Ted Mikuls, MD, MSPH, Stokes-Shackleford professor of rheumatology, vice chair for research, internal medicine at the University of Nebraska, discusses interventions and treatments that could prevent lower extremity amputation for people with gout.
Ted Mikuls, MD, MSPH, Stokes-Shackleford professor of rheumatology, vice chair for research, internal medicine at the University of Nebraska, led a study that showed that heightened foot care and surveillance may have led to the lower rate of lower extremity amputation (LEA) among people with diabetes. Here, he explains how interventions and treatments could prevent LEA for people with gout, and that people being considered for LEA may not know they have gout.
Are there standards of care that people with gout but without diabetes need to prevent lower extremity amputation?
There really aren't standards in terms of what should be done with someone with gout without diabetes in terms of a frequency of a foot exam and such. I think the main message is that, for patients who are being considered for lower extremity amputation—and that's often people who have non-healing wounds on their feet, may have suspected osteomyelitis or deep infection of the bone or soft tissues of the foot, or even other places of lower extremity—I think for those patients, this study maybe should make providers take pause. Ask yourself the question: could this patient have gout? Could gout intervention or gout treatment make a difference for this patient? I think if you take time to answer those questions and you're definitive in your questions, a patient's going to be better off in the end and I think that's the take home.