Rheumatology Edition | What Everyone Should Know About Gout
Jan 9, 2024
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Join rheumatologists Lynne S. Peterson, M.D., and Clement J. Michet JR, M.D., as they dive into the painful world of gout. Discover the tricky symptoms and cutting-edge diagnostic tests that can clarify this condition. They discuss effective management strategies and the importance of medication alongside dietary changes. Learn about recent treatment innovations, including the latest guidelines and emerging therapies. With patient education at the forefront, this conversation unveils the crucial aspects of living with and managing gout.
Gout typically results from monosodium urate crystal deposition, causing severe pain during acute attacks and requiring effective management strategies.
Diagnosis involves a classic presentation and may need joint aspiration, emphasizing the importance of both acute care and long-term prevention.
Deep dives
Understanding Gout and Its Pathophysiology
Gout is primarily characterized by the deposition of monosodium urate crystals in joints, often resulting in severe pain, particularly in the big toe. This condition arises from increased uric acid levels due to either overproduction or under-excretion, with the latter accounting for 90% of cases. Risk factors include family history, metabolic syndrome, and certain medications, with women typically being less affected until menopause. Acute attacks often occur at night due to temperature changes and fluid shifts in the body, leading to a rapid onset of pain.
Diagnosis and Management of Gout
The clinical diagnosis of gout is typically based on the classic presentation and may require joint aspiration to confirm the presence of urate crystals. During an acute attack, serum urate levels can sometimes appear normal, so physicians should not discount a gout diagnosis based solely on lab results. Effective management includes addressing both acute flare-ups and long-term prevention, with nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids often recommended to control inflammation. Current guidelines suggest beginning urate-lowering therapy for patients experiencing frequent flares or those with significant joint damage.
Lifestyle Impacts and New Treatment Options
Lifestyle factors such as diet can influence gout attacks, although simply reducing uric acid through diet alone is often insufficient for those with hyperuricemia. Newer therapeutic options have emerged for chronic gout management, including xanthine oxidase inhibitors like allopurinol and febuxostat, with the latter reserved for patients intolerant to allopurinol. Pegloticase, a new genetically engineered treatment, shows promise but requires careful monitoring due to potential infusion reactions. These advancements underscore the importance of long-term treatment, as gout is a chronic condition that necessitates ongoing management to prevent future flares.
Rheumatologic problems are some of the most common health conditions we see as primary care professionals. In many cases, taking months and sometimes years to properly diagnose, rheumatologic conditions can become frustrating for both the provider and the patient. There are a variety of new tests available to help us establish a diagnosis, as well as multiple new and effective treatment options. This episode is the first of a seven-episode mini-series on Mayo Clinic Talks dedicated to rheumatologic health problems to aid in the recognition, diagnosis, and treatment for your patients. Please stayed tuned in future weeks for the next six episodes!
Gout is the most common inflammatory arthritis and is a result of the deposition of monosodium urate crystals in and around the joints. It’s typically a mono-articular arthritis and is more common in men. Many patients who have had an acute attack of gout say it’s the worst pain they have ever experienced. Management consists of both treating acute episodes as well as preventing future attacks. The topic of this podcast is “What Everyone Should Know About Gout” and our guests include Lynne S. Peterson, M.D., and Clement J. Michet JR, M.D., both rheumatologists from the Mayo Clinic. We’ll discuss the pathophysiology of gout, its typical presentation, how to establish a diagnosis and management tips.
Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
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