Gout: Careful Management Leads to Excellent Outcomes

Painlive.com—August 20, 2012

Dr. Theodore R. Fields, director of the Rheumatology Faculty Practice Plan at Hospital for Special Surgery, discusses the causes, diagnosis, and treatment of gout.

Gout is one of the most painful forms of chronic arthritis. Successful treatment requires controlling the patient’s uric acid levels, proper selection of the appropriate individualized drug therapy, and patient education to ensure compliance.

Gout is an ancient disease, clearly described in writings from the time of Hippocrates. The pace of research and new publications in gout was relatively slow until about four years ago, but since then the rate of gout publications has dramatically increased.

Many of the principles of gout management that will be discussed here are old, but several new options for the management of difficult gout cases have been developed in the last few years, and a number of gout agents are currently in development. Use of these new strategies and new agents for gout will improve treatment outcomes. However, even more important to ensuring effective treatment of this condition is the more precise use of both older and newer agents, along with patient education and motivation.

The best news about gout is that we can assure our patients that if they are compliant with their medications, the long-term prognosis is quite excellent. In a five-year, long-term extension study of gout in which the patients kept their uric acid below 6.0, by the end of the third year the percentage of patients experiencing gout attacks was approximately 2%, and at five years it was 0%.1 This is an important fact for patients to realize early on in their gout treatment. This knowledge can help them stay the course and deal with the early phase of gout management, when they may actually have increased numbers of attacks.