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A primary care practitioner can often manage gout without the patient having a consultation with a rheumatologist, but a consultation should be considered if the diagnosis is unclear, there is uncertainty as to whether or not to start uric acid-lowering medication, attacks continue to occur despite treatment, or possible medication side effects are making treatment difficult

113 Limitations include the lack of long-term follow-up to assess for the enduring nature of acupuncture treatment effects

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