The gout patient in general practice.

A study of the clinical profile of gout-diagnosed patients was undertaken within general practice in Great Britain. At the time of the first attack of acute gouty arthritis, the mean age was 52.3 years and 15.6% of the total 1077 patients were female. Males had an earlier clinical onset than females and the average frequency of attacks of acute gouty arthritis was 0.91 per patient year. Ten per cent of the cases were believed to be secondary gout, with diuretic therapy the most frequent cause. The sample showed a highly significant association between gout and the higher social classes, a family history among blood relatives in 23% of cases, tophi were noted in 4.6% of cases where sought and 38.2% of cases were 10% or more overweight and significantly heavier than a non-gouty population. The great toe joint was most frequently involved, both in the first episode and in all acute episodes combined. The most frequently occurring associated chronic condition was hypertension which was present in 27.8% of cases. Renal stones occurred in 6.1% and renal impairment in 2.2%. Only 20.4% of the patients were referred to hospital, with the younger being referred more frequently than the older. Those with joint involvement other than the great toe had a greater chance of being referred, as did those who also had angina pectoris, myocardial infarction and hypertension. Allopurinol appeared to be the drug of choice for long-term control therapy and phenylbutazone for the acute attack.