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The diagnosis and treatment of gout and crystal arthropathy requires a careful review of a patient’s symptoms, physical findings, and previous testing. During a patient’s first appointment at the Gout and Crystal Arthropathy Center, we will review his/her medical history, perform a physical examination, and decide what additional tests are necessary to make an accurate diagnosis, typically through confirmation of uric acid or other pathologic crystals in and around the joints. We will also conduct a careful review of the patient’s medical records; therefore, we ask all patients to bring their previous medical notes, as well as related test results, including available radiographic evaluations.
Once the diagnosis is confirmed, we deliver optimal gout care with a coordinated long-term strategic approach that involves several key components that go beyond initiation of anti-gout drugs. This gout care strategy consists of patient education, individualized lifestyle advice, and appropriate use of anti-gout medications (typically, uric acid-lowering therapy) to achieve and sustain treatment targets of disease control and a potential cure (i.e., sustained uric acid control, absence of gout symptoms, and normalization of quality of life). Over a one-year period, this approach can lead to more than 90% of patients achieving the primary treatment target of uric acid <6 mg/dL as recommended by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR), and to 85% achieving a serum urate level of <5 mg/dL, the target level recommended by the British Society for Rheumatology.
Our gout management strategies include initial patient education by experienced specialists, which is considered a key to its success. Center doctors Hyon Choi, MD, DrPH, Mark Fisher, MD, MPH and Minna Kohler, MD will apply their clinical and research expertise in gout and crystal arthropathies to develop personalized care plans for our patients. We promote communication with the patient, and prioritize taking sufficient time to explain the meaning and significance of hyperuricemia (elevated uric acid levels) in relation to crystal formation, and the clinical manifestations of gout, as well as the importance of treating-to-target when using uric acid-lowering therapy and the need for preventing and treating flares of gout.
In addition to research and treatment for gout, our specialists also provide coordinated long-term care for pseudogout and other crystal arthropathies.
The Gout and Crystal Arthropathy Center, as guided by the needs of our patients and their families and friends, is dedicated to delivering the very best personalized, comprehensive, compassionate, and efficient health care and support to our patients; advancing the treatment of these diseases through cutting-edge research and education; and improving the health and well-being of the diverse communities we serve through these efforts by treating and preventing gout, pseudogout, and crystal arthropathies.
Dr. Hyon Choi is the Center director and Director of Clinical Epidemiology in the MGH Rheumatology Unit, and has been a leading rheumatologist-investigator with a primary focus on gout throughout his academic career. The significance of Dr. Choi’s contributions has been widely accepted by the field, and his findings have been referenced by many articles as well as by the recent guidelines from the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR, 2012).
Dr. Mark Fisher is the Assistant Clinical Director of the MGH Rheumatology Unit, and he has ongoing gout projects that focus on inpatient acute gouty arthritis flares and their impact on length of hospital stay and other key inpatient gout care issues, as well as comparisons between primary care versus rheumatology management of gout.
Dr. Minna Kohler is the Director of Rheumatology Musculoskeletal Ultrasound in the MGH Rheumatology Unit, and her research focuses on the diagnostic and therapeutic utility of ultrasound in rheumatic conditions.
Our dedicated team of specialists also work closely with experts in other specialties and centers across the hospital that are relevant to gout care, including the Diabetes Center, Heart Center, endocrinology, nephrology, nutrition and others.
The Gout and Crystal Arthropathy Center fosters translational research collaborations with the Massachusetts General Hospital Center for Immunology and Inflammatory Diseases, Harvard School of Public Health, and the Broad Institute of Harvard and MIT. One of the principal missions of our Center is to unify basic and translational research efforts with the ultimate objective of clarifying the genetic and inflammatory mechanisms of gout and crystal arthropathy to identify novel treatment avenues for these conditions.
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