Gout can be managed in primary care without specialist rheumatological input. However, NICE points out that only a third of people with gout are given appropriate medication, and of these only a third use the medication effectively. Chronic kidney disease may contraindicate some medicines.[1]

Several drugs for treating gout are considered urate lowering therapies (ULTs) which eliminate urate crystals, prevent flares, shrink tophi and prevent long-term joint damage.

Allopurinol and febuxostat are xanthine oxidase inhibitors, reducing uric acid production, and are the core ULTs in NICE guidelines.

Other ULTs may not be readily available in the UK or not be licensed to treat gout. Probenecid (discontinued before 2015) inhibits tubular reabsorption in the kidney increasing uric acid elimination in urine.[5,13]

Sulfinpyrazone and benzbromarone (via unlicensed specials supply) are also uricosuric, promoting the excretion of uric acid, but tend to be reserved for people who cannot use xanthine-oxidase inhibitors.[14]

Fenofibrate has been found to lower uric acid concentrations by 20% and reduce the risk of a gout attacks.[15]