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and people should avoid consuming more
than the recommended levels.
Certain medicines such as diuretics can also
increase risk of gout by increasing serum
uric acid levels.
If recurrent attacks of gout occur,
urate-lowering medicines may be indicated
if lifestyle changes have been made.
These medicines should be initiated in the
inter-critical gout period, that is during the
asymptomatic interval between recurrent
attacks of acute gout.
• Allopurinol – used first line to lower serum
uric acid levels as long-term, once -daily
Guidelines recommend a low
initial dose, increasing every 2–4 weeks
depending on renal function and urate
• Colchicine is used during the
introductory period until after the
target dose for allopurinol is reached,
as plasma urate changes caused by
allopurinol can worsen an attack.
Are there side effects of medicines
used for treating gout?
The potential adverse effects, precautions
and contraindications of medicines for
treating and preventing gout attacks are
important, as gout is often associated
with other comorbidities. Table 1 outlines
potential adverse effects of medicines.
This is not an exhaustive list and referral
to other reference texts may provide
Where can I find more information?
Providing patients with information will
encourage self care in managing gout.
The following websites provide further
• Arthritis Australia – provides
information and support on arthritis at:
• Arthritis Foundation – provides
information, practical tips and programs
to manage arthritis at: www.arthritis.org
• Australian Rheumatology Association
– provides lists of arthritis medical
specialists at: www.rheumatology.org.au
• NPS MedicinesWise Medimate –
further information on medicines at:
then a reduced dose until signs of
joint inflammation have abated,
and then cease.
• Corticosteroids are often the preferred
treatment in patients with complex
medical conditions where NSAIDs
are contraindicated. Corticosteroids
may be given systemically or by
intra-articular injection when one or
two joints are involved.
• Colchicine is reserved when NSAIDs
and corticosteroids are inappropriate
Do I need to see my doctor?
Referral to a GP should always be
recommended if gout is suspected and
has not previously been diagnosed.
Confirming the diagnosis is important to
rule out other more serious conditions
such as joint infection. If gout is left
untreated, it is more likely to affect more
than one joint as it progresses, therefore
early management is key.
Can gout be cured – what is the
Managing gout in patients with diabetes
presents a challenge because of the
substantially greater prevalence of
Despite higher comorbidity rates in
patients with diabetes, allopurinol is safe
in both groups at the doses tested and
thus can be used effectively to manage
gout in diabetes.
How can future attacks of
diabetes induced gout be
Over half of all people with gout will
experience a repeat attack within a
year of their initial attack, which is why
prevention of future attacks is important.
There are numerous lifestyle measures
that people with gout can undertake
to reduce the recurrence of attacks.
These include decreasing the purine
content of their diet, reducing alcohol
intake and reducing fructose-containing
soft drink intake.
Foods naturally high in
purines such as game, offal, seafood, liver
and kidneys should be avoided.
spirits also contain high levels of purines
This relationship however is complex
and while there is evidence of these
conditions co-existing, in some cases
diabetes may reduce the future risk of
developing gout through associated
uricosuric effects of polyuria and
impaired inflammatory response.6
Treating Robert’s sore toe
You discuss appropriate over-the-counter
analgesic options to help treat the pain
that Robert is experiencing in his toe.
Due to his multiple comorbidities and
severe pain, you also advise Robert that,
because of the symptoms he described
and his history of diabetes, it would be
worthwhile visiting his GP for a review
as he could be experiencing a condition
Robert returns two days later for a script
for colchicine after seeing his GP, who
confirmed he was suffering from an acute
attack of gout. Robert would like his script
dispensed and some information on gout
so that he can better understand what is
going on and what caused such pain.
What causes the pain from gout?
The uric acid crystals, which form in and
around the synovium joints (the soft
lining of the joints), are what causes the
pain and inflammation associated with
gout.2 The presence of uric acid crystals
leads to pain, redness and inflammation
in the affected joint/s.
How can the pain in gout be
Gout should be treated as early as
possible to limit morbidity and possibly
shorten the duration of the attack.
Self-care techniques to treat gout
pain include, rest and elevation of the
affected limb, keeping the joint cool
by removing surrounding clothing and
applying an ice pack.
Pharmacological treatment choices for
an acute attack of gout include7:
• NSAIDs are the preferred choice if not
contraindicated e.g. in active peptic
ulcer disease or allergy. Australian
guidelines recommend a full dose
NSAID until symptoms abate and
COUNSELLING IN PRACTICE
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