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Am Fam Physician. 1999;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.

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