Improving the management of gout

Abstract

Gout has been referred to in the past as “the king of diseases and the disease of kings”, as Pascal Richette and Thomas Bardin write in their Seminar in The Lancet today. However, the perception of the disease among the public and the way in which the condition is currently managed in the clinic has not befitted this grand reference. The public often consider gout—the most common inflammatory arthritis in men in developed countries—to be solely a self-inflicted ailment caused by excessive consumption of alcohol and rich food. Meanwhile, treatment for gout has not been optimum because many practitioners confuse the management of acute gout and hyperuricaemia. Furthermore, because gout is an ancient disease (it was first described by the Egyptians in 2640 BCE), it has not been a high priority for the pharmaceutical industry when compared with rheumatoid arthritis. Combined, these factors have meant that gout has been somewhat neglected. However, this situation is changing. There are now guidelines for the management of gout from the European League Against Rheumatism (published in 2006) and the British Society for Rheumatology and British Health Professionals in Rheumatology (published in 2007). These deserve wide reading and dissemination among physicians, particularly general practitioners, especially because the prevalence of gout is likely to increase in the future, as risk factors, such as metabolic syndrome and obesity rise. As Richette and Bardin highlight, patients' education is one important area in the management of gout that can be improved. For example, patients with hyperuricaemia should be told that they need to be cautious about what they eat and drink. Patients need to know that they can manage acute attacks with colchicine or non-steroidal anti-inflammatory drugs, because early initiation of therapy increases effectiveness. And patients with recurrent gout taking allopurinol to lower their urate concentrations also need to be aware that they should not stop use of the drug if they have an acute attack. The effective management of gout requires good communication with patients, so that patients can better manage their condition themselves. GoutGout is a common arthritis caused by deposition of monosodium urate crystals within joints after chronic hyperuricaemia. It affects 1–2% of adults in developed countries, where it is the most common inflammatory arthritis in men. Epidemiological data are consistent with a rise in prevalence of gout. Diet and genetic polymorphisms of renal transporters of urate seem to be the main causal factors of primary gout. Gout and hyperuricaemia are associated with hypertension, diabetes mellitus, metabolic syndrome, and renal and cardiovascular diseases. Full-Text PDF