Non pharmacological modifications if patient with gout

non-pharmacological recommendations for patients with gout

In patients with milder cases of gout, non pharmacological modalities could be of great benefit (1). Patients should be educated about:

• the importance of lifestyle changes
  • in overweight patients - dietary modification to achieve ideal body weight should be recommended (‘crash dieting’and high protein/low carbohydrate (Atkins-type) diets should be avoided).
  • reduction of high purine foods and red meat
    • however there is some clinical data has shown that consuming purine-rich vegetables does not increase the risk of gout (1)
  • avoiding dehydration
  • reduction in alcohol intake - beer, stout, port and similar fortified wines are best avoided
  • inclusion of skimmed milk and/or low fat yoghurt, soy beans and vegetable sources of protein and cherries, in the diet should be encouraged
  • moderate physical exercise (2)
• keeping the affected joints elevated in a cool environment (avoiding clothing and using an ice pack)
• avoiding trauma to the affected joint and intense physical exercise.
• compliance with long-term therapy
• prevention of flares early in the course of urate-lowering therapy (ULT)
  • initiating ULT will change SUA levels, the therapy itself may cause a gout attack (called a mobilization flare). (1).

Reference:

• (1) Hamburger M. 2011 Recommendations for the diagnosis and management of gout and hyperuricemia. Postgrad Med. 2011;123(6 Suppl 1):3-36.
• (2) Jordan KM et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford). 2007;46(8):1372-4