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Abstract
Gout is a type of inflammatory
arthritis which can cause
recurrent episodes of acute
pain and joint inflammation.
Epidemiological
studies show it is 2-6 folds
more common in men than in
women. It is caused by raised
serum uric acid levels which,
when gets deposited in joints
and tissues can cause significant
pain and morbidity. Untreated
gout can cause permanent joint
damage. Hyperuricemia can
also cause urate nephropathy
and renal stones. It is associated
with other cardiovascular
diseases.
Risk
factors include male sex,
obesity, genetics, purine
rich food, alcohol, certain
medications, chronic kidney
disease, hypertension and
diabetes mellitus.
Gout
can present as rapid onset
pain and swelling of any joint,
predominantly of the first
metatarsophalangeal joint.
Tophi can present as painless,
nodules on extensor surfaces
of joints or other body parts.
Diagnosis
is by identification of uric
acid crystals in joint fluid
aspirates.
Management
involves modifying risk factors,
treatment of acute attacks
using non- steroidal anti-inflammatory
drugs, colchicine, steroids
and long-term prophylaxis
medications. Prophylaxis is
based on treat to target approach
and involves urate lowering
drugs like allopurinol, febuxostat.
There are other newer drugs
available in secondary care.
Despite
the availability of effective
prophylactic medications to
lower uric acid levels, the
prevalence of gout is increasing.
It stresses the importance
of patient education as well
as initiating urate lowering
drugs in patients presenting
with recurrent attacks and
those with other co-morbid
risk factors.
The
aim of this article is to
provide an overview of gout
and its management in primary
care. We, as authors also
highlight the importance of
patient education and empowerment
in better understanding of
their disease and adherence
to long term management. We
also strongly advocate starting
urate lowering therapy for
at risk patients by primary
care physicians. This will
not only prevent future gout
attacks, but also reduces
long term complications like
joint damage, tophi, renal
stones, renal impairment and
reduce the risks of cardiovascular
disease.
Key
words: Gout, inflammatory
arthritis, hyperuricemia,
urate lowering therapy, prophylaxis
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