Quality of Care in Patients with Gout: Why is Management Suboptimal and What Can Be Done About It?

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Quality of Care in Patients with Gout: Why is Management Suboptimal and What Can Be Done About It?
Edwards NL.
Curr Rheumatol Rep. 2010 Dec 14. [Epub ahead of print]
(http://www.ncbi.nlm.nih.gov/pubmed/21161617?dopt=Abstract)
Gout is a common inflammatory arthritis. We know a great deal about its etiopathogenesis and have relatively safe and effective therapies for it. Gout, however, remains a poorly managed disease with mistakes made in securing an accurate diagnosis and in using appropriate therapies for acute and chronic stages of the disease. Synovial fluid analysis with polarizing microscopy is the "gold standard" for confirming the diagnosis of gout but has been used in fewer than 10% of all patients diagnosed with gout. The newly adopted European clinical guidelines offer a practical alternative to synovial fluid analysis, but primary care physicians are not well-versed in their use. Other serious errors in the management of gout are related to the use of medications to treat acute and chronic gout. Frequently, the anti-inflammatory drugs used to treat acute symptoms and urate-lowering drugs used to prevent long-term destruction are improperly dosed, leading to dissatisfaction on the part of patients and physicians. Widespread education about evidence-based diagnostic and treatment guidelines is desperately needed.

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Almost all physicians and gout patients ignore the true etiology of gout and blindly believe that gout is caused by uric acid. People with reumatoid arthritis, cancer, etc, may reach uric acid values in excess of 13 and never develop gout. The crystals in gout are sodium urate and sodium salts are notoriously soluble. They precipitate out only when blood is acidic and the patient has high iron and molybdenum and low copper and magnesium levels and the temperature of the joint is low. Fe stores can be readily determined with a ferritin test. Ideally ferritin should be between 30 and 55 as is the case in most 21 year old men). However, people with gout often have a ferritin that exceeds 150. Excess Fe and Mo are easily eliminated through blood donation every two months until ferritin drops below 55, which can then be maintaines with donation everytime it exceeds 60. Copper deficiency can be corrected taking 1 to 2 mg of copper a day (depending on weight, it can be bought at GNC, etc) and magnesium deficiency can be corrected taking 200 mg/d magnesium (as citrate). A diet rich in vegetables, low fat dairy products and fruits, with moderate beef and wine consumption keeps blood alkaline.