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19120 Arthritis Aus Gout Booklet

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19120 Arthritis Aus Gout Booklet Taking control of your Gout A practical guide to treatments, services and lifestyle choices How can this booklet help you This booklet is designed for people who have gout. It will help you understand your • make healthy choices for your condition so that you can better general health and wellbeing manage your symptoms and continue • find support and additional to lead an active and healthy life. information to cope with the This booklet offers information and impact of gout. practical advice to help you: The information inside is based • understand what gout is and on the latest research and what it means for you recommendations, and has been reviewed by Australian experts in the • understand how medicines can field of arthritis to make sure it is help treat gout attacks and current and relevant to your needs. prevent future attacks So go ahead — take control of • work with your healthcare team your gout! to manage the disease in the short and long term © Copyright Arthritis Australia 2014 Supported by: AstraZeneca Pty Limited ABN 54 009 682 311 Alma Road, North Ryde NSW 2113 2 Taking control of your Gout Contents Understanding gout 4 Treating gout 10 Diet and lifestyle 16 Who can help? 21 Working with your GP 22 Seeing a rheumatologist 23 Other health professionals 24 Seeking support 26 Glossary of terms 28 Useful resources 29 Medical and consumer consultants Tanya deKroo, Information Resources Coordinator, Arthritis Australia Wendy Favorito, Arthritis Australia Consumer Representative and Board Member Assoc Prof Neil McGill, Rheumatologist Assoc Prof Julian McNeil, Rheumatologist and Chair of Australian Rheumatology Association’s Therapeutics Committee Assoc Prof Peter Youssef, Rheumatologist and Chair of Arthritis Australia’s Scientific Advisory Committee Arthritis Australia 3 Understanding gout What is gout? the main reason for more than Gout is an extremely painful form nine out of ten people with gout). of arthritis. Often referred to as the If uric acid levels remain high, small, ‘disease of kings’, it was thought that needle-like crystals of monosodium gout resulted from overeating and urate monohydrate (urate) start drinking too much alcohol. In fact, forming in and around the joints gout can affect anyone regardless (Refer figure 1 on page 5). These of diet and alcohol intake. crystals form slowly, over months or Gout occurs as a result of high levels even years. A gout attack occurs when of uric acid in the body. there is inflammation in the joints where these crystals have formed. What is uric acid? As the gout attack settles, the pain and inflammation will disappear but Uric acid is present in small the crystals still remain in the joint(s). amounts in our blood. It is made as our bodies break down natural substances called What are the symptoms purines. Purines are found in of gout? our bodies’ cells, as well as Generally, the first symptom of gout is some of the foods we eat. severe pain from a gout attack. Uric acid levels can be high for months or even years before a gout attack Our kidneys usually remove any occurs. An attack of gout usually comes excess uric acid from our bloodstream on very quickly, over just a few hours, into our urine. However, people and often overnight. The affected with gout have higher-than-normal joint(s) becomes inflamed, causing amounts of uric acid in their bodies. intense pain, redness, heat and swelling. This can be a result of: Often the joint is extremely sore to • producing too much uric acid touch – even just the light pressure of and/or the bed sheets can be excruciating. • the kidneys being unable to Without treatment, a gout attack remove it quickly enough (this is usually lasts about one week. 4 Taking control of your Gout While the affected joint(s) is What causes gout? inflamed, it can be extremely painful Gout occurs in people with to walk or use the joint normally. higher-than-normal levels of uric acid Gout commonly affects the big in their body. Some people with gout toe, although other joints can be may produce too much uric acid. More commonly, it results from the affected, including the ankles, knees, kidneys being unable to get rid of hands, wrists and elbows. enough of the excess uric acid. Some Urate crystals can also collect under of the known risk factors for having the skin forming small, solid, white high uric acid levels include: painless lumps called tophi (Refer • Genetic factors: Having figures 2 and 3 on page 6 and 7). higher-than-normal uric acid The most common places tophi form levels can run in families and are on the toes, ears, fingers, hands, is one of the most common forearms, knees and elbows. causes of gout FIGURE 1 Bone Cross-section Capsule of joint with (ligament) urate crystals Synovium Cartilage Urate crystals Cross-section of a joint showing urate crystals deposited in the cartilage Graphics used with kind permission of Arthritis Research UK. Arthritis Australia 5 Understanding gout • Being overweight or obese • Overeating, particularly certain foods that are linked with gout • Having high cholesterol, high attacks, although this is still not blood pressure or glucose well understood from research. intolerance See page 16 for information • Having kidney disease about gout and diet • Taking certain diuretics (‘water • Drinking too much alcohol may tablets’): These medicines drain raise uric acid levels in the blood water from the body and can by increasing the production affect the kidney’s ability to get of uric acid and reducing how rid of uric acid. much is passed out in urine. Gout attacks seem to be more common Some people can have high uric acid in beer and spirits drinkers than in levels but do not experience gout people who drink wine. However attacks. However, if you’re prone to there is no scientific proof that gout, several factors have been linked only certain types of alcoholic to gout attacks including: drinks cause gout FIGURE 2 Gout affecting the big toe Gout most commonly affects the big toe. The joint becomes red, hot, swollen and extremely painful. PhotographyPhotography used used with with kind kind permissionpermission of of Elsevier Elsevier.. © © Elsevier Elsevier 2011. 2011. Taken Taken from from Rheumatology Rheumatology, fifth ,edition. fifth edition. EditedEdited by by Marc Marc C C Hochberg, Hochberg, AlanAlan J Silman,Silman, Josef Josef S SSmolen, Smolen, Michael Michael E W Eeinblatt Weinblatt and andMichael Michael H Weisman. H Weisman. Graphics used with kind permission of Arthritis Research UK. 6 Taking control of your Gout Urate may collect under the skin, forming small white pimples (tophi), but these aren’t usually painful Photography used with kind permission of Elsevier. © Elsevier 2011. Taken from Practical Rheumatology, third edition. Edited by Marc C Hochberg, Alan J Silman, Josef S Smolen, Michael E Weinblatt and Michael H Weisman. Understanding gout • Consuming large amounts of Who is affected by gout? fructose, a type of sugar, can Anyone can get gout. However, gout increase uric acid levels in the in pre-menopausal women is rare blood. It is found in high levels in and your doctor may wish to further soft drinks sweetened with corn investigate your symptoms.Gout most syrup (not used in soft drinks commonly affects the big toe. The manufactured in Australia) and Can gout causejoint long-term becomes red, fruit juices problems? hot, swollen and extremely painful. • Dehydration (not drinking Once the inflammation of a gout enough water) attack settles down, your joints may Photography used with kind permission of Elsevier. © Elsevier 2011. Takenfeel from normal Rheumatology again., fifth edition. However, the urate • Edited Being by Ma rcill C Hochberg,with a Alan fever J Silman, Josef S Smolen, Michael E Weinblatt and Michael H Weisman. crystals remain in the joints. • ‘Crash diets’ or fasting • Having an operation • Injury or trauma to the joint. FIGURE 3 Tophi caused by urate collecting under the skin Urate may collect under the skin, forming small white pimples (tophi), but these aren’t usually painful PhotographyPhotography usedused with kindkind permission permission of of Elsevier Elsevier.. © Elsevier© Elsevier 2011. 2011. Taken Taken from fromPractical Rheumatology Rheumatology, fifth, thir edition.d edition. EditedEdited by by Marc Marc CC Hochberg, Alan Alan J JSilman, Silman, Josef Josef S Smolen, S Smolen, Michael Michael E W einblattE Weinblatt and Michael and Michael H Weisman. H Weisman. Graphics used with kind permission of Arthritis Research UK. Arthritis Australia 7 Understanding gout Another attack may not happen for are crucial in preventing long-term months or even years. If gout is not complications from gout. managed well and uric acid levels remain higher-than-normal, the time How will my doctor between attacks may get shorter, the diagnose gout? attacks may become more severe and Many people with gout do not more joints may be affected. receive the right treatment because The first few attacks of gout may not they have not been diagnosed cause any permanent damage to the properly in the first place. joint(s). However, if uric acid levels The only way to diagnose gout with remain high over time, gout can certainty is by your doctor looking at progress into a chronic (long-term) samples of your joint fluid under a condition causing: microscope. A needle is used to draw • Formation of tophi (solid lumps a small amount of fluid from one of of urate crystals), especially on your affected joints. This fluid is then the toes, ears, fingers, hands, examined under a microscope to see forearms, knees, and elbows whether urate crystals are present. If (Refer figures 2 and 3 on pages the crystals are present, your doctor 6 and 7) can confirm that you have gout.
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