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CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
Robert, a 52-year-old male, comes into the pharmacy asking for something
to help relieve a painful toe. He tells you that he has had severe pain and
stiffness in his right big toe and says that it also feels swollen.
The pain has been worsening since he
noticed it a few days ago. Robert has a
history of hypertension which is well
controlled and was also diagnosed
with non-insulin dependent diabetes
approximately 18 months ago for
which he takes metformin twice
daily. He is otherwise “pretty healthy”
and hasn’t had this problem with his
What is gout?
Gout is a type of arthritis and is
characterised by an attack of pain,
redness and swelling which often begins
in one joint.
70% of people with gout
experience their first attack in the big
Other affected joints may include
the midfoot, ankles, knees, fingers,
wrists and elbows; this is due to the
temperature in these joints being lower
than the rest of the body increasing the
likelihood of crystals forming.
From onset, gout symptoms often
subside over a period of days to
1–2 weeks if the condition is untreated.
It may be palindromic i.e. a person
suffering from gout will have recurrent
attacks between which they will feel
no symptoms. Recurrent attacks may
eventually fail to resolve completely and
thus the condition would be classified
as chronic. The onset of gout in males is
around the age of 40–60 years, whereas
it more commonly affects women
What causes gout?
Gout is caused by a build-up of uric acid
in the blood which is a waste product
mainly excreted by the kidneys.2 If there
is too much uric acid produced, or
too little excreted, build up may occur
leading to crystal formation in and
around the joints resulting in gout.
Gout is 3–4 times more likely to
occur in men than women due to
the release of oestrogen during the
female reproductive cycle, increasing
excretion of uric acid via the kidneys.2
Other factors that may increase the risk
of gout include a diet high in purines,
such as sardines and liver, as well as
drinking large quantities of beer or
spirits – both of which contain high
levels of purines.2
Brooke Myers is a hospital pharmacist and accredited
consultant pharmacist based in Brisbane, Queensland.
After reading this article, pharmacists should be
• Discuss the link between elevated serum uric acid
and metabolic syndrome associated with diabetes.
• Discuss options for managing gout in diabetes.
• Explain measures to help prevent future attacks
Competency standards (2010) addressed:
Accreditation number: CAP140606A
Gout...with a side of diabetes
BY BROOKE MYERS, MPS
How is gout diagnosed?
To diagnose gout, a general practitioner
(GP) considers the following2:
• symptoms such as more than
one attack of pain, swelling and
• high levels of inflammation within one
day of onset, only affecting one joint
• medical history
• serum uric acid test; which is not
definitive, although an elevation is
often an indication of gout.
The GP will also rule out the chance of
Is diabetes linked to gout?
Gout is quite often associated with
other comorbidities, including
hypertension, chronic kidney disease,
obesity, hyperlipidaemia and diabetes.
These comorbidities can complicate
management and also affect a patient’s
Gout has been associated with diabetes
mellitus for more than a century.
High uric acid levels, which can lead
to gout and increase the frequency of
acute attacks of gout, also independently
correlate with hypertension, insulin
resistance and the risk factors of
Often gout and
type 2 diabetes co-exist due to shared
physical characteristics including obesity,
increased age and male gender, which are
risk factors for both of these conditions.
Because of this association, health
professionals should consider presence of
both gout and diabetes in each individual
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