The American College of Physicians has issued new guidelines for the treatment of gout.
The new guidelines suggest that physicians should look to control gout with corticosteroids, nonsterodial anti-inflammatory drugs, or colchicine to treat patients with acute gout.
“Physicians should consider using corticosteroids first in patients without contraindications because they are one of the most effective anti-inflammatory medications available and they are as effective as NSAIDs for managing acute gout, but have fewer adverse effects,” said Nitin S. Damle, MD, MS, MACP, president, ACP. “Although a generic formulation of colchicine is now available, it is more expensive than NSAIDs or corticosteroids. This is an important consideration for patients, especially as prescription drug prices continue to increase.”
The ACP also recommended that if a physician decides to prescribe colchicine for acute gout, that they do so in a low dose. That’s because studies have shown that lower doses of colchicine are just as effective as higher doses, and lower doses reduce the risk of adverse side effects, which most commonly were diarrhea and gastrointestinal distress.
What Didn’t Make The Cut
The ACP decided that a couple of treatment options didn’t quite make the cut, and those choices have been ruffling some feathers in the medical community. They said there was insufficient evidence to show that gout-specific counseling on dietary choices was more beneficial than general health counseling at reducing uric acid levels, and they advised against recommending long-term uric acid-lowering therapy in most patients after an initial gout attack or in patients with infrequent gout attacks.
Those recommendations aren’t bad, as it makes sense that we shouldn’t jump straight to long term uric acid-lowering therapy, but many doctors still seem to believe that gout-specific dietary counseling would be beneficial for gout management. Diet choices and alcohol intake play a big role in the development of uric acid in the body, and oftentimes making significant health changes in terms of diet and exercise can provide full relief without the need to get medications involved, so gout-specific guidance should not be overlooked.
Finally, the ACP also proposed a recommended strategy for diagnosing the condition. The say that physicians should conduct a synovial fluid analysis when clinical judgement indicates that diagnostic testing is necessary in patients who may be dealing with gout.
“While joint aspiration with synovial fluid analysis for uric acid crystal analysis is the reference standard for diagnosing gout, most patients are seen initially by their primary care physician or an emergency room physician where synovial fluid analysis is less frequently and less easily performed,” Dr. Damle said. “In certain situations, physicians should use clinical judgement so that patients can begin treatment if gout is suspected.”
The earlier the condition is detected, the easier it is to manage the problem and prevent adverse effects like surgery, hospitalization or the need for long-term antibiotics. If you believe you have gout, speak with a foot specialist sooner rather than later, and make some healthy dietary and lifestyle choices to help manage symptoms.
