Te porohau Gout

A lot of people think that gout is caused by food and drink such as seafood, meat, and beer. However, what you eat and drink only makes a small difference to your uric acid (also called urate). 

High uric acid is mainly affected by your genes (passed on by your parents), your kidneys, and your weight.

Your kidneys usually filter out extra uric acid which then comes out in your wee (urine). 

If you do not get rid of enough uric acid, the levels in your blood increase. The uric acid can then turn into tiny, sharp, glass-like crystals which collect in your joints causing gout.

The crystals can also cause lumps under your skin called tophi.

Gout can come on suddenly and often starts at night. It often affects your big toe but can affect your:

• knees
• feet
• wrists
• ankles
• hands.

The joint becomes painful, red, and swollen.

Your healthcare provider will ask you about your symptoms and examine the affected parts of your body. They can usually diagnose gout by examining your sore joint. They will arrange a blood test to measure your uric acid levels, either at the time of your attack, or later.

If it is not clear whether you have gout or a joint infection, you may need to have a procedure called a joint aspiration. This involves taking fluid out of the affected joint using a needle and syringe. The fluid is sent to a laboratory to be tested.

Gout is treated in 3 ways:

• medication to treat an attack or flare-up
• medication to prevent further attacks and long-term damage to your joints
• lifestyle measures to help prevent further episodes.

Treating a gout attack

There are various treatments to help relieve the pain and swelling of a gout attack. These include non-steroidal anti-inflammatories (NSAIDs), colchicine and a class of drugs called corticosteroids, most often prednisone.

All anti-inflammatories can have serious side effects especially if used for more than a few days. This is especially important if you have other health conditions and are on other medicines.

Your healthcare provider will discuss the medications with you and give you advice on what is most appropriate for you.

Your healthcare provider will recommend you take medication to lower the uric acid in your blood if you have:

• had more than 2 attacks of gout in a year
• complications of gout
• a strong family history.

This will reduce your chance of getting acute gout and long-term damage.

The goal with this medication is to keep your uric acid levels below 0.36 mmol/L. You will need blood tests to check your levels.

• You usually start the medication at a low dose and increase it slowly to reduce side effects.
• It can take weeks to months to work and you may get gout attacks when you are first taking it. You may need to take an anti-inflammatory medicine with your preventer for the first few months.
• It is important to take your urate-lowering medicine every day, even when you feel well. Continue taking it while you have a gout attack.

Urate-lowering medication is an ongoing, long-term treatment that you have to continue taking for many years.

• Allopurinol is the most commonly used urate-lowering medication.
• If you cannot take allopurinol, your doctor may prescribe another medicine such as probenecid or febuxostat.