Gout continues to be a problem in New Zealand, particularly in Māori and Pacific populations. In a recent paper, authors report higher use of NSAIDs in Māori and Pacific people compared with other groups, and a higher rate of hospital admission due to gout in Pacific people.1
NSAIDs are effective for control of flares but don’t lower high serum urate; at the same time, they increase the risk of CVD, gastric inflammation and kidney damage.
There has been the suggestion that preventive urate lowering medication such as allopurinol should be started after a second attack, however recent advice encourages consideration being given to starting after a first attack.2
Allopurinol must be started at a low dose of 50-100 mg (depending on renal function) and up-titrated over a few months to avoid flares and allergic reactions.3