GoutPal Interactive

The advice that most family practitioners give gout patients is much like it was 25 years ago.    However, there is a lot of research that has been done which could help gout sufferers with their gout and goutcare.   The gout-related websites fill the gap some but really we need someone, skilled in medicine, to update the advice that most practitioners give their patients.  We need the medical establish to update the guidance they give based on the latest research.   Most practitioners follow the mainstream medical journals.   If we could get some answers and find some new advice on better ways to deal with gout (and maybe other arthridies) and then get it published in those journals, we could improve the care of gout-sufferers, inconceivably.  I suggest a webpage where people could put what they would like to ask organizations like the American Medical Association.

I can think of some questions that I would like evaluated based on research done in the last twenty five years?

(1) In following a diet, what attention should be paid to iron-rich foods?   Should we be including foods that inhibit iron absorption?

(2) Is there an advantage to reducing the iron levels in our bodies in avoiding gout attacks and in lowering inflammation by regular blood donations?

(3) In our diets, should we including more L-Argenine rich foods since L-Argenine has been shown to help with hyperuricemia?

(4) Since obstructive sleep apnea has been shown to contribute to the development of gout, shouldn't medical practitioners be counselled to screen for it more closely?

(5) When blood tests show high uric acid levels, shouldn't practitioners counsel the patient to increase his/her water consumption?    In other words, treat the higher uric acid levels as a sign of underconsumption of water.  

Frankly, I consider this some very legitimate questions.  If the other gout-related websites did the same, maybe we could get some answers.

Post edited 9:00 pm – March 10, 2010 by zip2play

I never saw it either.

I'll field a couple as I see them.

1.) Yes, for men some attention should be given to limiting iron consumption…becasue we cannot get rid of it.. Inhibition of iron after it is ingested seems a lot more difficult than not ingesting it in the first place. For men, donate blood regularly, although I am not sure the gout-iron connection is solidly made but I am reasonably sure that iron is atherosclerrotic.

2.) Not sure

3.) L-arginine is an overhyped amino acid popularized by the silly “research” of the Life Extension kooks., Sandy Shaw and what's his name. We get far more arginine in protein rich foods than we get from pricey supplements. Taking amino acids separately is a waste of money.

4.) I have not seen any cause and effect or even correlation between sleep apnea and gout. With obesity, yes, and heart disease, yes.

5.) The amount of water in the bloodstream is regulated SOLELY by the amount of sodium and sodium only. Veer a little high or a little low and death ensues pretty rapidly. So, no, trying to dilute uric acid in the blood is not realistic. However, to avoid kidney stones, of which urate stones are a category, then extra water will keep solutes in the urine is solution.

Two questions I'd like to ask any doctor:

1. How much time did you spend studying gout in med school?

2. Do you think the range of NORMAL uric acid on lab printouts is of any relevance in gout treatment?

Finding a common approach between the medical profession and gout sufferers is a subject dear to my heart, though I have little in the way of concrete proposals.

Any ideas how we might progress this, or should we simply let it lie?

GP-  I manage physician practices for a living.  I currently have 95 doctors/ nurse practioners/ physician assistants in 25 clinics that I manage.  It's sad to me how little the typical doctor knows about gout.  Even more sad (and frustrating) to me that my own nephrologist had labs for 2 years showing my UA levels around 9-10 and I told him 2 years ago I had gout and all he did was treat the symptoms (colchicine, prednisone), but never the UA.

To me, at least the basics of gout education have to get out to doctors and to patients.  I guess by basics, I mean:

* You must treat UA levels not just pain and inflammation– Allopurinol and other options

* You should also treat the pain– colchicine, nsaids, etc.

* You can help with water, diet, perhaps some of the natural remedies, but these alone are not enough if your UA levels are too high– refer back to the first point.

* See a rheumatologist- they are the gout experts (I've managed doctors in over 20 different specialties and did not realize rheumatology was the specialty I needed to see until your post educated me.  I don't think most of us think of gout as a form of arthritis and don't make the connection, so we stick with our family practice, internal medicine, or nephrologists- none of whom really understand gout.   I guess the latin root of arthro is joint and itis is pain or inflammation, so I guess gout is definitely a form of arthritis).

While there is far more beyond those four basics that doctors and patients should know, if people understand those 4 things and then worked with a rheumatologist on details beyond that, we'd be way ahead of where we are today.

The harder part is how to get this message out.  A simple educational brochure about gout would go a long way.  The rheumatologists would stand to benefit financially by helping primary care docs understand gout better and get referrals to treat gout patients, so perhaps the american college of rheumatology or other national rheumatology organizations would work together to create an educational brochure or something.  ??

Post edited 3:04 pm – March 14, 2010 by zip2play

[quote] I don’t think most of us think of gout as a form of arthritis and don’t make the connection, so we stick with our family practice, internal medicine[/quote]

I think using a GP for ANYTHING is a mistake and that is a considered opinion after decades of treatment and at least 5 GP’s (all in New York City, not Podunk.) General Medicine has become nothing more than taking Blood Pressure (usually wrongly) and then taking a blood draw and sending it to a lab whhere the lab decides whether the results are in range. THen we get to pay the GP again so he can read the item or two that is out of range to us. An old Commodore 64 computer could do a better job because it has a larger database. If you have a rash, the GP refers you to a dermatologist. If you have a stomach ache you get a referral to a gastroenterologist. I have oftten wondered if any of my doctors could even stitch a cut or would they send you to a surgeon.

For gout go to a rheumatologist and get the right diagnosis and the right treatment…or come here andd forge a prescription (just kidding…you can buy the drugs online.

(What happened to the Format bar?)

Post edited 5:09 am – March 16, 2010 by vegetarianGuy

zip2play said:

Post edited 3:04 pm – March 14, 2010 by zip2play

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[quote] I don’t think most of us think of gout as a form of arthritis and don’t make the connection, so we stick with our family practice, internal medicine[/quote]

I think using a GP for ANYTHING is a mistake and that is a considered opinion after decades of treatment and at least 5 GP’s (all in New York City, not Podunk.) General Medicine has become nothing more than taking Blood Pressure (usually wrongly) and then taking a blood draw and sending it to a lab whhere the lab decides whether the results are in range. THen we get to pay the GP again so he can read the item or two that is out of range to us. An old Commodore 64 computer could do a better job because it has a larger database. If you have a rash, the GP refers you to a dermatologist. If you have a stomach ache you get a referral to a gastroenterologist. I have oftten wondered if any of my doctors could even stitch a cut or would they send you to a surgeon.

For gout go to a rheumatologist and get the right diagnosis and the right treatment…or come here andd forge a prescription (just kidding…you can buy the drugs online.

(What happened to the Format bar?)

Agree with everything but the bolded part does not guarantee better treatment   All said and done my GP was good enough for handing me 3 more months of AlloP today.