Arthritis New Zealand Gout Georgina Greville RN Arthritis Educator

Arthritis New Zealand Phone & group clinics Seminars Support Groups Community presentations Research Advocacy

Why is Gout so important? It is more than treating the pain

Gout Treatment Preventing this

Preventing serious long term damage Joint damage Kidney damage from high BP and NSAIDS Increased risk diabetes and CVD Financial and social impact High incidence in Maori and Pacific Island people

Gout in Counties Manukau Prevalence in primary care –14.9% Pacific men –9.3% Maori men –4.1% European men –(2.0% women) > 200 admissions to MMH each year Leading cause for new referrals to rheumatology clinic at CMDHB Richard Hulme CMDHB casemix

Whakapapa of Gout Protective of malaria Present prior to Europeans Whanau whakapapa of gout Ask about their whakapapa of gout.

What are your experiences with Gout? What are the problems?

What I have learned Patients often don’t understand their condition – that the crystals can damage their bones With understanding their management makes sense and they are more likely to continue treatment They need follow up calls

It is not all about food and alcohol We need to get rid of the myths and legends of Gout Focus on Uric acid and dissolving the crystals to prevent gout attacks and damage

Understanding Uric Acid’s role in Gouty Arthritis How do you explain gout?

Gout explanation The main cause of Gout is your kidneys not getting rid of enough uric acid out of your blood. When the uric acid level in your blood is high you make uric acid crystals in your joints. The crystals cause your gout pain. To get rid of gout you have to get rid of the crystals

If I only have 30 seconds Pain medicine treats the pain but does not get rid of the Uric Acid crystals that cause your gout attacks. Allopurinol reduces uric acid in your blood which dissolves your crystals. If you keep your uric acid low by keeping on taking your allopurinol you can’t grow new crystals and cant get more gout.

Uric acid blood test Target <0.36 mmol/L Blood test when no gout pain if possible

Uric acid chart on Medtec Patient manager Inbox Renal function Chart Urate Graph

Recalls When patients are started on Allopurinol Recall in one month to Check how they are going – any gout attacks? remind them to Increase dose to 200mg / 300mg or higher keep taking their meds

Gout attacks Treat as soon as feel first sign How ?

Long term (Chronic) Gout

Start preventative medication If you have two gout attacks in a year talk to GP about starting Medication to lower your uric acid or one gout attack / year and other risk factors

Medication to Prevent Gout Pain months till pain free Allopurinol Wait 2-3 weeks after pain stops before starting Allopurinol or start with prednisone Once started Allopurinol don’t stop! Allopurinol gradually increase dose till uric acid <0.36mmol/L Colchicine To prevent gout pain for 3-6 mths

Diet and Gout

Diet and lifestyle No feast and famine

Treat to target Urate < 0.36mmol/L Early treatment prevents attacks and joint damage Reduce CVD risk, diabetes &kidney damage Reduce size of tophus ( Gout lumps)

To increase rate achieving target uric acid and staying on medication Focus your conversations on uric acid and dissolving the crystals follow up calls / txt Treat to target – know the results

Gout Quiz Can Gout and OA both be in same joint? Does colchicine and NSAIDS get rid of the crystals? If people followed dietary advice their gout would be well controlled? Should Allopurinol be started after 1 st gout attack? Are acute gout attacks mainly caused by diet and alcohol? Does someone who has high uric acid but doesn’t get gout get treated with Allopurinol? Is UA often in normal range during acute attacks? Does gout go away when the pain goes away? Should Allopurinol be continued during acute attacks? Can Gout attacks continue after target uric acid is achieved? Vegetable sources of purines should be stopped? Target Uric acid is 0.30mmol/L for people who have tophi.

Useful Websites: wwww.arthritis.org.nzwwww.arthritis.org.nz – Arthritis New Zealand ww.arthritisresearchuk.org Australian rheumatology association

Questions?

Thank you