Chronic Gout

Person with a sore foot due to chronic gout and high levels of uric acid
WHAT IS GOUT?
It is a type of inflammatory arthritis, that is to say, a painful condition caused by the deposition (build-up) of uric acid crystals in one or more joints.2,3
Some people develop chronic gout, also called gouty arthritis. This is when people experience repeated flare-ups that can lead to joint damage, deformity and limited joint motion.2,4

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MAKING A LIFELONG ADJUSTMENT TO LIVING WITH GOUT
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International guidelines on the management of gout advocate that patient education is essential, including firstly the principles of causation, secondly managing acute attacks and thirdly the importance of effective long-term treatments.1a

Big toe affected by gout due to high levels of uric acid

WHY IS IT IMPORTANT TO LEARN ABOUT CHRONIC GOUT?
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Gouty arthritis can lead to chronic disability and furthermore, joint damage can get progressively worse.1j,3b
Moreover, chronic gout increases the risk of developing osteoarthritis and increases the risk of kidney disease.2d,3b However, long term management with effective medicines can slow down the progression of the disease.1b,5b

MANAGING CHRONIC GOUT.
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In essence, there are 3 basic principles for the effective management of gout. They are the following:

 

Table with tips on the management of gout

THE ROOT CAUSE OF GOUT: URIC ACID
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High levels of uric acid in the body is known as hyperuricaemia which could certainly lead to other conditions like gout.2e,3a
Why does this happen? One reason is that your body might ‘make’ too much uric acid, while another reason may be that your body has difficulty getting rid of it. As a result, there is an abundance of uric acid circulating in the blood, leading to the formation of uric acid crystals in the joints. Thereafter the crystals cause the joint to become inflamed, causing pain, swelling and warmth.2e

WHO IS AT RISK OF DEVELOPING GOUT?
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  • Firstly, it is important to know that most often the uric acid in the blood becomes abnormally high when the kidneys cannot eliminate enough of it in the urine. Moreover, conditions that impair the kidney function include kidney disease, high blood pressure and diabetes, putting these people at higher risk of developing gout.1j,3b
  • Secondly, some medications such as diuretics (water pills) used to treat high blood pressure may increase the uric acid level in the blood.2f
  • Thirdly, consuming too much purine-rich food can also increase the uric acid level in the blood and what is more, combining a high-purine diet with alcohol or beverages containing high fructose corn syrup can worsen matters.3d,e

FOODS THAT CAN INCREASE URIC ACID LEVELS TYPICALLY INCLUDE
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  • Liver, kidney3d
  • Anchovies3d
  • Asparagus3d
  • Meat gravies and broths3d
  • Mushrooms3d
  • Mussels, sardines and herring3d
  • Sweetbreads3d

TREATMENT
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Gout treatment has the following 3 goals:3f

 

 

LONG TERM MANAGEMENT:
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Gout is the only arthritis that can be alleviated with Urate-Lowering Therapy1.

People that suffer from chronic gout may be prescribed a treatment called Urate-Lowering Therapy (ULT), which lowers the uric acid level in the blood. Lowering these levels to less than 6 mg / dL is needed to prevent deposits of uric acid. 2h,3k
When the level is maintained under 6 mg / dL then it will stop being deposited into tissues and existing deposits will eventually dissolve.3k
The benefits of this daily urate-lowering therapy are not only seen in long-term control of flare-ups but also in the prevention of chronic damage to the kidneys and joints.5b,c
These medicines are required if you have the following:1f,2h,5d

  • Frequent, severe flare-ups (more than 2 during the same year) despite taking colchicine or other painkillers
  • Damage to joint and tophi (lumps under the skin)2k
  • Kidney disease or kidney stones

 

GOUT AND KIDNEY DISEASE
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High levels of uric acid in the blood are associated with increased risk of kidney disease.2d For these people in particular, there is a higher likelihood of gout progression and development of tophi.5b
On the other hand, taking medicines to lower uric acid can prevent progression of gout with added benefit of preventing progression of kidney disease.5b

LIFESTYLE MODIFICATIONS
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LONG TERM OUTLOOK
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Treating gout patients to prevent crystal formation and promote crystal dissolution has been a principle of management for more than 50 years!1h,i
With early diagnosis, treatment enables most people to live a normal life.2j Furthermore, for many people with advanced disease, lowering uric acid blood levels can resolve tophi and improve joint function and quality of life.1h,3l
Brought to you by Aspen in the interests of patient education.  This information is provided for educational purposes and does not replace the advice from your Doctor. For more information please consult your Doctor or Pharmacist.

 

WHAT DO THESE MEDICAL TERMS MEAN?
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Tophus/Tophi
Deposits of uric acid can form lumps below the skin around a joint. The lump is called a tophus. Multiple lumps (tophi) develop after a person has had gout for many years.2k
Uric acid
A by-product of nucleic acids (DNA and RNA) in cells and from purines in food.3m
Hyperuricaemia
High blood levels of uric acid.3a A uric acid level in the blood over 7 mg/dL is considered high.2l
Kidney stones
Medically called urolithiasis, kidney stones form in the urine and are composed of uric acid.3b
Urate-lowering therapy (ULT)
Prescription medication taken every day to lower uric acid level in the blood which prevents crystal formation and promotes crystal dissolution.

 

Click here to read more about GOUT (you are about to leave the Medinformer website)



Chronic gout and elevated uric acid levels medical references

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