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Bones and joints

Treatment of gout and how to improve it

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. Gout is the most common form of inflammatory arthritis worldwide. Treatment of gout must be quick and correct.

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

“Indeed, gout diagnoses are steadily increasing as is treatment of gout… 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. These crystals 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.

“Gout unfortunately has a stigma associated with it. 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. Left untreated, gout can lead to joint and kidney damage, permanent disability. Similarly, it can cause an increased risk of death by heart attack or stroke.” Treatment of gout is essential.

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.

Potential for misdiagnosis within treatment of gout

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.Treatment of gout and osteoarthritis differs greatly.

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. This can lead to giving the patient the wrong treatment of gout.”

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