Guest: Dr. N. Lawrence Edwards
Presenter: Neal Howard
Guest Bio: Dr. N. Lawrence Edwards is a specialist in internal medicine and rheumatology, and serves as professor of medicine in the Division of Clinical Immunology at the University of Florida in Gainesville, Florida. He is also program director of the Medicine Residency Training Program and vice chairman for the Department of Medicine at the University. In addition, he is the chairman and chief executive officer for the Gout & Uric Acid Education Society.
Segment overview: Dr. N. Lawrence Edwards, MD, rheumatologist and chairman of the Gout and Uric Acid Education Society (GUAES), talks about the Gout Information Kit for medical professionals designed to help improve patient disease management and outcomes.
Health Professional Radio – Gout Information Kit
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us today. Our guest in studio is Dr. Lawrence Edwards, Specialist in Internal Medicine and Rheumatology, serving as Professor of Medicine in the Division of Clinical Immunology at the University of Florida in Gainesville, Florida. He’s also Chairman and Chief Executive Officer for the Gout and Uric Acid Education Society. And he’s here with us in studio to talk about the gout information kit that’s been designed for medical professionals to help improve patient disease management and overall outcomes. Welcome to the program Dr. Edwards.
Dr. Lawrence Edwards: Thank you Neal. It’s a pleasure to be with you again.
N: Thank you. The Gout Information Kit, is this something that physicians can have delivered to them or is this some online course or informational source?
E: Well, it is both. By contacting our website, gouteducation.org, we can send out a number of things, some of them are informational posters that again help dispel some of the myths about gout but we also have patient brochures that are printed up that we send out by the box load to doctors’ offices. The brochure is called About Gout and it describes the disease itself, the various symptoms, what the causes of elevated uric acid level are, it does have a chapter on, a few pages on the role of diet and a discussion generally about the therapeutic interventions that we use work out. So those are the types of things that come in the informational packet that physicians can get.
N: You talked about misconceptions about gout specifically, I mean as physicians you’re familiar with arthritis, rheumatoid, some of these other afflictions that are associated with inflammation. Why do you think there’s so little, I guess understanding about gout?
E: Well patients and physicians focus on the acute symptoms, the very hallmark types of excruciatingly painful forms of gout. They last for a week or so and then they resolve and by the time the patient gets sent to see their physician for their annual exam it’s 3 or 4 months behind them and they don’t emphasize it and the doctor’s not bothered because he’s more worried about their blood pressure and their kidney disease and their diabetes and other things and so it’s a little priority thing. What’s not recognized by both physicians and patients is how this disease progresses if left untreated, if we’re not lowering the uric acid gout will progress into a chronic and crippling form of arthritis, every bit as bad as advanced rheumatoid arthritis as far as leaving people incapable of using their hands and their feet and being up and walking and being independent. So it’s that part of the disease that ends up in the rheumatologist office but aren’t seen very commonly in the primarily care office. So the initial symptoms, the first decade of these intermittent flares can frequently be overlooked and not treated aggressively as far as lowering uric acid down.
N: Now I understand that the Gout Information Kit is designed for medical professionals in their effort or their attempt to improve patient disease management. How much of the kit focuses on teaching the physician how to start the conversation about something that is surrounded with such misconception?
E: Well we actually do that on our website, we have a number of videos that have been done by gout experts from around the country that focus on all aspects of gout – the acute treatment, the more chronic uric acid lowering treatment. And we even have ones on how physicians should be talking to their patients at the very first time about the diagnosis, about the proper emphasis on diet versus medications and so these educational videos are contained on our website, it can be viewed at any time.
N: Is there any, I guess age cut-off where it presents less or more or is this something that can come up at any time?
E: Well it’s interesting, the men certainly get gout at a younger age than women do. There are unusual families where the age of onset is very young, so the young males might develop it even in their teenage years but more common picture of gout is a male in his 40s or 50s or a woman in her mid-60s to mid-70s that first develop these symptoms. It can come on anytime between teenage years and I had a patient that came in the clinic several days ago, that was 92 and had his first episode of gout just several weeks ago, so they pretty much covers the spectrum.
N: Now when someone has been diagnosed and they’ve been treated, are there things that they’re going to have to continue to do at home other than, I guess maybe reducing some of the things that raise uric acid? Is there ongoing maintenance, I guess maybe in the same way that a person who may have a…have to shave it off periodically, is this something that you find happening once a person has been treated for gout?
E: We don’t want anybody with gout shaving anything off. (Crosstalk) Well we tell them in the beginning that this is a condition, the elevated uric acid’s a condition that they’ve had for years and probably even decades and that the ultimate goal is to get them into a state where they’re having no symptoms related to the gout at all and that can be achieved by lowering uric acid. If they have unusual diets and occasionally I’ll see patients down here in North Central Florida, our nearest coast community as it will fishing village called Cedar Key and I have several people that come over from there that there and they’re shrimpers and their whole diet, breakfast, lunch and dinner is shrimp and a couple of cans of beer and that’s just about as bad a diet as you could have for somebody who had gout. So in those situations I do try and get them into a more balanced, western diet but for the most part, and we emphasize foods that can trigger the flares, they’re not causing the gout but they’re triggering the flares and this is red meat and shellfish and beer and we ask them to cut back on those things, they don’t have to eliminate them entirely but just not to be binging on them. Then if we get them started on a uric acid lowering drug and adjust the dose of that medication to where their uric acid is less than 6 then the whole trick with gout from there on out, for the rest of their life in fact is to be on that medication that will keep their uric acid in a good range and if they do that then occasional dietary indiscretions, other types of physical activity they might otherwise clear up the disease can be done without the risk of causing the gout to become symptomatic again.
N: So what do you tell the person that believes that drinking cherry juice is just as effective as taking their medication?
E: Well it hasn’t been well studied. There have been a couple of studies looking at beneficial effects of cherry juice, another high potent forms of vitamin c for lowering uric acid and you can get a little bit of reduction of uric acid but not to the point that it’s gonna cause somebody with gout to no longer have gout, their uric acid levels still gonna be in the elevated range and overtime their disease is gonna get worse as far as treating acute symptoms it does, cherry juice does seem to have some pain relieving properties but again no better than the standard therapies that are otherwise used. So it may have a role, I think there’s more studies that need to be done about cherry juice but it isn’t gonna cure their gut overtime.
N: Great, alright. You’ve been listening to Health Professional Radio, I’m your host Neal Howard, thank you so much for joining us. We’ve been in studio today with Dr. Lawrence Edwards, Specialist in Internal Medicine and Professor of Medicine in the Division of Clinical Immunology at the University of Florida in Gainesville, Florida. He’s also Chairman and Chief Executive Officer of the Gout and Uric Acid Education Society. We’ve been in studio today talking about the kit that’s designed for medical professionals in order to help them improve overall patient disease and outcomes when it comes to the management of gout. It’s been great having you here with us today Doctor.
E: Thank you Neal. It’s been a pleasure.