Clinical Case Database / Category: Case Based Discussion

Fresh perspective on acute gout for foundation year doctors

Publication details

Dr Christine Fox, Dr Ray Armstrong, Dr Luke Sammut
Foundation Years Journal, volume 10, issue 9, p.26 (123Doc Education, London, October 2016)

Abstract

Once considered a "disease of kings" due to its association with an affluent lifestyle, gout is now one of the more common forms of inflammatory arthritis. Gout is the clinical manifestation of hyperuricaemia and crystal deposition in joints and soft tissue. This includes arthritis, tophaceous collections, uric acid nephrolithiasis and nephropathy. Most often, gout is understood to refer to the inflammatory arthropathy caused by uric acid crystal deposition (1). The disease is the commonest arthritis of middle-aged men, and prevalence increases with advancing age for both sexes (2). Gout results from the interaction between genetic susceptibility, constitutional components, and environmental triggers. In the UK, 7% of men aged over 75 are affected by gout. The overall prevalence of gout has been increasing, with one study reporting an increase of over 60% from 1997 to 2012 (3). This rise is possibly due to the shift in the population's diet and lifestyle, as well as increased longevity and improved medical care (3). Despite the significant rise in the number of people affected by gout, only around a quarter of people with prevalent gout were prescribed urate-lowering treatment (4). Left untreated, gout can develop into a painful and disabling chronic disorder. Persistent gout can destroy cartilage and bone, causing irreversible joint deformities and loss of motion (5). A more recent study also demonstrated suboptimal care in many aspects of gout management (6). Collectively, these results reflect widespread lack of knowledge of gout and poor alignment with current recommendations of best practice within the UK. In this review we aim to highlight to foundation year doctors the current evidence for the diagnosis and management of acute gout.

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Authors

Dr Christine Fox (Corresponding author)

Specialist Registrar in Rheumatology
University Hospital Southampton
Tremona Road
Southampton
SO16 6YD
christinefox@doctors.org.uk

Dr Ray Armstrong

Consultant Rheumatologist
University Hospital Southampton
Tremona Road
Southampton
SO16 6YD
ray.armstrong@uhs.nhs.uk

Dr Luke Sammut

Specialist Registrar in Rheumatology
University Hospital Southampton
Tremona Road
Southampton
SO16 6YD
lukesammut@yahoo.com

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