Five Plain Truths About Gout

1) Gout is no longer the disease of kings, or even of the affluent. It is hitting harder in lower socioeconomic groups.
2) A low purine diet is no longer a strongly recommended intervention. Cutting back on organ meats and alcohol is. Purine rich vegetables, once viewed as triggers, may be safe because of their fiber content.
3) Uric acid crystals are involved in gout, but it is primarily an inflammatory condition. So not everyone with high uric acid gets gout. This is just like how high cholesterol and low inflammatory markers seems safer than average cholesterol and high inflammatory markers. And, heart attacks and strokes are more likely to happen in the months following a gout attack.
4) Colchicine, one of the treatment options for both acute and chronic gout, works without lowering uric acid levels at all. It treats inflammation, just like the commonly used attack medicine indomethacin and my personal choice, prednisone.
5) Allopurinol, which we use to prevent gout attacks by lowering blood uric acid levels, can also cause them. It should never be started during a gout attack. If attacks happen in the beginning of treatment, I give short prednisone bursts to get patients through the initiation phase.

1 Response to “Five Plain Truths About Gout”

  1. 1 David Felker September 3, 2022 at 3:00 pm

    Concur with all 5 points, doc!
    40 mg prednisone for 3 days

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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