Management of Hyperuricemia and Gout

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 Management of Hyperuricemia and Gout

Experts emphasize the need for
indigenous treatment guidelines

KARACHI: An experts meeting which was attended by physicians, rheumatologists, orthopaedic surgeons and Diabetologists held here at the CPSP Campus on September 15th 2015 has emphasized the need for indigenous treatment guidelines for the management of Hyperuricemia and Gout. Prof. Austin G.Stack MD, Professor and Chair of Medicine at University Hospital Limerick, Graduate Entry Medial School, University of Limerick Ireland was the guest speaker at the meeting organized by PharmEvo Pharmaceuticals and it was moderated by Dr. Masood Jawaid, Director Medical Affairs in PharmEvo.

The discussion started with a question do we need indigenous guidelines for the management of these disorders to which Prof. Kamran Hameed from Ziauddin Medical University opined that it was much more needed because of variability of care being provided to patients.  It was also important to note as to who is providing the treatment and where. There was a need for somebody to monitor it.  We in Pakistan are not used to follow the rules. Pathways in guidelines are already available in the literature. We need to look at what are the priorities for Pakistan. We cannot say that alcohol is bad but we can emphasize that it is one of the risk factors.  Dr. Masood Jawaid remarked that guidelines are always evidenced based.


PharmEvo organized a discussion session of experts to look into the possibilities of forming
indigenous guidelines on Management of Hyperuricemia and Gout. Prof. Austin Stack
from Ireland was the guest speaker. Picture shows the session in progress.

It was also stated that with higher uric acid, the threshold will change. Higher uric acid should be given some importance. Work up on a patient with high uric acid should be a routine investigation in patients suffering from cardiovascular diseases. Prof.Ejaz Ahmad Vohra opined that we must collect some data. One of the participants remarked that insurance companies have lot of useful data. They charge more premiums from those who have high uric acid and some other risk factors. They also take into consideration smoking, eating habits, drinking which vary in different parts of Pakistan. Prof.Waris Qidwai Chairman of Family Medicine at Aga Khan University said that it was an excellent initiative. Majority of the healthcare was provided by family physicians and GPs. Hence the focus of these guidelines should be on Family Physicians and we need to organize some Continuing Medical Education (CME) programmes for them in this regard.

Participating in the discussion Prof.Shahid Noor from Liaquat National Hospital remarked that it is important to create awareness among the public as well as healthcare professionals about the risk of high uric acid. Just like high blood pressure, high blood sugar, high uric acid is also bad for health. Prof.Austin remarked that getting together a group of like minded people in itself was a great achievement which needs to be commended. Someone should steer this group. Primary care physicians are very important. This group should go through the literature and for every country the great challenge was how to get these guidelines implemented once they are formulated, he remarked.

Implementation of the guidelines and quality assurance, it was further stated, are extremely important. To begin with we must have some baseline data. Then we should undertake education, documentation of knowledge and experience. Education of our peers as well as primary care physicians, both was important. We need to develop a strategy for good governance. We should find out what is doable which is always different from what is desirable and what is ideal. Dr.Rashid Nasim from Darul Sehat Hospital remarked that there is a tendency for high uric acid and it must be taken seriously by the primary care physicians. Prof. Kamran Hameed said that in the practice of rheumatology the most abused investigationsinclude ASOT, Uric Acid and RA factor. Let us review the literature.  For t treating non-gout Hyperuricemia we must have some evidence otherwise people will point fingers at Pharma industry initiated management guidelines. Dr.Rashid Naseem said that Vitamin D deficiency and hypocalcaemia is often treated without any evidence. It is important that clinical evidence should be collaborated with Hyperuricemia.

Mr.Jamshed Ahmad Chief Operating Officer of PharmEvo pointed out that they were already selling their drug very well and they have no interest to promote the drug. This was not a marketing gimmick. We are interested to update the knowledge and build their professional capacity as we feel no one else is doing anything in this field.  However, we in PharmEvo feel that it is our duty to organize such CME meetings and no one should ever doubt our intentions. We need to audit the quality of care being provided to patients.

Mr. Shaukat Ali Jawaid Chief Editor Pulse International remarked that Pakistan Association of Medical Editors (PAME) has been collaborating with PharmEvo for the last many years promoting the art of medical writing, scientific publishing by organizing workshops and symposia in different medical institutions all over the country.  We have always upheld the professional ethics and what to talk of mentioning the name of PharmEvo or any of their products; we even do not allow them to display their logo. They have never interfered in our scientific programme despite the fact that they arrange for all the logistics and sponsor all these programmes including the travel of facilitators. PharmEvo is known as an ethical pharmaceutical company and they have always lived upto this image, he remarked.