AUDIT ON THE NON-PHARMACOLOGICAL MANAGEMENT OF THE GOUT -DO WE GIVE THE COMPREHENSIVE ADVICE AS RECOMMENDED BY THE GUIDELINES?

Background: The lifestyle management plays an important role in the management of Gout. The guidelines from the BSR recommends following advice: maintain ideal body weight, increase vegetable protein and reduce animal proteins, increase water intake thereby avoiding dehydration, reduce alcohol intake, avoid herbal medications, rest and elevate affected joints in a cool environment (Jordan et al 2007). More recently, it has been suggested that there are many opportunities to improve the lifestyle measures in the management of gout (Becker and Chohan). It was recommended by the BSR to assess the practice of health professionals educating patients on the importance of non-pharmacological treatment. Objectives: An audit to assess the adherence for the recommendations given by the British Society of Rheumatology (BSR) on the non-pharmacological management of Gout at a tertiary teaching hospital in the North West of UK. Methods: Data was obtained from the hospital records for all patients who had synovial fluid analysis confirming Gout from June 2007 to April 2009. Information regarding lifestyle advices were collected from case records and confirmed by direct clinic interviews and telephonic conversation. These patients had been previously admitted to the medical ward under General Physicians. Results: Total numbers of synovial fluid results confirming gout were 150. Data was collected for 49 patients (33%). Male to female ratio was 4:1. Hypertension was noted in 65% (n=32) of the patients, IHD in 45% (n=22) and DM in 19% (n=9). The number of patients seen by the Rheumatologists were 36% (n=18) and General Physicians were 64% (n=31). The patients who got a complete non- pharmacological life style advice were only 12% (n=6) and were advised by the Rheumatologists. Number of patients who received advice on life style change is summarized in the table. RecommendationsNumbersPercentages Weight reduction2246% Alcohol intake2859% Protein source1736% Avoid dehydration2757% Herbal remedies410% Rest joint2144% Avoid trauma1532% Conclusion: The lifestyle advice in the management of the Gout was not provided as per to the recommendations given by the BSR. Advices given were incomplete in most patients; Rheumatologists fared better than General Physicians. There were variability in the advice given and some of them such as optimization of alcohol and water intake were given more commonly than the others such as avoiding herbal medicines and trauma. Reinforce the importance of non-pharmacological management in Gout as complementary to drugs. As an important portion of patients are seen by General Practioners and General Physicians it is important to improve the understanding of Gout management amongst all doctors and other team members involved in the clinical care by formal and informal teaching, introducing flow charts and check lists in outpatient clinics and medical wards. To provide Gout information leaflet to patients to improve self care. References: 1. Becker M.A and Chohan S. Current Opinion in Rheumatology, March 2008, 20/2: 1040-8711 2. Jordan KM, Cameron JS, Snaith M, Zhang W, Doherty M, Seckl J, Hingorani A, Jaques R, Nuki G. On behalf of the British Society for Rheumatology and British Health Professionals in Rheumatology Standards, Guidelines and Audit Working Group (SGAWG). Rheumatology, May 2007, 10: 1093-1095 Disclosure of Interest: None declaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 610Session: Bone diseases other than osteoporosis, metabolic diseases and crystal diseases (Poster Presentations )