5 Gout Counseling Pearls Clinicians Should Share with Patients

A growing number of patients with gout may be seeking convenient pain relief at retail clinics, as a research letter recently found that cases of gout have been steadily increasing, even as cases of rheumatoid arthritis have been decreasing.

“The findings may reflect suboptimal care received by gout patients and its increasing prevalence,” read the letter published inJAMA. “The gout findings suggest the need to improve care and prevention.”

As of 2013, approximately 8.3 million individuals in the United States (3.9%) have gout pursuant to chronic hyperuricemia, making it the most common inflammatory arthritis. The aging patient population and increasingrates of obesity—which happen to be 2 main gout risk factors—indicate that the number of patients with gout will likely continue to grow.

According toguidelinesreleased by the American College of Rheumatology in 2012, patient education is essential and must cover diet, lifestyle, treatment objectives, and management of comorbidities.

As the gout population grows, clinicians should make sure to talk about the following pieces of information and advice.

1. Bouts of early gout ebb and flow

Patients should know that pain associated with gout can come and go unpredictably.

In about half of patients, onset starts with a severely inflamed big toe. Early flares may also occur in the midfoot, ankle, heel, or knee. Later flares may move to the wrist, fingers, and elbow.

Patients may report pressure sensitivity so severe that touching the joint as lightly as possible still spurs great pain. Others may report fever, chills, and malaise.

Untreated gout flares can last days to several weeks, then wane, and then recur again.

2. Foods with purine are best avoided

Gout is caused by hyperuricemia, an uncontrolled metabolic disorder that leads to the deposition of monosodium urate crystals in cell tissue and too much uric acid in the blood. Uric acid is the metabolic product resulting from the metabolism of purines that are naturally found in many foods, such as organ meats like liver from any animal source and several types of fish, including anchovies, sardines, herring, and trout.

Clinicians can encourage patients with gout to enjoy berries and lemons instead.

Allberriesare naturally filled with antioxidants, which help repair cell damage. Cherries in particular also have anthocyanin and bioflavonoids, which can help alleviate arthritis pain.

Lemons are filled with vitamin C, which is known to help strengthen tissues in the body and neutralize uric acid. Lemonade counts, as long as it contains real lemons.

3. Avoid alcohol

Excessive alcohol intake is one of the most common risk factors for patients with gout because it interferes with uric acid clearance.

Decreasing alcohol consumption is generally seen as one of the main lifestyle changes that will help alleviate gout pain, so clinicians should be sure to recommend it to patients.

If a patient must consume alcohol, then the best option is wine, according to clinical guidelines. Beer, on the other hand, is specifically cited as an alcohol to avoid because it increases patients’ uric acid levels and reduces the body’s ability to clear the substance from its system.

4. Maintain a healthy weight

Being overweight or obese rounds out the top 3 risk factors for gout.

If patients lose weight following an initial attack, then their serum rate levels may normalize without antihyperuricemics. Eating well and exercising are 2 lifestyle changes that promote a healthy weight and normal blood sugar levels; therefore, they should always be recommended to patients.

5. Comorbidities must be managed properly

Patients who fail to effectively manage their comorbidities may experience more severe gout symptoms.

Diseases associated with gout include chronic kidney disease, hyperlipidemia, hypertension, metabolic syndrome, and type 2 diabetes.