Nonpharmacologic treatment includes diet, lifestyle modifications, and general health promotion to control comorbid conditions including obesity, metabolic syndrome, hypertension, hyperlipidemia, diabetes, and CKD.[1,10,13] There is a paucity of rigorous data determining the true impact of diet and lifestyle intervention in gout patients; however, smaller studies have been published,[14–18] and a systematic review is currently under way.
Lifestyle recommendations include regular exercise to achieve physical fitness, weight loss to achieve a body mass index (BMI) that promotes general health, maintaining proper diet (i.e., low-fat or nonfat dairy products, vegetables), hydration, and smoking cessation. Foods that patients should avoid include organ meats high in purine content (e.g., liver, kidney), high-fructose corn syrup–sweetened beverages, alcohol overuse (i.e., >2 drinks/day in males and >1 drink/day in females), and alcohol consumption during gouty attacks. Servings of red meats (e.g., beef, lamb, pork), seafood (e.g., canned fish, shellfish), fruit juices, table sugar, and salt should be restricted.
Many drugs may elevate serum urate concentrations; thus, it is recommended that if such a drug is determined nonessential, it be discontinued once a diagnosis of gout is obtained. In some circumstances, and if dictated by the presence of comorbid conditions, some medications that could elevate serum urate concentrations may still need to be continued.
US Pharmacist. 2013;38(3):22-26. © 2013 Jobson Publishing