Arthritis New Zealand
Gout
Georgina Greville RN
Arthritis Educator
Arthritis New Zealand
• 0800 663 463
• www.arthritis.org.nz
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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
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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
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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
3 - 6 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
• 0800 663 463
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 1st 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.nz – Arthritis New Zealand
ww.arthritisresearchuk.org
www.healthnavigator.org.nz.
http://www.rheumatology.org.au/ Australian
rheumatology association
Questions?
Thank you