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Arthritis New Zealand

Arthritis New Zealand presents a comprehensive guide to understanding gout, its causes, prevention, and treatment options. Learn how to manage gout to prevent long-term damage and improve your quality of life.

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Arthritis New Zealand

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  1. Arthritis New Zealand Gout Georgina Greville RN Arthritis Educator

  2. 0800 663 463 www.arthritis.org.nz Phone & group clinics Seminars Support Groups Community presentations Research Advocacy Arthritis New Zealand

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

  4. Gout Treatment Preventing this

  5. 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

  6. 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 eachyear • Leading cause for new referrals to rheumatology clinic at CMDHB Richard Hulme CMDHB casemix

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

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

  9. 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

  10. It is not all about food and alcoholWe need to get rid of the myths and legends of GoutFocus on Uric acid and dissolving the crystals to prevent gout attacks and damage

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

  12. 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

  13. 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.

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

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

  16. 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

  17. Treat as soon as feel first sign How ? Gout attacks

  18. Long term (Chronic) Gout

  19. 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 Start preventative medication

  20. 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 Medication to Prevent Gout Pain

  21. Diet and Gout

  22. Diet and lifestyleNo feast and famine

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

  24. 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

  25. 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.

  26. Useful Websites: wwww.arthritis.org.nz – Arthritis New Zealand ww.arthritisresearchuk.org www.healthnavigator.org.nz. http://www.rheumatology.org.au/ Australian rheumatology association

  27. Questions?

  28. Thank you

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