A recent study conducted by SingHealth Polyclinics (SHP) has revealed that nearly 30% of patients visiting SHP clinics have poorly controlled gout, with Malay individuals, men, and patients with heart conditions being at a higher risk of struggling to manage the condition effectively.

The research, which analyzed the medical records of nearly 8,000 gout patients across eight SingHealth Polyclinics—Bedok, Bukit Merah, Outram, Marine Parade, Pasir Ris, Punggol, Sengkang, and Tampines—between 2018 and 2019, highlights significant gaps in treatment and medication management.

Key Findings of the Study:

• Poor Management of Gout: Patients with poorly controlled gout experienced two or more attacks annually and received a clinical diagnosis of gout.

• Underprescription of Allopurinol: Despite its crucial role in reducing uric acid levels, over half of patients with poorly managed gout were not prescribed allopurinol. Only 13% received adequate doses (≥300 mg).

• Comorbidities: Gout patients commonly had high blood pressure (79%), high cholesterol (73%), and diabetes (29%) – significantly higher than the general population. Interestingly, those with hypertension or diabetes managed their gout better, likely due to medications like losartan and SGLT-2 inhibitors that also lower uric acid.

• Heart Conditions and Gout: Patients with congestive heart failure faced greater difficulties in gout control, as diuretics prescribed for fluid management can increase uric acid levels.

Insights from Experts:

“Our findings show that specific groups, including Malay men and those with higher uric acid levels, are particularly vulnerable to poorly managed gout. Socioeconomic factors could contribute to these disparities, but further research is needed to clarify this link,” shared Dr. Prawira Suartha Oka, Family Physician at SHP-Marine Parade and lead author of the study.

Dr. Oka added, “Many patients remain untreated or inadequately treated due to concerns about side effects, particularly with allopurinol. This gap in care highlights the need for improved prescription practices and patient education to better manage gout.”

A Comprehensive Approach to Gout Management
To address these challenges, SingHealth Polyclinics has introduced several initiatives:

1. Refresher Training for Doctors: Enhancing knowledge of gout management among junior and new doctors.

2. Team-Based Care: Regular patient reviews to ensure appropriate allopurinol prescription and dosage adjustments.

3. Care Manager Support: Nurses work with patients on lifestyle changes, including diet, hydration, and exercise habits.

4. Dietary Consultations: Collaboration with dietitians to help patients identify and avoid gout-triggering foods.

5. Health Pals Assistance: Helping patients schedule appointments and tests to monitor uric acid and kidney function.

“About one in three gout patients in our study struggle with effective management, which places them at risk for painful flare-ups. By implementing team-based care and focusing on patient empowerment, we aim to reduce this burden and improve health outcomes,” said Clinical Associate Professor Tan Ngiap Chuan, Director of Research at SHP and Vice-Chair of Research at SingHealth-Duke NUS Family Medicine Academic Clinical Programme.

Leveraging Technology for Better Patient Care
Prof. Tan further revealed that SHP is developing an AI-powered tool to improve patients' understanding of gout management and self-care practices. This innovative tool aims to empower patients with knowledge and strategies to manage their condition effectively, potentially reducing the frequency and severity of flare-ups.