The British Society of Rheumatology has issued guidelines for the management of gout.

Gout is a common disease, and you might think a common treatment strategy would have emerged. However, it appears that there is a lack of agreement about the exact treatment methods that should be used, and in fact there is great deal of variability ion how different doctors treat gout.

This is unfortunate for anyone seeking to control gout, whether with the help of a doctor or not. For one thing, if medical professionals can’t agree on the best drug regime, they are not likely to be able to come up with a suitable diet for gout or recommended gout foods. The patient in this situation has to fall back on information from the Internet, which may not always be entirely reliable: that’s especially true where someone is looking for information on a diet for gout or information about good gout foods (i.e. the ones which reduce the likelihood of an attack).

The British Society of Rheumatology is trying to produce evidence-based guidelines that can offer improved standards of medical care. It is also scientifically assessing the potential of xanthine oxidase inhibitors or urate oxidases in the tretament of gout. And in addition the Society offers clear recommendations and guidelines about alcohol consumption, as well as recommending dietary and lifestyle modification, and recommends strategies for the treatment of gout in unusual cases such as renal insufficiency, purine overproduction, or allopurinol hypersensitivity.

The Recommended Approach for the Management of Acute Gout

1) The joints which are affected by gout are to be rested in an elevated position.
2) Fast acting anti-inflammatory drugs at the maximum possible dosage should be administered immediately and continued for 1 to 2 weeks.
3) Naturally, in men and women where there is a risk of stomach problems, some protective agents such as proton pump inhibitors should be prescribed along with the painkiller of choice, which is usually a fast acting NSAIDs.
4) Colchicine is an effective alternative to NSAIDs but takes longer to work.
5) Allopurinol should not be started during an acute attack of gout, but should be continued if someone is already being treated with it and they develop an acute attack of gout.
6) Corticosteroids are an effective medication which may take the place of NSAIDs.

When allopurinol is given to dissolve urate crystals within the joint, there is a risk of a person suffering an acute attack for almost a year. Furthermore, the dose needed depends on the serum urate level. A dosage as high as 900 mg may be needed every 24 hours.

Suggestions for A Good Diet For Gout

Lifestyle Modification & Recommendations for Non-drug Based Therapy

As emphasized before, the best remedy is to find a diet for gout which aims to take a person to their ideal body weight in a gradual fashion.

• Crash dieting, or diets which involves consumption of high levels of protein and low carbohydrate, need to be avoided.
• Good  gout foods include skimmed milk, low-fat yogurt, soy beans, fruit and vegetables, and particular vegetable protein, and cherries.
• With gout, foods which should be restricted include liver, kidneys, other organ meats including brains, yeast extract, and shellfish, asparagus, anchovies and mackerel.
• Protein intake should be reduced.
• Those who have gout in the history of urolithiasis need to drink over 2 liters of water daily. When kidney stone formation happens repeatedly, potassium citrate may be given.
• As far as alcohol consumption is concerned, this is definitely part of a good diet for gout. In general, alcohol intake needs to be less than 21 units a week in men, and even lower in women (14 units per week). Having 3 alcohol-free days per week is recommended, and completely abstaining from beer, port, fortified wine and stout is best practice.
• Affected joints should be elevated and exposed in a cool environment (advice which, on the face of it, seems a little hard to understand, since lower temperatures encourage the precipitation of uric acid crystals). Ice packs and birdcages to prevent bed linen touching the affected joint are also effective ways of reducing pain. (Though low temperature is one of the precipitating factors for a gout attack, so ice packs should be used for a limited time only.)
• Moderate physical exercise is a good idea, but strenuous activity should be avoided.

Recommended Approaches to Caring For Gout

The aim of all medical treatment is to maintain a plasma urate level below 300 µmol per liter. This will require uric acid lowering therapy with drugs if more gout attacks occur within 12 months of the first. There are suitable therapies available for all men and women, including people with tophi, renal impairment, and kidney stones. The initial treatment is always allopurinol, as a low dose of 50 – 100 mg, which can be increased by between 50 and 100 mg every few weeks until the target of serum uric acid level below 300 µmol per liter is achieved.

For individuals who are resistant to allopurinol, or who show reduced levels of excretion of uric acid, uricosuric agents can be used: sulphinpyrazone or benzbromarone. Colchicine is often prescribed alongside allopurinol and uricosuric drugs.