Of late, many medical journals are abuzz with articles & studies focusing on suboptimal care of & the negative perceptions of gout (among patients as well as health care providers).
In fact, Annals of Rheumatic diseases, a reputed rheumatolgy journal, has published a review ‘gout: why is this curable disease so seldom cured?’
1) Gout is now the most common inflammatory arthritis & is in fact more common than Rheumatoid arthritis. The increasing incidence has been blamed on increasing life expectancy, lifestyle factors & use of medicines especially diuretics.
2) Gout is often looked at as an episodic ailment causing short term discomfort. However it is a chronic disease & failure to understand this results in recurrent episodes.
3) Urate lowering therapy (Allopurinol, Febuxostat) can trigger a fresh attack of gout. This should not be considered as a failure of therapy.
4) Urate lowering therapy is not started during an acute attack.
5) The bigger picture of gout is often forgotten. Gout is associated with hypertension, metabolic syndrome. Hyperuricemia & gout are independent risk factors for cardiac & kidney ailments. Due consideration of the bigger picture is required from the medical professionals.
6) Once Urate lowering therapy is started, regular followup is a must even in the absence of fresh attacks. Treatment is titrated to achieve a serum Uric acid level less than 6 mg/ dl.
Gout: why is this curable disease so seldom cured? Doherty M et al Ann Rheum Dis 2012;71:11 1765-1770
Patient and provider barriers to effective management of gout in general practice: a qualitative study. Spencer K et al Ann Rheum Dis 2012;71:1490-1495