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Rapid response to:

Clinical Review

Diagnosis and management of gout

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7553.1315 (Published 01 June 2006) Cite this as: BMJ 2006;332:1315

Rapid Response:

More pertinent opinions and observations on Gout.

It would not be unusual for Gout to attack unilateraly since, if one
is right-handed then Tennis Elbow will occur in the Right-sided Flexor
origin.

A Right-handed golfer will suffer his Gout in the Left forearm.

All people walk or stand lop-sided so the strains and pressure will
be to one side or the other.

Therefore Left Podagra or Right Podagra for instance.

It is quite true, as Dr. Kuldip P. Anand (8th June) has well pointed
out that a "normal Urate Concentration" does not exclude a diagnosis of
Gout.

It is my opinion that "there is no normal figure". That each of us
has an inherited threshold over which one gets an attack and below it will
be pain-free. That is a personal matter bequeathed by one's parents and
grandparents' parents. Choose them well.

For example, 25 mgm.% may produce no evidence of
Gout or kidney stones in one patient, whereas any higher than 3.2 mgm.% in another could bring on pains in practically every joint.

It would be of interest to know if Dr. Kuldip P. Anand had any
experience of Ayur-vedic prescriptions for arthritic pain. Such as those
containing Ginger, Turmeric, Frankincense and Japanese Wild Cherry? This
seems to work very well and Chinese people will say "Of course we knew
that Ginger was good" for arthritis!

Safer to keep away from long-term use of Diclofenac things and
Indomethacin and Celecoxib in any of their forms. The Spanish and French
will usually prefer them as suppositories.

Colchicine is so much cheaper too. The restrictions in diet will
also save money.

In India patients should avoid eating gourds, if they do, that is.
And many other unkown Oxalate and Urate containing vegetables and fruit
(Durian for instance and Alphonse Mango) and what one knows not what of.

Competing interests:
None declared

Competing interests: No competing interests

10 June 2006
GEORGE Y. CALDWELL
General Practitoner
SINGAPORE 259858
31 BALMORAL PARK, #18-33,