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Management Of Chronic Gout – A Delphi (Consensus) Consultation Of UK-Based Clinical Experts


• Gout is a serious, chronic, progressive and life-limiting condition associated with pain, physical disability, numerous comorbidities, a reduced quality of life, and an increased risk of mortality. It is the most common type of inflammatory arthritis and is caused by hyperuricaemia (elevated serum uric acid [sUA] levels), which results from the (over-)production and inefficient renal excretion of uric acid.
• Clinical guidelines relevant to the United Kingdom (UK), e.g. the British Society of Rheumatology (BSR) and European League Against Rheumatism (EULAR) guidelines, recommend a treat-to-sUA-target approach.
• Allopurinol (a xanthine oxidase inhibitor [XOI]) is recommended for first-line treatment of chronic gout in the UK. In patients who cannot tolerate allopurinol, or whose renal impairment prevents sufficient allopurinol dose escalation, treatment with febuxostat (an XOI) is recommended. Uricosurics are seldom available for second-line treatment in a primary care setting in the UK.
• Several treatment aspects that are pertinent to the management of gout in the UK lack consensus. Hence, this research aimed to derive consensus among UK clinical experts on treatment paradigms and disease progression to support the health technology appraisal (HTA) of a new second-line uricosuric.

Authors: Garth Baxter, Ernst Johannes, Jenny Lee, Natalie Aldhouse, Alastair Hepburn