Would you ignore this lump on your finger?
Tophus on little finger
By Dr Irwin Lim, Rheumatologist
If I had this on my finger and didn’t know what it was, I’d be worried.
Given I do know what it is, I’m still worried.
Rheumatologists still see this too often. It always intrigues me how some people can just ignore this sort of growth while others will get worried by the slightest discomfort in their finger. Vagaries of human nature?
For those non-doctors reading this, the diagnosis is gout, and specifically tophaceous gout. For the non-rheumatology doctors reading this, it’s an indication this patient definitely needs urate-lowering therapy.
A lump like this signifies way too high levels of uric acid in the body and signifies that the patient will have chronic joint problems and destruction, as well as probable kidney damage as the uric acid crystals also accumulate in that organ.
Tophus with underlying joint destruction
Why do you think we still have people ignoring this?
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.Does Gout occur in Women?
By Dr Irwin Lim, Rheumatologist
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.The doctor gave me Allopurinol to help but it actually made my gout worse!
By Dr Irwin Lim, Rheumatologist
Gout is a really painful, inflammatory joint disease related to having high uric acid levels. Allopurinol is a key medication used to treat gout.
Allopurinol works by lowering the level of uric acid in the blood. Once this level is low enough, the frequency and severity of attacks is reduced.
But, it’s a tricky medication to use.
Many patients get started on it and then find that they actually get a more severe attack of gout. This video helps explains why we think this happens.
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.What’s that lump on your finger?
By Dr Irwin Lim, Rheumatologist
I’ll let you have a guess. One of the most common causes of inflammatory arthritis.
When a rheumatologist sees this, the diagnosis is obvious.
Gout.
Specifically, tophaceous gout. It takes years to grow these lumps.
Typically, gout causes painful, swollen joints. High levels of uric acid in the blood lead to uric acid crystals precipitating in joints, and episodically, this leads to joint inflammation. Over time, the joints become more permanently damaged and the uric acid crystals deposit in the kidneys, and in the skin.
Soft tissue swelling around damaged joints
What constantly surprises me is how some patients still seem to be able to let the disease progress to this point. Gout is not a silent disease.
In fact, it is a terribly painful disease in its early phases. It’s been called the disease of kings and the king of diseases.
Gouty tophi around the olecranon (elbow)
It’s also reasonably easy to treat. The aim is to lower the uric acid level in the blood and when adequate suppression is achieved, the disease is typically very well controlled.
The difficult part is usually patient compliance.
Do you know patients who still suffer with gout?
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.GOUT: the most curable joint disease is the worst treated
By Dr Irwin Lim, Rheumatologist
This afternoon, I attended a symposium on this at EULAR 2012 and the title was a good one. Hence, this post written in most part, while I was listening to the talk.
I want to concentrate on the concept that gout is potentially curable.
Perfectly curable for the majority of patients.
Gout is also the most prevalent inflammatory joint disease in the world.
But so, so poorly treated and managed.
It’s also terribly frustrating to treat.
Gout patients, mainly men, are typically really non-compliant. The contributing factors of weight and diet can be addressed but often men are not prepared to make the changes. For Australian men, the “elephant in the room” – alcohol, alcohol, alcohol – is often neglected.
And yet, we have very effective agents already.
Once the acute attack is settled using whatever anti-inflammatory agent your doctor may choose (choices include colchicine, NSAIDs/Cox 2 inhibitors, steroid, etc), the aim needs to shift to reducing the amount of uric acid in the body (too much uric acid leads to increased crystal depositing in the joints which at times lead to the horrible inflammation typical of a gout attack).
The most useful agent to lower this uric acid is Allopurinol and it is effective.
Allopurinol is unfortunately used poorly with most general practitioners just prescribing a fixed dose, typically 300mg daily. What should happen is the dose should actually be increased to suppress the level of uric acid measurable on blood tests to an appropriate level (I typically aim for a serum urate <0.36 mmol/L).
I am not trying by any means to be comprehensive in this post in discussing treatment protocols and options.
What I hope to highlight is that gout is eminently treatable.
To be able to actually tell a patient that you can cure their arthritis (in most cases) is a really satisfying thing.
So, if you or a friend/family member has gout, it’s time to actually get it sorted out.
Why live with a disease that is potentially curable?
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