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It is usually in solution in the blood and filters through the kidneys into the urine. In people with gout, the uric acid level in the blood exceeds its solubility and crystals are deposited in joints and other tissues. In joints this causes the synovium to become inflamed. Initially, episodes of inflammation last only a week or so with no symptoms in between. However, untreated acute attacks occur more frequently and chronic inflammation results in damage to affected joints leading to stiffness and limited mobility.

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PThese cycles all have serious side effects and must be used under specialist knowledge. Viral reflexes are common, since in children.


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There is a feeling in the podiatry profession that ultimately independent prescribing would allow them to provide the best care in many situations. The clear advantages of supplementary prescribing for a consultant podiatrist working in the community now are that a referral system has been set up with the GPs of vulnerable patients in a local area; the patients receive timely and appropriate access to urgent treatment; there is improved compliance for many patients; management of serious foot ulcers follows published protocols; drug monitoring for adverse effects and drugdrug interactions is the responsibility of the prescribing podiatrist; and the patients are likely to need fewer episodes of care.

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You should be able to answer the following review questions from the material presented in this chapter.

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References Bolam v Friern Hospital Management Committee All England Law Reports Bolitho v City and Hackney Health Authority All England Law Reports Burke, L.

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