Gout

Messages about gout for health professionals

The people we talked to had messages for health professionals including:

• Be sympathetic, listen, and understand how painful gout can be. Talk to each patient as an equal. Make sure that practice staff know how painful attacks can be, and that urgent appointments or advice may be needed if someone has no medication at home to treat an attack.

Shirley felt that it would make a big difference if doctors were more understanding and sympathetic towards people with gout.

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Age at interview: 78

Sex: Female

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Well I think they could perhaps be a bit more understanding of it. And sympathetic I think. I know that doctors have an awful lot to deal with and I know they can’t all be sympathetic to you but it makes a big difference. I listen to the radio, last night there was a call in talking to this doctor, and people were phoning in for various things and he was so sympathetic and I thought, “Why can’t I have a doctor like that?” So there is such a thing as sympathy.

•   Take gout seriously. Managing it well is a high priority for people even though it is not life-threatening.

•   Remember that gout can affect joints other than the big toe, and also women as well as men.

•   Gout can affect younger people too. Consider issues related to treatment like pregnancy/breastfeeding for younger women with gout.

•   Find out about the causes and treatment options for gout, and give people enough verbal and written information to manage their gout.

Peter believes it is important for health professionals to be clear about the difference between facts about gout and things that are still unknown.

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Age at interview: 63

Sex: Male

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As a health professional, I think, be very clear about what the black and white bits are and the grey bits are, and get that clear in your mind. And if there’s an area of complete uncertainty, well sort that in your brain how you’re going to deal with it. Don’t give out, you know, cod bits of advice as a health professional, be clear. “This is what the medical evidence shows. This is definite, you know, it’s caused by this and you will get attacks, and this is how to manage it, and this is the grey area, maybe, but we can do a blood test and you might fall very clearly in a group that would benefit from prevention”, and so on, but get all those arguments clear. But then I would have said, really trust the patient, on average, and give confidence to the patient that they can manage their problem themselves, with appropriate support, and bearing in mind that individuals differ, and some will want more reassurance and support than others.

•   Make time to talk about gout and treatment options with people rather than telling them only about what you have prescribed.

•   Refer to a specialist if initial treatments are not working and/or people are experiencing recurring attacks. This is better than repeatedly prescribing different medications to see if they work.

•   Tell patients to come back if they continue to have attacks.

•   Let people know that gout is not a life-threatening condition, and though it can’t be cured, it can be managed very effectively with the right treatments.

Jeff thinks it is important for health professionals to be clear that gout is a lifelong condition that can be managed effectively.

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Sex: Male

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Oh my advice would be, to be absolutely straightforward about it. No - no sort of might be or - or around the edges if you know what I mean. “Look you’ve got it, you’ve got it for life, we’ll manage it, all we can do, we can’t cure it, we can manage it and it’s down to you to manage it, you know, we’ll try this, we’ll try that and when we’ve got something then it’s down to you to manage it.”

• Trust patients, and give them confidence that they can manage the condition themselves with appropriate support.

• Regularly monitor uric acid levels and kidney function (e.g. every year). Ask people if they are still having attacks/symptoms to check treatment is effective and provide reassurance that there are no unwanted long-term effects.

Sam would have liked the opportunity to discuss possible long-term effects with her doctor.

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Age at interview: 41

Sex: Female

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She just said that I'd start off on the lower dose, see how I go with that, and if needs be they'd pop me up but there was nothing - there was nothing on what the long term effects then could be. But then I suppose they - every case is different and you know you play it by ear really. But I would have liked to have known a bit more because then I could have asked questions there and then, rather than go on the net and look and think, “Oh my god, am I going to be like this? Is this how it's going to end up? And how long is it going to be” and I think if they were able to set my mind at ease a bit more, rather than have to read up on things.

•   Explain and give reassurance about the reasons for doing blood tests to check things like kidney function.

•   Be aware of the impact that gout attacks may be having on the patient’s everyday life as well as on their family and friends.

•   Once gout is diagnosed, prescribe enough medication for treating attacks so that people can keep a supply at home rather than having to get to the surgery when they are in pain.

•   Prescribe enough medication so that patients who are taking long-term tablets do not have to have repeat prescriptions too frequently.

Val would find regular reviews reassuring. She asked her GP to adjust her repeat prescription so that she didn’t have to renew it as frequently.

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Sex: Female

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What message or advice would you give to health professionals who are working with patients who’ve got gout?

I think to keep an eye on us really. And to automatically …like you get for your blood pressure you get a review or you get your flu jab don’t you and asthma warnings and, I think would be to keep an eye on us and maybe to flag up on their computer six monthly or something, “Review this patient about their gout”. I think that would be really, really helpful.

And in terms of it being helpful, is that in terms of sort of reassurance to you or in terms of identifying anything or …?

Yes, I think reassurance that you are being looked after instead of just doled out this packet of tablets every month, two months whatever they prescribe them. I mean mine was monthly, and I was getting to the position where I was almost running out before I remembered to renew it so last time I renewed it I put a little note on the prescription, “Please could I have two monthly as I’m on it for long term” and it did come back two monthly and I thought, “Oh thank goodness for that”. I mean it’s just little things like that and you think then you wouldn’t get caught out. Like you’d go to wherever you keep the medication, you’d get out the second packet and you think to yourself, “I’ve got to watch this now because I’ve started on my second packet”. Because when you’ve just got a month’s supply you tend to just forget, you know, that would help.

• It is important to think about treatments to prevent attacks and joint damage rather than only those that treat the symptoms of individual attacks.

• Explain the difference between treatments for attacks and long-term treatments.

Ian feels that GPs need to understand how painful gout is. They need to think about preventative treatments, not just treat the symptoms of an attack.

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Sex: Male

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What message or advice would you give to health professionals who are working with patients who've got gout?

Yeah - understand that it is painful, that’s the - getting across how painful it is, and really understanding that, and it can blight you for a day really, because of it. Understand that. I - the second part is my opinion rather than I base it on any fact, you know, can you prevent the gout happening in the first place or are you treating the symptoms? And I think that would be important for GPs to understand learning it, and get plenty of information about - and I wouldn't - if somebody keeps coming and is, you know, is regularly being prescribed pain relief for gout, as a GP I would say, “is there a - we'll have to do something else here”.

• Make sure people are aware that attacks may still happen for up to two years after starting ongoing medication.

• Gout is not usually self-inflicted. It is important to be aware of the myths about the causes of gout. Find out what the patient knows and believes so that you can make sure they have a good understanding.

John said doctors need to find out what patients know so that they can explain things to them in the best way.

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Age at interview: 43

Sex: Male

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When you’ve got the knowledge, you don’t realise what the lay person’s knowledge is. And I think it’s really easy to forget. So I think partly personal experience and professional experience as well - while at medical school. Because, it’s so easy. You just go, “Oh this is what the condition is” and you completely forget what you knew and thought about these particular things before you’d entered medical training.

Make sure that you address the myths really. Make sure they have a proper understanding. Because, unless you elicit what people already believe about gout, you won’t necessarily be able to address those things. So yeah, find out what people think first – then go through the education process.

• Inform patients that diet has less of an impact on triggering attacks than people may think. Reducing high purine foods and alcohol might make a difference, but this is unlikely to reduce uric acid levels enough to prevent attacks and/or long-term damage.

• Advise people about where they can find information about gout and diet, or refer them to a dietician if appropriate.

Last reviewed December 2016