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Gout: Undertreated and Mistreated
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Posted on: 04/10/2008
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Physicians and patients are often confused about when and how to treat gout. In this review article, Dr. P. A. Simkin from the division of rheumatology (University of Washington - Seattle) offers an update and an explanation for the control of gout.
Diagnosis is made with arthrocentesis and X-rays. Arthrocentesis refers to removing some of the fluid in the affected joint and analyzing it for the telltale urate crystals present in many cases of gout. The absence of these crystals does not mean the patient doesn't have gout. But the presence does confirm the diagnosis.
Diet is the first, and most important, key to preventing gout. It's clear that the increased number of food products containing high-fructose corn syrup is a factor. Since World War II (when foods were restricted), the number of cases of gout has increased every year.
Restricting carbohydrates, especially containing corn syrup may prevent this painful, arthritic condition. Restricting alcoholic beverages (especially beer) and limiting wine is also advised. Obesity is also a risk factor for gout. Some foods and beverages can help the body rid itself of excess uric acid (cause of gout). These include ascorbic acid (vitamin C), dairy products, and coffee.
For many years physicians have advised patients to avoid foods with high purine content. Increased purine results in an increase in the uric acid that causes gout. Too much intake of sweetbreads, anchovies, and lentils was considered part of the problem. But diet alone is not enough to control the arthritis associated with gout. Other approaches to treatment are also needed.
Aspiration (removing fluid from the joint) provides decompression. This means it takes pressure off the nerves and soft tissues around the joint. Pain relief and preventing infection are the main goals of aspiration. The pathway or track caused by needle insertion actually provides a vent for fluid to drain. It may prevent rupture of the joint capsule.
Urate lowering medications such as allopurinol or probenecid are used to lower urate crystal levels. Drugs can also help dissolve crystal deposits from the tissues. A nonsteroidal antiinflammatory drug is often prescribed to help with pain and reduce the risk of inflammation.
Once the gout is under control, patients often stop seeing the doctor. However, even people with well-controlled gout should have regular follow-up and education to reinforce the hows and whys of treatment. Periodic measures of serum uric acid concentration should be taken. The risk of flare-ups is less when the uric acid levels are low (below six mg/dL).
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References:
Peter A. Simkin, MD. Sharing Decisions in Gout: Better Communication for Better Outcomes. In The Journal of Musculoskeletal Medicine. March 2008. Vol. 25. No. 3. Pp. 116-123.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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