SLR - October 2013 - Riquel Gonzalez
Reference: Carlos Lavernia. Management of Gout. A 57-year-old Man with History of Podagra, Hyperuricemia and Mild Renal Insufficiency. JAMA 2012; 308(20);2133-2141.
Scientific Literature Review
Reviewed by: Riquel Gonzalez, DPM
Residency Program: Mercy Hospital, Miami, FL.
Podiatric Relevance: This article is important for podiatrists because despite the significant advances in the understanding of gout’s risk factors, etiology, pathogenesis, prevention and treatment, its incidence is increasing. It is more often accompanied by comorbid conditions like chronic kidney disease and diabetes mellitus, which represent a challenge for the management of gout.
The authors of the article were attempting to answer the following clinical questions: Does the patient really have gout? How should attacks of gout be prevented? Which urate-lowering therapy is best, and how should it be prescribed? How should gout be monitored? When should a patient with gout be referred to a specialist?
Methods: This article is base on a case study and literature review.
Results: Frequent gout attacks are a clear indication for urate-lowering treatment. Therefore education regarding risk factor modification, treatment goals, and prognosis are essential. It is important to evaluate the adequate treatment of gout attacks, its prevention with major risk factor modification, anti-inflammatory medications, choosing a urate-lowering medication therapy and patient monitoring.
Conclusions: Although urate-lowering treatment is usually lifelong, patients who make major life style changes and control their comorbid conditions could eventually discontinue treatment. For those with moderate to severe gout, urate-lowering treatment can eliminate acute attacks of arthritis and prevent complications. In the future, new risk factors for gout will be identified and a new way of preventing and managing this common disease will become available.
From my point of view, I conclude that the treatment for gout is a combination of different factors including education regarding risk factor modifications, treatment goals, and prognosis. One must also consider appropriate choice of a urate-lowering therapy, combined with accurate patient monitoring, identification of new risk factors, and control of existing comorbid conditions.
The information that this article provided could help foot and ankle surgeons in treatment of patients with gout, who we encounter in our practices every day. We need to understand that the treatment of gout is not only prescribing a urate-lowering medication or anti-inflammatory, but also educating the patient about risk factor modification and evaluate the comorbid conditions that often accompany gout, including chronic kidney disease and diabetes mellitus. It is also important to know when and where to refer the patient to a specialist.