Better gouty arthritis treatment is a major concern for gout sufferers throughout the world. British rheumatologists have completed some guidelines for the management of gout.
The aim of those guidelines is to:
develop concise, patient-focussed, evidence-based recommendations for the management of gout for doctors and allied heath professionals in primary care and hospital practice in the UK, which will also provide a useful resource for patients.
As gout patients around the world know, the quality of gout management is often poor in all countries, so these guidelines are a welcome standard that you can measure your care by.
The most important guidelines relate to the management of acute gout. This is the stage of gout where you experience painful swapping in one or more joints. It is usually the point where you are first aware that something is wrong, and the point where most gout patients first seek medical attention.
Other guidelines refer to lifestyle changes after this acute stage, and management of later stages of gout. All these guidelines are provided to be evidence based, but the report notes the lack of strong evidence in many areas of gout management. As they say, and we know to our cost:
Gout is a common disease both in primary care and hospital practice … many of the recommendations for treatment are based on expert consensus rather than research evidence and audits of practice suggest that treatment is very variable.
Most guidelines are graded according to the quality of evidence supporting them. The grades are:
- At least one randomized controlled trial
- At least one non-experimental descriptive study (eg comparative, correlation or case study), quasi-experimental study, or non-randomized controlled study
- Expert committee reports, opinions and / or experience of respected authorities
The acute gout management guidelines are:
- Rest the affected joints (C) and take analgesic, and / or anti-inflammatory drugs for 1-2 weeks (A).
- Maximum doses of fast-acting oral NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are the best if you can tolerate them (A).
- If you have an increased risk of peptic ulcers, bleeds or perforations, your doctor should also prescribe gastro-protective agents, following standard guidelines for the use of NSAIDs and Coxibs (A).
- Colchicine can be effective alternative but is slower to work than NSAIDs (A). In order to diminish the risks of adverse effects (especially diarrhea) it should be used in doses of 500 μg, two to four times per day (C) .
- Do not start taking allopurinol during an acute attack (B), but if you are already taking allopurinol, it should be continued and the acute attack should be treated conventionally (A).
- You can take opiate analgesics as well as anti-inflammatories (C) .
- Corticosteroids injections are very effective in acute gout in one joint (B) and corticosteroids injections and tablets can be effective if you can not tolerate NSAIDs, or nothing else seems to work (A).
- If you take diuretic drugs for hypertension, discuss alternative blood pressure lowering therapies with your doctor, but if you have suffered heart failure, diuretic therapy should not be discontinued (C) .
If you are having, or have recently had, an acute gout attack, it is critical that you review the bold guidelines (A) and make sure that you have received an appropriate gouty arthritis treatment. If not, make an appointment with a specialist on the worldwide listing of rheumatologists.
The two (B) graduated guidelines (5 and 7) are also important, and if they are relevant to you, discuss them with your doctor as soon as possible.
The italicized guidelines (C) are still very important, but they may not affect you, or your doctor might hold a different opinion. If you have any doubts about these issues, you must still discuss them fully with your doctor, or seek a consultation with a rheumatologist.
Source by Keith Charlie Taylor