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Gout Dugout.Issue #070 | getting the right gout diagnosis | gout almost meets its Waterloo
June 30, 2015

Hello and Welcome to the June (Summer) 2015, edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read from that gives you useful ideas that may help with your gout.

Copy and print if you prefer to read a version on paper. If you are extra busy now you could bookmark it for later.


I had some correspondence recently with someone who was diagnosed with gout. This is another of those failed gout diagnosis stories, although this time it was not a failure to diagnose gout correctly, as it often is, but a diagnosis of gout when it wasn’t. And confusing it with psoriatic arthritis.

Because of a painful finger she went to a hospital’s Emergency Room (Accident and Emergency Unit) where a hand surgeon examined her finger swelling and announced - “gout.”

This "diagnosis" was followed by four years, that's four years, of my correspondent thinking she had gout, despite the absence of one of its hallmarks, a blood uric acid level above 7.0 mg/dL (about 6.5 in women).

However, determined to get to the bottom of the problem, she recently saw a rheumatologist who also examined the finger swelling (there was another on a toe). There was the absence of the gout tell-tale mark of a small pustule(s)(pimples), often developing tophi, among the finger’s redness discolouring. The rheumatologist was clear it was not gout - "not a gout picture."

Moral of the story? If you think you have gout see a rheumatologist, the more gout-experienced the better. Not a GP(PCP) or other non-specialist. In this case the rheumatologist's experience at seeing gouty fingers was decisive, whereas a hospital hand surgeon's was not.

Gout comes under the remit of rheumatologists, sometimes podiatrists. A good rheumatologist will have a polarizing microscope.

You might think that is banal and obvious advice but most gout sufferers, just about everywhere on the planet, do not immediately think of a rheumatologist, or not for years, during which time gout becomes more entrenched because it is not being dealt with properly.

Best test is a joint aspiration (aka arthrocentesis) which is why the rheumatologist needs a polarizing microscope. Although even this is not perfect if gout is in a body joint where it’s hard to extract enough synovial fluid to examine for the presence of the monosodium urate (MSU) crystals.

And here's a tip My correspondent took photos of her finger and toe from 4 years earlier to the rheumatologist and these helped him to decide.

A gouty middle finger with a white pustule (pimple) - a sign of gout


June 18th marked the 200th anniversary of the battle of Waterloo, one of the world’s most significant battles. The British led (Duke of Wellington) coalition of Britons, Germans, Belgians, Dutch and Prussian Germans finally defeated Napoleon Bonaparte for good.

The 4 days of celebrations saw huge crowds near the Belgian village of Waterloo to watch re-enactments of the battle and other celebratory events.

There is a small gout story about Waterloo and here it is. The British major-general Sir Charles Alten had been suffering gout for 20 years and on the morning of the battle (a Sunday in 1815) was enduring yet another attack. However when the battle began, at about 11.30 am, his gout flare mysteriously disappeared, as he attended to more serious matters. Alten was wounded and survived but at 9.30 pm on a summers’ evening when the battle was over, his gout flare returned !

I am sure people would prefer not to be involved in something like Waterloo to distract their gout pain for 12 hours !!

Charles Alten was also named Carl August Von Alten, a German in British army service, from what was then the kingdom of Hanover. There is a statue for him in Hanover, Germany and you can see it here.

The link is to his wikipedia entry, but it does not mention his gout.

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It wasn’t so long ago that had a makeover and a new column was added amongst other changes.

But for the past 2 years the number of visitors arriving from mobile phones has skyrocketed to be now around 50% of all visitors. The other 50% are from desktops, laptops and tablets. Because the pages had not been designed for mobiles, mobile visitors' viewing experience was not so hot and they spent less time on a page.

So when a few weeks ago the website hosts offered a new responsive-to-mobiles design, I jumped at the chance to make another big change that would improve visitor experience. Although without the rise of the mobile viewer I would not have thought it necessary.

I am not particularly thrilled about all these mobile visitors because I don’t believe most people can learn about gout from a small screen and probably in a non- contemplative situation.

But if you prefer to visit by mobile, you will find the pages format much better now in a mobile; they will load much faster (as they will now on desktops and the others), which is always desirable. The typeface (font) is larger, which I hope makes the content easier to read. So too the headlines.

On the other hand, the downside is that the pages are not as attractive-looking as before – it’s a no frills design that I’ll aim to make more slick. Navigation is now horizontally across the top of each page, not vertically down the left column. There is no third column any more.

As a result traffic is up. Further improvements are on the way.

I urge and remind you to use the search box on the home page to find information about gout topics you wish to know more about.

You can see the new home page at the link below. The changes apply to all pages except one, and the back issues of this newsletter.

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If you are not a subscriber to the Gout Dugout, this free gout newsletter, you can sign up at this page - click on the link below.

Go to the home page by clicking on the link below.


There is no single drug medication that is certain to cure/control all cases of gout, but it is possible that pegsiticase/SEL-212 might one day become the gold standard treatment. If not for all gout cases, (earlier stages of gout would probably not require it), but the later stage gout cases, usually those where tophi have developed.

Pegsiticase is one of the biologic drugs for gout and this class lower uric acid quickly and by large reductions. The problem with gout biologics is their reactions from the immune system and other side effects. Much more of these than we get from orally taken meds.

Pegsiticase/SEL 212 marries pegsiticase, once known as uricase peg-20, to the SVP (synthetic vaccine particle) technology of Selecta Biosciences.

This prevents/inhibits the unwanted immune system responses of other biologics for gout. So you can see what a huge potential there is here.

The news is that, as they promised last year, Selecta have announced a Phase 1 trial of pegsiticase has commenced. It's the beginning of a long road to approval that may take 10 years, but this one is worth remembering.

If you want to learn more, there is a full page review of pegsiticase and SEL-212 for gout on this page of the website.


Use's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Rasburicase? Type that in the site search box.

There are currently around 235 pages, including all the back issues of this newsletter. It works. Use it!

Next issue in SEPTEMBER. One item will be about an herb, it's also a spice, that reduced uric acid by 2.80 mg/dL - that's an excellent reduction - in a study. I learned about this from a friend of the website, and it's incredible that I'd never heard of this before.

Thanks for reading, all the best of health.

John Mepham BA (Econ)
Makati City,

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