Living with gout - Prof. Geraldine McCarthy

1. Living with Gout information evening Supported by

2. What is gout? Who gets gout? What causes gout? What are the symptoms? The phases of gout? How is gout diagnosed? How is gout treated? TOPICS COVERED Keep your uric acid down Controlling your gout Avoiding getting an attack Getting a gout attack - tips Talking to your doctor Your gout diary

4. WHAT IS GOUT? A very painful form of ARTHRITIS Chronic condition requiring long term care and management Typical flares or gout attacks commonly occur initially in big toe Affected area will be red, swollen and extremely painful If untreated, attacks can lead to joint and bone destruction, deformities or disabilities, which can greatly affect your quality of life Can also affect: • Knees • Ankles • Elbows • Hands • Wrists

6. WHO GETS GOUT? Unfairly depicted as: ‘THE DISEASE OF KINGS’ Most likely to affect older males and females post-menopause Diet is a contributing factor, however, genetics play a large role Poor kidney health can also lead to a higher risk of developing gout Up to 1 in 40 Irish people have gout Gout can affect anyone, male or female, young or old 20 – 30 – 40 – 50 – 60 – 70 – 80

8. WHAT CAUSES GOUT? Purines occur naturally in the body and also in certain food and drink; • Red meat • Offal • Shellfish • Alcoholic beverages • Sweetened soft drinks Caused by ‘HYPERURICEMIA’ a high level of uric acid in the blood Uric acid is produced by the breakdown of purines in the body Sharp needle-like crystals can form in the joint – body sees these as intruders A gout patient should ideally have a blood uric acid level of <360µmol/L Foods & drinks high in purines

10. WHAT ARE THE SYMPTOMS? Relief treatments will reduce this time considerably Symptoms occur suddenly, commonly at night – severe pain and inflammation Joint warm to the touch Pain increases in intensity, most severe within 12 – 24 hours If untreated, flare can last 6 – 10 days

11. What is gout? Who gets gout? What causes gout? What are the symptoms? The phases of gout How is gout diagnosed? How is gout treated? TOPICS COVERED Keep your uric acid down Controlling your gout Avoiding getting an attack Getting a gout attack - tips Talking to your doctor Your gout diary

12. THE PHASES OF GOUT PHASE 1: ASYMPTOMATIC HYPERURICEMIA • High blood uric acid but no symptoms • May develop into gout Phase 1 No symptoms PHASE 2: ACUTE GOUT • Gout flare occurs. More likely to follow • Long term treatment may start Phase 2 - Acute Gout No symptoms PHASE 3: INTERCRITICAL GOUT • Period of time between flares • No pain at this point in time • Underlying causes of gout still present Phase 3 – Intercritical Gout TIM E PHASE 4: CHRONIC TOPHACEOUS GOUT • Substantial crystals present in joint • Pain intensity increasing, pain between flares • Tophi (visible crystal deposits) form under skin Phase 4 – Chronic Gout If poorly managed, attacks may occur more frequently, last longer and be more painful PAIN

14. HOW IS GOUT DIAGNOSED? Gout can be diagnosed in two ways 2. JOINT ASPIRATION In a hospital setting, fluid is drawn from the joint by syringe and analysed under a microscope – definitive diagnosis For an accurate reading, your doctor may wait until after your flare has subsided to check your blood uric acid levels 1. CLINICAL DIAGNOSIS Your doctor has recognised many of the classic signs of gout and is confident of this diagnosis through experience

16. 2. PREVENTION TREATMENTS Steroids HOW IS GOUT TREATED? 1. RELIEF TREATMENTS Gout is a relatively simple condition to treat - flares and prevention • Taken during a gout flare – early as possible • Reduce inflammation and pain • May be taken after a flare for some time • No effect on blood uric acid levels Colchicine NSAIDs Uricosuric agents Increase excretion of uric acid Urate lowering treatments Prevent uric acid production • Taken long term to prevent gout flares • Help to lower the level of blood uric acid • Should not be stopped during a flare • Relief treatments co-prescribed to prevent flares

18. Long term treatments help to lower your blood uric acid to <360µmol/L KEEP YOUR URIC ACID DOWN! Like other conditions, GOUT HAS A TARGET WHY <360µmol/L? • Dissolves uric acid crystals • Prevents formation of crystals • Reduces joint damage • Prevents future gout flares Note: If you have had gout for a number of years, your doctor may aim for a target below 300μmol/L for a period of time to dissolve significant deposits of urate crystals

20. Get Active!! Excessive weight around the waist increases CV risk also WHAT CAN I DO TO CONTROL MY GOUT? Watch your weight Being overweight increases the risk of gout Avoid high protein diets (Atkins) Increase activity levels Avoid rapid weight loss

21. Consider other conditions that may affect your kidney health WHAT CAN I DO TO CONTROL MY GOUT? Look after your kidneys Kidneys play a vital role in removing uric acid from your body Limit excessive alcohol (especially beer)and sugary soft drinks Watch what you drink Drink plenty of water

22. Some foods are recommended WHAT CAN I DO TO CONTROL MY GOUT? Watch what you eat Some food and drink should be limited FACT!! Contrary to popular belief, asparagus doesn’t increase your risk of gout

24. HOW CAN I AVOID GETTING A GOUT ATTACK? Watch out for triggers • Dehydration • Surgery • Under-eating • Over-eating • Medicines • Chemotherapy • Alcohol binge • Immobility Link your tablet taking to a daily task – e.g. brushing you teeth Keep taking your tablets Keep your URIC ACID down Set a reminder each day

26. WHAT SHOULD I DO WHEN I GET A GOUT ATTACK? Speak to your doctor Rest the affected joint Place an icepack on the joint Take prescribed painkillers early Take other medications as directed Avoid unnecessary contact with the joint Wear appropriate footwear Use appropriate bed clothes Drink water and avoid alcohol

28. Ask the following questions TALKING TO YOUR DOCTOR How does the treatment you have prescribed help my gout? How often should I be taking my treatment? What should I do if I miss a dose? What should I do if my symptoms are not relieved? Will my gout medication interact with any other treatments I am taking? Will any of my current medications increase my level of uric acid? Alternatives? What is my uric acid level? Is my uric acid level below or above my target? <360µmol/L

30. Record the following information YOUR GOUT DIARY Gout attacks monitoring • Date of attack • Duration of attack • Severity of pain • Any comments Uric acid monitoring • Date checked • sUA reading • Any comments

31. Any questions? Supported by

Living with gout - Prof. Geraldine McCarthy

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Living with gout - Prof. Geraldine McCarthy