GP Clinical: Websites on the management of gout

Websites related to this week's Clinical Review, selected by Dr Keith Barnard

ALLOPURINOL TREATMENT

There are a number of treatments for chronic gout, but allopurinol is probably the one with which most GPs in the UK are familiar.

This site explains how allopurinol works. It is aimed more at chemists than GPs; this means you will see some strange diagrams that some older readers might need to be reminded represent molecular structure.

But there is much else that is comprehensible to the GP here, with some useful images, including my favourite depiction of gout drawn by James Gilray in 1799 and a splendid-looking contraption that helps gout sufferers to mount a horse.

If you need a smile, take a look at this.

Why go there: find out how allopurinol works.
Downside: somewhat esoteric.
Information from: Royal Society of Chemistry.
Address: www.chemsoc.org/ExemplarChem/entries/2001/sinnott/gout.htm

A DUBIOUS SOLUTION

Maybe I'm too hard on herbal remedies, but when you read that it is possible to 'remedy gout naturally in just minutes with these award-winning herbal patches', my scepticism neurones start firing like a Gatling gun.

Then I read the testimonial, which said: 'With your patches I'm coming back from near death.'

Somehow belief in God came into it as well, which might exclude a few potential clients, and the before-and-after pictures are suggestive of cellulitis rather than gout in my opinion.

The treatment on sale here is a herbal patch that is stuck on the sole of your foot, 'releasing a lot of biological energies and herbal medicines into your blood'. It seems these energies transfer into body tissues that correspond to the reflex areas in your foot.

Ten patches will set you back about £40.

Why go there: why, indeed?
Downside: no need to spell it out.
Information from: OneRom Group, Inc.
Address: www.healerpatch.com/gout-plus.html

PATIENT INFORMATION

This is no ordinary patient leaflet. It is a professionally produced, full-colour, fully illustrated, eight-page booklet, presented as a downloadable PDF. The UK charity that has produced this excellent layman's guide to gout has really pushed the boat out here.

If there is a criticism, it is that they have used several pages to make this a rather flashy presentation. This makes it attractive to look at, but is not so good for the trees, and is probably unnecessary to attract a sufferer who wants to know more.

There is no denying, however, that this is one of the best sources around of information for patients.

Why go there: sensible and reliable.
Downside: could be three pages shorter.
Information from: UK Gout Society.
Address: www.ukgoutsociety.org/docs/all_about_gout.pdf

- Clinical Review, page 41

WEBSITE OF THE WEEK

This PDF, from a continuing education journal based in South-East Asia, is one of the most up-to-date and concise summaries of gout available.

Apart from some X-rays and images of gouty tophi, there are flow charts and tables about purine metabolism and uric acid levels.

The important causes of both these situations are highlighted, including hypertension, diuretics, renal disease, lymphoproliferative disorders and severe psoriasis.

Why go there: concise overview.
Downside: none.
Information from: Medical Progress Journal.
Address: www.medicalprogress.com/dispdf.cfm?fname=MPOCT2003Gout.pdf.

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