Clinical update

Gout

Updated guidance on this painful inflammatory condition says patients should be offered treatment earlier.

Updated guidance on this painful inflammatory condition says patients should be offered treatment earlier

gout
Patient education is important in the management of gout. Picture: iStock

Essential facts

Gout is the most common cause of inflammatory arthritis worldwide. Incidence and severity is increasing in the UK, with about 2.5% of the population affected. It can be a very painful and debilitating condition, yet management continues to be poor. Inadequate information for patients is one of the key barriers to improvements in care.

What’s new

Patients should be offered treatment earlier in the course of their disease and given better education about the condition, according to updated guidance. The British Society for Rheumatology’s guideline on the management of gout says health professionals should not wait for patients to develop disabling symptoms before prescribing urate-lowering therapies. Persistent myths that the condition can only affect men and is entirely self-inflicted through lifestyle may be preventing people seeking early diagnosis and treatment, the guidance says.

Signs and symptoms

Gout most commonly affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers, causing severe pain. The joint will often be swollen, hot and very tender, and the skin red and shiny. Symptoms develop rapidly over a few hours and typically last three to 10 days. The condition can also cause tophi, or lumps under the skin, stones in the kidneys and urinary tract, renal disease, bursitis and cellulitis.

Causes and risk factors

Gout is caused by a buildup of urate (uric acid) in the blood which forms crystals in and around affected joints. The condition mainly affects men over 30 and women after the menopause. It is more common in men than women. Risk factors include obesity, high blood pressure, diabetes, kidney problems, family history and drinking too much alcohol and sugary drinks. Eating foods such as red meat, offal and seafood also increases risk.

How you can help your patient

Patient education is very important in the management of gout. Inform patients that attacks should be treated as soon as possible and any established urate-lowering treatment continued. Provide verbal and written information about the causes and consequences of gout and hyperuricaemia, how to manage acute attacks, lifestyle advice about diet, alcohol consumption and obesity, and the aims and use of urate-lowering treatment.

Expert comment

jenkinsWendy Jenkins is a senior research nurse in the gout study team at the University of Nottingham

‘Gout is very common but unfortunately it’s not usually taken seriously and therefore it is often under-treated. An attack of gout causes severe inflammation of a joint, which is extremely painful and debilitating. Over time these attacks become more frequent and spread to involve other joints. As gout is the only curable chronic joint disease and is usually easily managed with urate-lowering therapy it makes sense to treat the condition appropriately.

Educating the patient and discussing treatment options with every patient who has a diagnosis of gout is very important. Many patients need support when commencing treatment with urate-lowering therapy, one of the reasons being that this may initially cause an increase in gout attacks in some patients.

With the correct training, nurses would be ideally placed to improve the care of patients with gout.’


 

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