Journals Watch - Gout, back pain and hypertension

Too busy to read the journals? Let Dr Jonathan Holliday guide you through the latest research.

Soft drinks and gout
BMJ doi:10.1136/bmj.39449.819271.BE

I thought that it was only alcohol intake that had to be curtailed if one developed gout, but now it appears that soft drinks containing fructose and other fructose-rich foods also need to be moderated.

In this study in the US and Canada, over 46,000 men with no gout at baseline were followed up, over a period of 12 years, with food-frequency questionnaires.

During this time, 755 cases of gout were reported. It was found that an increasing intake of sugar-sweetened soft drinks was associated with an increasing risk of gout.

Those men who drank five to six servings of soft drinks weekly had almost double the rate of gout compared with those who drank less that one drink monthly.

Diet soft drinks had no such increased risk, while fruit juices and fructose-rich fruits such as apples and oranges also increased the risk of gout.

Is this another case of what you can and cannot drink or eat safely? At least this is good reason, apart from weight-loss, to advise patients to avoid fizzy drinks.

Heavy lifting and back pain
BMJ doi:10.1136/bmj.39463.418380

The number of days lost from work due to back pain remains high in the UK, and back pain is one of the most common reasons to be absent from work.

This study set out to answer whether advice about correct lifting techniques can therefore reduce the incidence of back pain and consequent loss of working days and disability.

A large number of studies looking at whether advice and training in working techniques, and lifting equipment prevent back pain in jobs that involve heavy lifting were assessed.

Results were compared with control groups who received no intervention, or only minimal training. Disappointingly, none of the comparisons showed any significant difference.

Findings challenge the current practice of advising workers on correct lifting techniques.

Amlodipine or atenolol for hypertension
Heart 2008; 94: e4

Should we prescribe amlodipine or atenolol for hypertension? In terms of efficacy, many of us would assume that we know. But in these days of real value for money such assumptions are not accepted.

So this article looking at the cost-effectiveness of an amlodipine-based regimen (5-10mg amlodipine plus 4-8mg perindopril as needed) compared with an atenolol-based one (50-100mg atenolol plus 1.25-2.5mg bendroflumethiazide as needed) was interesting, and supportive.

This was a prospective, randomised trial carried out in Sweden and the UK. It showed that in the UK the cost to avoid one cardiovascular event or procedure would be EUR18,965 (£14,000) and the cost to gain one quality-adjusted life-year would be EUR21,875 (£16,000).

It costs about a third less in Sweden apparently - although I don't know why.

Which tetracycline for acne
Br J Dermatol 2008; 158: 208-16

I have a lot of teenage boys on my list as we are close to a large boarding school for boys, so this review article was potentially going to change my practice - and perhaps it should.

Like many, my first-line treatment for acne is lymecycline, for a combination of efficacy and compliance reasons.

However, this review of all clinical trials investigating oral tetracyclines for the treatment of inflammatory acne (1962-2006) finds no apparent benefit for these actions.

Instead, it found that no significant difference between the available tetracyclines in terms of improvement in inflammatory and non-inflammatory lesions, and the antibiotic dosage had no apparent impact on efficacy.

So it is back to the oxytetracycline, it seems.

GP appraisal: what GPs think
Br J Gen Pract 2008; 58: 82-7

We all have our own views about appraisal, but it is interesting to see what others think.

This was a good-sized study in which a random 25 per cent of the entire Scottish GP population were canvassed.

Some 47 per cent thought that appraisal had altered their educational activity; 33 per cent of responders reported undertaking further education or training as a result of appraisal, and a rather sad 13 per cent felt that appraisal had influenced their career development.

In the days of PGEA, I guess it was close to 100 per cent of GPs who undertook further training. For the most part, it was the minority who felt that the impact was anything more than 'in a small way'.

This cannot be said to be a ringing endorsement.

Dr Holliday is GP in Eton, Berkshire

The quick study
  • Gout risk may be increased by consuming fructose-rich soft drinks.
  • Back pain is not significantly reduced by advising on heavy lifting technique in the workplace.
  • Hypertension can be treated cost-effectively with an amlodipine-based regimen, as compared with an atenolol-based regimen.
  • Acne is improved by whichever tetracycline is prescribed, and there is no significant difference between the efficacy of those available.
  • GP appraisal has some effect on GPs' educational activity, although little effect on career development.


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