Question

My 85 year old mother has been suffering from gout and now has developed bursitis. Are the two conditions related and what is the prognosis for gout?

Answer

There is evidence to suggest that gout is much more frequent in affluent than in malnourished populations. Gout is due to problems that arise because there is a deposition of crystals of urate in certain tissues. The deposition depends on the concentration of urate in the blood, and this in turn depends on the production and the elimination of urate from the body. Most patients with gout have a problem with excretion of uric acid. This abnormality is most unlikely to resolve in most patients, and the tendency to have gout will usually never go away.

What does go away in most patients is the clinical manifestation of the disease. Acute attacks may last up to 15 days if they are not treated, but should disappear more quickly if sufferers are given current medical treatment. It is not usual for the condition to cause bursitis, but this is a recognised problem.

Some people never have a second attack; in others the next episode may occur only after many years. Unfortunately the frequency of attacks and the number of sites involved gradually increase with time. If there are many attacks, then there may be chronic pain, but this does not usually develop for about 10 years.

What can be done to prevent further acute attacks?. Alterations in lifestyle may help, such as a gradual weight loss, reduction in alcohol consumption and possibly an alteration in medication if that medication leads to a high urate level in the blood (for example, some diuretics). The most important preventative method is drug therapy, which is usually of great benefit.