In the MD Insights program “The ‘Disease of Kings:’ Addressing Misperceptions and Treating Gout Effectively Now and in the Future,” Theodore R. Fields, MD, professor of clinical medicine at Weill-Cornell Medical College, and director of the Rheumatology Faculty Practice Plan at Hospital for Special Surgery, discusses gout diagnosis, misperceptions about the disease, and the consequences of undertreatment of this condition. He also reviews current gout treatment options and discusses potential future treatments.
In this opening segment, Theodore R. Fields, MD, discusses the importance of early diagnosis and the use of needle aspirates as a diagnostic tool for gout.
According to Dr. Fields, in some cases a patient will have an attack or flare up someplace on their body that makes it difficult to do a fine needle aspiration biopsy on gouty tophi to identify urate crystals. Researchers are developing “better diagnostic criteria that allow us to make a clear diagnosis of gout even in cases when we don’t have the crystals. Now have dual energy CAT scan; we have ultrasound with criteria for diagnosing gout,” he said.
“Gout is a curable disease, and it’s really important to diagnose it as soon as we can,” Dr. Fields said. Although most guidelines say that treatment should begin only after a patient has experienced 2 attacks of gout in 1 year. However, Fields said “If somebody even has one attack of gout and has renal disease, that’s a reasonable time to treat them. If the patient has a tophus or the patient has joint damage related to gout it’s reasonable to go in and treat that patient. You really don’t need to wait.”
“Gout is a progressive disease. We know that it gets worse over time, so it’s really important to go in there and treat the patient as soon as they meet the criteria for gout. And we know that it’s essentially a curable disease as long as they stay on the medicine,” he said.