MUSCULOSKELETAL
MATTERS
Bulletin 8
DIAGNOSIS AND
MANAGEMENT
OF GOUT
Gout is the most common form of inflammatory
arthritis and affects around 2.5% of adults in the
UK. This bulletin summarises current guidelines
on the diagnosis and management of gout, along
with findings from recent research with gout
patients. More detailed information can be found
in a new ‘gout’ section on www.healthtalk.org.
Gout Diagnosis
Clinical diagnosis is relatively
straightforward when classic
features such as sudden onset
of severe joint pain, swelling,
tenderness and erythema affect
the first metatarsophalangeal
(MTP) joint. When these features
are not present, or joints other
than the first MTP joint are
affected, definitive diagnosis
requires confirmation of the
presence of monosodium urate
(MSU) crystals in synovial fluid or
tophi. Serum uric acid (SUA) levels
should not be used to confirm or
refute a suspected gout diagnosis.
Previous research suggests that
up to 26% of clinical diagnoses of
gout are incorrect.
Knowing about other people’s
experiences can help patients
to ask questions and make
decisions about their own
care.
www.healthtalk.org provides
information on peoples’
experiences of gout.
Key findings and
recommendations to
improve gout diagnosis
Our research shows that the
limitations in using SUA levels for
diagnostic purposes are generally
not communicated effectively
to patients.
Recommendation: Communicating
this information to patients will
help to prevent and/or correct
false beliefs.
Delays to diagnosis more often
occur for women and those
presenting with attacks in joints
other than the first MTP joint. Gout
is not uncommon in women, and
patients may present with gout in
joints other than the first MTP joint,
such as the midfoot, knee, ankle,
wrist, elbow and small joints of
the hands.
Recommendation: If classical
symptoms are reported, and the
patient does not recall physical
injury, then gout should be
considered as a potential diagnosis.
A diagnosis of gout is often
surprising to patients, and can be
particularly distressing for women
because of perceptions that it is a
male condition. Men and women
may be concerned about other
people’s perceptions of gout being
caused by ‘rich living’.
Recommendation: Increased
sensitivity in communicating the
diagnosis (including dispelling myths
about it being a male condition)
will help to reduce any negative
psychological impacts.
Patients often believe that their
lifestyle choices have caused gout,
whereas genetic factors, comorbid
medical conditions and medications
are also important. Patients often
make extensive changes to their
diets, regardless of whether these
are scientifically proven and/or have
been recommended by their GP.
Recommendation: Diagnosis
provides an opportunity to
emphasise: a) the chronic nature
of the condition; b) that the causes
are not always lifestyle-related; and
c) that the patient should return to
discuss long-term treatment.
These bulletins are designed to provide information for general practitioners, the primary care team, teachers, trainers and policy makers about musculoskeletal problems in practice.