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How to improve treatment of gout


Dr Geraldine M McCarthy 

MD, FRCPI, Clinical Professor of Medicine, Consultant Rheumatologist

Gout is much more prevalent than many believe. One in 40 people in the UK live with the condition which is the most common form of inflammatory arthritis worldwide.

60% of the adult population in Ireland is classified as either overweight or obese. Since being overweight or obese is a risk factor for gout, it is of little surprise that the prevalence of gout is so high in Ireland. 

“Indeed, gout diagnoses are steadily increasing… particularly as the obesity epidemic progresses,” says Professor Geraldine McCarthy, Consultant Rheumatologist at the Mater Misericordiae University Hospital, Dublin. 

“When the kidney is malfunctioning, it cannot remove uric acid from the body efficiently. This excess uric acid then accumulates in your joints as hard, needle-shaped crystals which inflame the lining of the joint (the synovium). The result is severe, painful swelling and redness of the joint”.

Breaking down the stigma and shame

Professor McCarthy believes more needs to be done to address the stigma around this painful and increasingly-common condition.

“Unfortunately there is a stigma associated with gout. The stereotypical individual with gout is one who is greedy, consuming too much alcohol, eating too much rich food and is overweight,” says Professor McCarthy.

“Some people become embarrassed to go to the doctor as they feel it will reflect badly on them. However, left untreated, gout can lead to joint and/or kidney damage, permanent disability and an increased risk of death by heart attack or stroke.” 

Effective treatment of gout

Medication and lifestyle changes such as exercise, weight loss and cutting down on alcohol can reduce, or ultimately stop, recurrent gout attacks. However, Professor McCarthy highlights the need to avoid common misconceptions about treatment for gout. 

“It is incorrect that if you are receiving urate-lowering therapy (such as allopurinol or febuxostat) that you should stop the drug if you get an acute gout attack… even doctors get this one wrong sometimes,” she says.

“Also, when patients start urate-lowering therapy, they are initially at an increased risk of gout attacks. Therefore, to prevent these attacks early on in their treatment, we recommend them to take additional medication such as colchicine consistently for three, six and sometimes nine months, depending on the amount of crystal deposition there is throughout the body,” says Professor McCarthy.

Potential for misdiagnosis

Often, people who report persistent pain in the big toe, without swelling and redness and have high uric acid in the blood are diagnosed with gout, when these symptoms could actually be osteoarthritis and not gout.

The gold standard for diagnosis is to take a small sample of fluid from the affected joint and analyse it using a polarised-light microscope. Although the process is ‘very easy’, according to Professor McCarthy, misdiagnoses can still occur. 

Acute calcium pyrophosphate crystal arthritis or ‘pseudo-gout’ can cause similar attacks, but it’s calcium crystals that are deposited in the joint rather than urate crystals.

Professor McCarthy encourages patients to consult their doctor if they exhibit symptoms of gout. “If you don’t confirm what type of crystal it is, you can make the wrong diagnosis and then give the wrong treatment.”  

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