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GOUT: the most curable joint disease is the worst treated

GOUT: the most curable joint disease is the worst treated

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By Dr Irwin Lim, Rheumatologist

This afternoon, I attended a symposium on this at EULAR 2012 and the title was a good one. Hence, this post written in most part, while I was listening to the talk.

I want to concentrate on the concept that gout is potentially curable.

Perfectly curable for the majority of patients.

Gout is also the most prevalent inflammatory joint disease in the world.

But so, so poorly treated and managed.

It's also terribly frustrating to treat.

Gout patients, mainly men, are typically really non-compliant. The contributing factors of weight and diet can be addressed but often men are not prepared to make the changes. For Australian men, the "elephant in the room" - alcohol, alcohol, alcohol - is often neglected.

And yet, we have very effective agents already.

Once the acute attack is settled using whatever anti-inflammatory agent your doctor may choose (choices include colchicine, NSAIDs/Cox 2 inhibitors, steroid, etc), the aim needs to shift to reducing the amount of uric acid in the body (too much uric acid leads to increased crystal depositing in the joints which at times lead to the horrible inflammation typical of a gout attack).

The most useful agent to lower this uric acid is Allopurinol and it is effective.

Allopurinol is unfortunately used poorly with most general practitioners just prescribing a fixed dose, typically 300mg daily. What should happen is the dose should actually be increased to suppress the level of uric acid measurable on blood tests to an appropriate level (I typically aim for a serum urate <0.36 mmol/L).

I am not trying by any means to be comprehensive in this post in discussing treatment protocols and options.

What I hope to highlight is that gout is eminently treatable.

To be able to actually tell a patient that you can cure their arthritis (in most cases) is a really satisfying thing.

So, if you or a friend/family member has gout, it's time to actually get it sorted out.

Why live with a disease that is potentially curable?

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