Gout update.
For #doctors and #pharmacists in #Canada. An overview I wrote for The Medical Post/Canadian #Healthcare Network.

"Refresher on #gout: the only curable arthritis
Often only seen in crisis, patients with gout can be cured with the right treatment and follow-up.
By Pippa Wysong

Gout is the most common inflammatory arthritis, yet it is frequently underdiagnosed, misdiagnosed and often mistreated.

Yet, according to rheumatologist Dr. Jean-Philip Deslauriers, once patients are on the right treatment, it’s the only arthritis where a cure can be achieved.

“With other arthritis conditions, the goal is remission. But with gout one can get rid of the underlying disease and attain a cure,” he said. Dr. Deslauriers is a clinical professor of #medicine at the University of Sherbrooke and spokesperson for the Arthritis Society of Canada (ASC).

“Gout is easy to treat, and most cases can be managed by family #doctors,” told the Medical Post in an interview. Gout is a painful #arthritis caused by elevated levels of serum uric acid (UA), hyperuricaemia.

Prolonged hyperuricaemia (which is generally asymptomatic and can be present for years) leads to the deposition of monosodium urate crystals in synovial fluid and other body tissues. Eventually, neutrophils will venture into the joint to try to destroy the crystals (partly unsuccessfully) but end up triggering an episode of painful inflammation—a gout crisis in which patients present with inflamed, painful and swollen joints. Often, but not always, the affected joint is in the foot or ankle, especially the first metatarsophalangeal joint.

Crystals can also be deposited in other tissue and sometimes break through the skin creating yellowish-white nodules called tophi.

There are several reasons why gout can be missed. One is that symptoms are intermittent and it can take years for crystals to build up inside joints. A patient may present to an outpatient clinic or ER where acute symptoms are treated with colchicine, #NSAIDs, cortisone infiltration or prednisone for their acute crisis, and then sent home and told to see their family physician for follow-up.
Crisis and oft missed opportunity

But a crisis, in the early stage of the disease, tends to last for only three or four days. By the time patients see an FP, they feel fine and may not mention it—if they even have access to an FP.

“Often there is only management for the crisis itself. If we don’t address the underlying cause which is too much uric acid in their blood, crises will happen again, more intensely and more frequently. And the disease will affect more joints. Over time this can lead to deformity and erosion, possible crystal formation in soft tissue called tophi,” Dr. Deslauriers said.

According to the 2018 recommendations for gout by the European League Against Rheumatism (EULAR), several features need to be taken into account for a diagnosis. These are: monoarticular involvement of a foot or ankle joint; previous acute episodes; rapid onset of severe pain and swelling; erythema; being male and associated #cardiovascular diseases, plus hyperuricaemia.

For a definite diagnosis, crystals need to be seen in synovial fluid or tophus aspirates.

Both the EULAR and American College of Rheumatology (ACR) guidelines state that once gout is confirmed, treatment to lower UA levels can start even while the patient is in crisis

“This is a very important point because if not done when the patient is assessed during his acute crisis, it often isn’t done at all,’’ Dr. Deslauriers said...."

The rest of the story is on the site. Sorry, password protected for people in Canadian healthcare.

#MedMastoson #rheumatology

https://www.canadianhealthcarenetwork.ca/refresher-gout-only-curable-arthritis