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You are here: Home / Articles / ACR Recommends You Treat the Symptoms for Gout Patients

ACR Recommends You Treat the Symptoms for Gout Patients

February 15, 2017 • By Bruce N. Cronstein, MD

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In 1982, my wife (also a rheuma­tologist) and I attended our first American Rheumatism Association (now the ACR) national meeting. After the meeting we stayed with a friend in a suburb of Boston, where we also had the opportunity to meet our hostess’ in-laws, a retired general practitioner and his wife. When her father-in-law shook hands with me, I noticed that he had large, irregular, rock-hard excrescences over his PIPs and DIPs, one of which was draining whitish toothpaste‑like material.

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February 2017

This retired practitioner told me that he had arthritis that often acted up for which he took a well-known brand-name drug (he did not believe in taking generics) for symptomatic relief. When I realized that the drug he was taking was a potent corticosteroid (triamcinolone), I then noticed his rounded face, florid complexion and buffalo hump and understood why he had such trouble getting out of a chair. I told him I thought he had tophaceous gout and that we had better therapies for that than triamcinolone, but he was the seasoned practitioner and did not think that, as a fellow, I could tell him anything he did not already know.

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In those pre-Sunshine Act and pre-CLIA days, one of the pharmaceutical companies had given rheumatology fellows polarizing lenses that could be used in a standard microscope to visualize crystals in joint fluid. This rather grouchy (understandable after I squeezed his hand), retired physician told me that the office in the rear of his home was equipped with a microscope, so I offered to show him the crystals.

Off I went with my pharma swag and some of the draining material on a slide to demonstrate negatively birefringent crystals, only to find that the microscope light source was a mirror that reflected light through the objective, an arrangement totally incompatible with the polarizing lenses (two pieces of dark polarized plastic cut from somebody’s broken sunglasses).

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Our retired physician was highly amused by my complete failure and took this as further evidence of my youthful inexperience and general ignorance. And now, over 30 years later, I have come to find out that perhaps he was correct in his approach to treating gout.

Artemida-psy/shutterstock.com

Artemida-psy/shutterstock.com

Treat to Avoid Symptoms

Although rheumatologists have followed a treat-to-target approach in the use of urate-lowering therapy for the treatment and prevention of recurrent gout attacks and tophaceous gout, the American College of Physicians’ (ACP) guidelines now indicate an alternative strategy. The ACP recommends a “treat to avoid symptoms” approach in which urate levels are not monitored.

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Filed Under: Conditions, Crystal Arthritis Tagged With: ACP, American College of Physicians, Gout, guideline, patient care, Practice Management, recommendation, rheumatology, symptom, therapy, treat-to-avoid, Treat-to-TargetIssue: February 2017

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