Tips from Other Journals
Explaining Gout to Patients by Using an Analogy
Am Fam Physician. 1999 Mar 15;59(6):1624.
Gouty arthritis is not a difficult diagnosis to make. Patients often suffer from recurrent attacks because of the complexity of the treatment regimen, with the potential for three medications to be taken on different schedules. Wortmann discusses an analogy that may make understanding gout easier for both patients and physicians.
The analogy used is, “Gout is like matches.” Everyone has uric acid in their blood; high levels of uric acid may cause gout. When too much uric acid accumulates around a person's joints, the uric acid acts like matches. An acute gout attack may be likened to “setting the joint on fire.” A nonsteroidal anti-inflammatory drug (NSAID) should be taken at this point, to prevent more matches from catching on fire. It isn't important which NSAID is used to “put out the fire,” but how quickly the fire is put out is very important. The more matches that catch fire, the longer it will take to put the fire out. However, if the matches still exist, they can catch on fire again—so NSAIDs should not be seen as a “cure” for gout. A urate-lowering medication, such as allopurinol, is used to “remove the matches.” In the analogy, no matches means no fire, which means no gout attacks. However, before all the matches have been taken away, they can still catch on fire. What is needed is something to “dampen the matches,” so that they cannot catch fire as easily. Colchicine is an agent used in this way to help prevent acute attacks.
Compliance often improves when the patient has a better understanding of the disease process; the analogy presented here may help patients understand and accept the steps they need to take in the treatment of gout. The accompanying table gives the standard treatment of gout, along with the corresponding phrase in the “fire” analogy.
Treatment of Gout
Treatment of Gout
Acute attacks: “Agents that put out the fire”
Indomethacin, 50 mg three times a day until all symptoms have resolved for 48 hours (any other NSAID may be substituted and used at the maximum approved dosage); or colchicine, 0.5 or 0.6 mg every hour until relief or intolerable side effects (abdominable cramping or diarrhea) occur, or until 10 doses have been taken without improvement; or corticosteroid intra-articular injections; or ACTH, 40 U intramuscularly, up to three times a day; or triamcinolone acetonide, 60 mg intramuscularly; or prednisone, 30 to 50 mg daily, tapering over seven days.
Prophylaxis against acute attacks: “Make the matches damp”
Colchicine, 0.5 or 0.6 mg, one to three times a day. Generally, this agent should not be employed unless the patient is also taking a urate-lowering Drug; colchicine is usually discontinued after the serum urate concentration Has been controlled and the patient has not had an acute attack for one to three months.
Urate-lowering agents: “Remove the matches from the body”
Allopurinol, generally 300 mg daily.
Uricosuric agents; probenecid, 500 to 1,000 mg twice daily, or sulfinpyrazone, 50 to 400 mg twice daily or benzbromarone, 25 to 120 mg daily.
The dosages of any urate-lowering agent are the lowest needed to maintain the serum urate concentration at or below 5 mg per dL.
NSAID = nonsteroidal anti-inflammatory drug; ACTH = adrenocorticotropic hormone.
Adapted with permission from Wortmann RL. Effective management of gout: an analogy. Am J Med 1998;105:513–4.
Wortmann RL. Effective management of gout: an analogy. Am J Med. December 1998;105:513–4.
Copyright © 1999 by the American Academy of Family Physicians.
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