Mismanagement of Gouty Arthritis Not Uncommon

Monday April 9, 2007

Gouty arthritis is characterized by sudden onset of severe pain, tenderness, warmth, redness, and swelling from inflammation of the affected joint. Gout usually affects a single joint and most often the big toe is affected (i.e. podagra). The knee, ankle, foot, hand, wrist, and elbow may also be affected. Shoulders, hips, and spine may eventually be affected by gout, but rarely. Although gouty arthritis is not considered a difficult disease to diagnose and gout treatments are very effective in most cases, errors in the management of gout are common.

According to a report in the April 2007 issue of ACP Medicine (American College of Physicians), one study has shown that 23 percent of gout patients with recurrent attacks had "inappropriate therapy". Another study revealed that 18 of 46 patients were given allopurinol doses which were too high. Other problems regarding treatment prescribed for some gout patients include:

Failure to adjust the initial dose of allopurinol in patients with impaired renal function.
Failure to adjust doses to prevent drug interactions.
Treating patients who had asymptomatic serum uric acid elevations.
Failure to monitor serum uric acid levels to ensure the target level was met.

On the last point, Shaun Ruddy, M.D. (the author of the report) claims that data shows only one third to one half of gout patients on allopurinol have serum urate levels measured within 6 months of starting the medication, which is considered a quality of care standard. Too often allopurinol is deemed a failed treatment when the failure is actually in monitoring and attaining the proper dose. Febuxostat, a new gout medication, is expected to be FDA approved soon and will expand treatment options.

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