Understanding and improving the use of allopurinol in a teaching hospital

Abstract

SUA concentrations were not routinely measured in the majority of admitted gout patients taking allopurinol. Without SUA measurements and allopurinol dose titration, patients with SUA > 0.36 mmol/L are at increased risk for acute attacks of gout in hospital.

Key barriers to gout care: a systematic review and thematic synthesis of qualitative studies

“…Some providers felt insufficiently trained to provide gout care and education and felt there was a need for improved or continuing medical education [13,23,28,38]. Many were not aware of or did follow any gout management guidelines [13,28,34,38].…”

“…Some providers felt insufficiently trained to provide gout care and education and felt there was a need for improved or continuing medical education [13,23,28,38]. Many were not aware of or did follow any gout management guidelines [13,28,34,38]. Gout was sometimes treated as an acute condition rather than a chronic disease [33]; treatment of acute gout was considered satisfying, as most patients would respond to treatment [23], and providers assumed that patients preferred this approach to taking long-term medication [13].…”

“…To treat acute gout attacks, physicians reported prescribing NSAIDs, colchicine or CSs [23,34,38]. Attack frequency was cited as the main reason for prescribing ULT [13,23,28,38,37]. Very few GPs mentioned tophi as an indication for FIG.…”

“…so they don't understand that this is a long-term therapy.' [28] Adhering to lifestyle advice '[Lifestyle changes] good at the beginning and then they get complacent and fall off the wagon and they tend not to care about diet afterwards.' [34] Feeling frustrated when treating patients 'At the end of the day, you can only do so much with medication.…”

“…first-line) ULT [13,23,38,34], and starting doses ranged from 50 to 300 mg [23,34,38]. Although this was sometimes adjusted based on SUA level, clinical symptoms and renal function [23,28,34], only half of the GPs in one study reported up-titrating allopurinol [38]; moreover, non-rheumatologists hesitated to exceed a dose of 300 mg [13,28]. Anti-inflammatory medication was sometimes prescribed alongside initial ULT [23,28,38,33,37], although others did not add this prophylactic treatment [38,37].…”