VIRTUAL WEBINAR VIA ZOOM
Practical Guidelines to Treating Gout in 2021
Dr Michelle Tellus
Rheumatologist | Hawthorn, Victoria
The Speaker
Dr Tellus completed her studies in medicine and graduated from The University of Melbourne in 1984. She trained as a medical resident and registrar at St Vincent’s hospital Fitzroy, and succeeded in obtaining her fellowship with the Royal Australasian College of Physicians in 1993. Dr Tellus has worked previously at The Royal Melbourne Hospital Bone and Mineral Unit as a clinical assistant, and has conducted research at the Royal Children’s Hospital in the area of Juvenile Rheumatoid arthritis. She has been involved in teaching medical students and giving educational lectures to GPs and specialists over the years.
Dr Tellus treats patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis incorporating DMARD and biological therapies where indicated. Her experience in the use of cytokine targeted therapy to “Treat to Target” has given her insight into the impact of these treatments to reduce inflammation and pain associated with these debilitating conditions. Dr Tellus’s interests focus on osteoporosis and the rheumatic diseases, their treatments and improving functional outcomes for her patients. She is currently a consultant at St. Vincent’s Private Hospital in East Melbourne and Fitzroy and at Warringal Private Hospital.
Gout Myth Busting
Myth: Gout is uncommon
Fact: 4.5% of Australians have gout.1
Myth: Dietary interventions alone can cure gout.
Fact: A low-purine diet alone won’t cure gout, but eating well and reaching a healthy weight will decrease and the complications of metabolic syndrome by preventing gout flares and helping lower uric acid.2
Myth: Gout is a benign lifestyle disease
Fact: Historically, gout has been portrayed as a benign and even comical condition that is self-inflicted through overeating and alcohol excess. However, genetic factors play an important part in the pathogenesis of primary gout. Most patients have a genetically determined inability to increase renal uric acid excretion by the kidneys when urate levels are raised.3
Myth: A clinical history and sUA levels are adequate for diagnosis
Fact: A patient with suspected gout should have a plasma urate assay, which may be normal in acute gout; aspiration of an affected joint, bursa or tophus; and a search for secondary causes, including impaired renal clearance of urate.3
Management of Gout
Every patient with gout should be informed about the pathophysiology of the disease, effective treatments, comormidities and educated about managing acute attacks and the need to eliminate urate crystals through lifelong treatment aimed at achieving an SUA target level.4
Five components of gout management:4
1. Rapid symptom relief for acute attacks
2. Lifelong urate-lowering therapy using a treat-to-target approach
3. Prophylaxis to prevent gout flares when starting or increasing urate-lowering therapy
4. Management of modifiable risk factors and associated comorbidities
5. Patient education
References
1. Pisaniello H, Lester S Gonzalez-Chica D. et al. Gout prevalence and predictors of urate-lowering therapy use: results from a population-based study. Arthritis Res Ther 20, 143 (2018). https://doi.org/10.1186/s13075-018-1633-9.
2. Arthritis Foundation, Gout [internet] accessed Sept 2021; available from www.arthritis.org/diseases/gout
3. Doherty M, Jansen T, Nuki G. et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012 Nov;71(11):1765-70. doi: 10.1136/annrheumdis-2012-201687. Epub 2012 Aug 3. PMID: 22863577.
4. Richette P, Doherty M, Pascual E. et al. 2016 updated EULAR evidence-based recommendations for the management of gout Annals of the Rheumatic Diseases 2017;76:29-42.
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