the Atlas shows about gout treatment.
The paper reports that only 69 percent of all people dispensed allopurinol for gout were receiving it regularly, yet without regular use its benefits are limited. Also, the recommended six-monthly laboratory testing for blood urate levels in those taking allopurinol was only happening for 34 percent of people.
Around 1 percent of all gout patients were admitted to hospital with gout in any given year. Māori and Pacific people had 2.5 times more admissions than those identifying as European or Other yet were also less likely than these groups to regularly receive allopurinol.
Associate Professor Nicola Dalbeth, chair of the Commission’s expert advisory group on gout, says it is recommended a person who is having more than one acute gout attack per year take medication to reduce the amount of uric acid in the blood to prevent further acute gout attacks.
“The most common and well tolerated gout prevention medicine is allopurinol. However, these data show that in DHBs where gout is most common, proportionately less allopurinol was prescribed.
“Patients who take allopurinol regularly don’t need as many other medicines to treat gout and have lower rates of hospital admission. We don’t know how many people should be taking allopurinol but data suggest there are people for whom taking it would improve their health.
“Pacific and Māori populations had at least twice the rates of gout compared with the general population, affecting up to one third of those aged over 65 years. Pacific populations had the highest rates of hospital admissions from gout, followed by Māori. Improving preventive care may reduce the number of acute flares of gout that are so severe they require hospital admission.”
Gout is the most common form of inflammatory arthritis and is caused by high levels of uric acid in the blood. Acute attacks of gout can be extremely painful and disrupt work and home life. Tophaceous gout, a chronic form of the condition, causes bone and joint damage and musculoskeletal disability.
Symptomatic management of acute gout attacks includes non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and prednisone. These medications aim to provide relief of pain and inflammation symptoms only. Allopurinol reduces the amount of uric acid in the blood and prevents gout attacks and joint damage.
People who are experiencing more than one attack of gout per year or who have joint damage due to gout should be prescribed long-term allopurinol. If this is you, please discuss with your family doctor.