Out with GoutA Patient Guide to Long-Term Gout Treatment

What Triggers Gout?

It is hard to say exactly what triggers an attack. They sometimes occur for no apparent reason, yet at other times there are definite triggers. These triggers may include:

• Alcohol & certain foods• Certain medications

(e.g. low dose aspirin, some diuretics)• Trauma• Acute illness and surgery• Stopping your chronic gout medication

Long-term consequences may include:

• More painful and frequent attacks• Chronic pain that doesn’t go away between attacks• Joint damage (occurring even between attacks)• Kidney stones and decline of kidney function

Gout Progression

While excess uric acid causes crystals that result in joint swelling, pain and flares, more serious damage can be done over the long term. Without proper treatment, you may have frequent attacks that last longer. An estimated 60 percent of people who have a gout attack will have a second one within a year.1 Over time, attacks may become more frequent, last longer, and involve more joints.

1. Arthritis Foundation Website: What is Gout? – accessed 21/10/2015; http://www.arthritis.org/about-arthritis/types/gout/what-is-gout.php

Gout isn’t limited to painful attacks. It’s a chronic, progressive disease that can have long-term effects, even between flares.

How gout develops varies from person to person, but the most important contributing factor is serum urate or uric acid levels. If uric acid levels are too high, crystals may continue to form in the joints, leading to serious damage over time.

Manage It!2

It is recommended that the level of uric acid in a person with gout should be less than 0.36 mmol/L to help crystals dissolve and prevent them from forming.

2. Taking Control of Your Gout, Arthritis Australia, 2014

The 3 Stages of Gout Progression

Time

Symptoms

Stages

High uric acid

level without

symptom

sHigh uric acid

level without

symptom

s

FlaresG

out diagnosisIntercritical period

(between flares)

Advanced or

chronic gout

Flare Flare Flare Flare Flare

1 2 3

Uncontrolled hyperuricaemia

0.36 mmol/L

Later attacks are more likely to involve more than one joint at a time, eventually becoming more severe, more frequent, longer lasting, and calling for longer recovery time.

Even when you aren’t experiencing painful flares, you still have gout. In fact, even during the period between attacks known as “intercritical gout”, joint damage may still continue.

2Stage Flares

1Stage High uric acid levels, no symptomsYou have high uric acid levels, but no flares. This stage is referred to as “asymptomatic hyperuricaemia”.

During this stage, most people don’t actually develop gout. Those who do may have high uric acid levels for decades before their first attack.

This is often when gout is first diagnosed. Referred to as “acute gout”, this occurs when excess uric acid begins to form crystals, causing inflammation in your joints that leads to the swelling and pain of a flare.

If left untreated, the period between attacks may disappear entirely, leaving a trail of constant joint damage.

In addition to chronic pain, crystal deposits can cause deformities, damage surrounding tissue, and lead to joint destruction.

3Stage Advanced or chronic gout

This phase of gout is the most disabling. Referred to as “chronic tophaceous gout”, it may cause you to experience constant joint pain.

Long-Term Gout Treatment

Once you’ve worked with your doctor to manage the immediate pain of a gout attack, it’s time to think about the long term. Preventing further attacks and complications associated with gout are important management goals.

High uric acid levels are the underlying disorder in gout. If you don’t know your uric acid levels, discuss it with your doctor during your next visit.

KEEP IN MIND! It’s possible to have flares when starting any urate-lowering therapy. However, this is a sign that the medication is working. In order to reduce the likelihood of a flare during the first months of treatment, anti-inflammatory medication (e.g. naproxen) or colchicine is recommended for up to 6 months as prescribed by your doctor.

Your doctor has prescribed a ‘urate-lowering therapy’ to help lower your uric acid level over the longer term. Read the Consumer Medicine Information leaflet included with your medication prior to taking it for the first time.

Taking Your Medication

If you lower your uric acid levels, you may reduce your risk of painful gout attacks over time.

Talk to your doctor about a comprehensive treatment plan. The best plan for you may include making healthy lifestyle changes, taking medication to reduce pain during flares, taking medication to prevent further attacks, and monitoring your uric acid levels.

Lower uric acid levels to 0.36 mmol/L or less to help crystals dissolve, and prevent them from forming – a critical goal in gout management2.

0.36 mmol/L

Visual representation only. Does not reflect actual ratio of uric acid level to risk of attacks. Not everyone who has high uric acid levels has been diagnosed with gout. This chart represents what may happen in someone already diagnosed with gout.

Uric

Aci

d L

evel

s

Lower risk of attacks

Higher risk of attacks

Lower uric acid levels lower your

risk of gout attacks over time

2. Taking Control of Your Gout, Arthritis Australia, 2014

The Importance of my daily gout medication

How urate-lowering therapy works to treat my gout (your doctor will explain the diagram below):

My Treatment Plan:

My Target Serum Urate/Uric Acid Level is: 0.36 or 0.30 mmol/LMy Serum Urate Level Tracker:

Serum Urate Level Date Follow-up Appointment Date

1. Treatment to reduce uric acid / urate level:

Medication: _____________________________ How Often: __________________

Do NOT stop your urate-lowering therapy during an acute flare of gout.

2. Treatment to reduce chance of flares when lowering uric acid / urate level:

Medication: _____________________________ How Often: __________________

3. If a gout flare occurs, then I need more treatment:

Medication: _____________________________ How Often: __________________

4. Further reading: Arthritis Australia Gout Book:

http://www.arthritisaustralia.com.au

A. Menarini Australia Pty Ltd, Level 8/67 Albert Ave. Chatswood NSW 2067. 1800 644 542. ABN 62 116 935 758. October 2015. ADE-AU-0422

Urate formation from diet and metabolism

Kidneys help remove uric acid from the body.

Urate Stores