Patient Education for Gout
Every person with gout must be fully informed about the disease pathophysiology, the existence of effective treatments, associated comorbidities, and the principles of managing acute attacks while eliminating urate crystals through lifelong lowering of serum uric acid below target levels. 1 This comprehensive education is a core aspect of management with a strength of recommendation of 95 (95% CI, 91 to 99). 1
Understanding the Disease
Patients need to understand that gout is a curable disease caused by uric acid crystal deposition in joints, which triggers painful inflammation. 1 The key concept is that gout requires lifelong management with a "treat to serum urate target" approach, aiming to keep uric acid levels below 0.36 mmol/L (6 mg/dL), and ideally below 0.30 mmol/L (5 mg/dL) for patients with tophi. 1 Observational studies demonstrate that full patient education increases adherence to urate-lowering therapy, leading to a 92% rate of effectively treated patients at 12 months. 1
Lifestyle Modifications
Weight loss if obese, dietary modifications, and reduced alcohol consumption (especially beer and spirits) are core aspects of management. 1 Patients should understand the following dietary principles:
Foods to Avoid or Limit
- Purine-rich foods including organ meats and shellfish increase gout risk (RR 1.51 for seafood). 1
- Beer consumption carries the highest risk (RR 1.49 per serving per day), followed by spirits (RR 1.15 per serving per day). 1
- Sugar-sweetened drinks and heavy meals should be avoided. 1
- Wine consumption does not significantly increase serum uric acid levels. 1
Foods to Encourage
- Low-fat or nonfat dairy products should be encouraged as they are inversely associated with serum uric acid. 1
- Regular exercise should be advised. 1
- Vegetables should be consumed freely. 2
Weight Loss Benefits
Successful weight loss reduces serum uric acid from 570 mmol/L to 470 mmol/L after 16 weeks of treatment. 1 Both low animal purine foods and weight loss independently reduce serum uric acid in patients with gout (level IIb evidence). 1
Managing Acute Attacks
Fully informed patients should be educated to self-medicate at the first warning symptoms of an acute flare. 1 Patients need to understand that early treatment is critical—the most important determinant of therapeutic success is how soon treatment is initiated, not which specific medication is chosen. 3 Non-pharmacological treatments such as topical ice application and rest of the inflamed joint are useful adjuncts. 3
Long-Term Treatment Adherence
Education is essential when introducing urate-lowering therapy, particularly regarding the risk and management of flares during the initial treatment period. 1 Patients must understand that:
- Urate-lowering therapy is lifelong and should not be stopped during acute flares. 4
- The goal is to dissolve existing urate crystals and prevent new crystal formation. 1
- Prophylaxis against flares is recommended during the first 6 months of urate-lowering therapy. 1
- Treatment success is measured by achieving target serum urate levels, absence of gout attacks, and resolution of tophi. 1
Comorbidity Awareness
Every person with gout should be systematically screened for associated comorbidities and cardiovascular risk factors, including renal impairment, coronary heart disease, heart failure, stroke, peripheral arterial disease, obesity, hyperlipidemia, hypertension, diabetes, and smoking. 1 These conditions should be addressed as an integral part of gout management (strength of recommendation: 91,95% CI 86 to 97). 1
Common Pitfalls in Patient Understanding
There is a pressing need to remove negative stereotypes associated with gout, which serve as barriers to optimal management, and to perceive gout as a significant medical condition rather than simply a lifestyle disease. 5 Many patients and healthcare professionals have significant gaps in knowledge about gout that impede optimal management. 5 The lack of knowledge about the disease and subsequent non-adherence to treatment have been identified as major barriers to effective treatment and cure of gout. 1