Gout pain

A new study from the UK documents that the rates of gout seem to be significantly rising over the last 10+ years.  Interestingly the vast majority of patients in that study are still not being treated for their gout.  As a rheumatologist this is disappointing.  Here is what you need to do if you could possibly have gout:

1. Make sure you actually have the diagnosis.  Labs are generally not enough.  Either fluid from a joint affected by gout or very subtle ultrasound findings read by a trained physician can make this diagnosis. Why do you need to make this diagnosis firmly? Well treatment is very different if you have gout or another cause for your arthritis.

2. If you do in fact have gout, the 3 main food groups you must avoid or minimize are the following:

-shellfish

-red meat

-alcohol

In fact, even among gout patients who have well controlled uric acid levels by lab testing, they can still flare up if they are dietary non-compliant.

3. Medical treatments: If you have more than 1-2 flares per year, evidence of damage in the joints, ultrasound evidence of gout crystals lining your joint, or a uric acid level greater than 8 despite dietary compliance, you should be on a medication to lower your blood uric acid level.  If not, the chances of more frequent gout flareups and progressive damage to the joints rises.

Lastly, who should you see for your gout? Well like anything else in medicine, it depends. I would say see someone who knows the ins and outs of gout treatment really well.  See someone who feels comfortable treating gout with all available medications, including the newer treatment options.  See someone whose aim it is to prevent progression, not just suppress symptoms with anti-inflammatory medications.  If you’re not sure if you’re treatment accounts for all of the above issues, ask your physician or obtain a second opinion.

 

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