Get Better Control of Your Gout

Gout is one of the oldest known human diseases – dating back to 2600 BC – but a new study shows it’s a disease that patients still don’t understand very well. The study, published online in January 2016 inArthritis Care & Research,found that just 14% of patients with this painful type of inflammatory arthritis actually knew what their uric acid level should be.

“It is an old disease for which there are really effective treatments and despite that, understanding of treatment goals is suboptimal. It is somewhat surprising,” said study author Ted Mikuls, MD, the Umbach Professor of Rheumatology at the University of Nebraska Medical Center, in Ohama. “Patients have pretty good knowledge of what causesgoutand what drugs are used for, so the lack of knowledge about a treatment goal stood out.”

痛风发生在血液中尿酸水平高的人(称为高尿酸血症)。这种酸会在关节中形成针状晶体，引起突然的、严重的疼痛、压痛、红肿、发热和肿胀。

Uric acid levels are checked with a simple blood test. Much like with cholesterol or blood pressure, current international guidelines recommend treating hyperuricemia to a target: specifically having a serum uric acid level below 6 mg/dl. Rheumatologists say when patients can maintain that level, they have less frequent flares, less pain, less joint damage and better quality of life and work productivity.

While people with diabetes often know their blood sugar levels and people with high blood pressure and high cholesterol know their current numbers and goals, people with gout don’t know their uric acid level or what it should be. Dr. Mikuls believes doctors aren’t doing enough to communicate the importance of checking uric acid levels – and treating to reach that goal. A typical 15-minute appointment might not be long enough to discuss that when more pressing issues may take priority, he says.

米库尔斯博士说:“如果病人不知道对取得良好疗效至关重要的事情，他们就很难参与到他们的治疗中来。”

Someone starting a gout medication begins with low-dose agents that are gradually increased, Dr. Mikuls says. That may require checking serum uric acid levels frequently in the beginning – perhaps as often every two to six weeks. Once a patient reaches their goal and stabilizes, annual checks are usually enough.

阿拉巴马大学伯明翰分校的风湿病学家、参与痛风临床研究的研究员贾斯温德·辛格(Jasvinder Singh)医学博士说，只有大约50%的人开始服用痛风药物来降低尿酸，但他们再次检查自己的尿酸水平。

But Dr. Singh says there are clear benefits for doctors and patients to understand the level. “Standard doses of these drugs get uric acid levels below 6 mg/dl in less than half of patients. So you may need to [increase] these doses. You can see changes in uric acid very quickly and the blood test shows that. The other thing we use uric acid testing for is to see if a patient is taking their medication. If they aren’t, their uric acid levels will stay the same and that can lead to an important discussion about what the barriers are for them.”

Some patients may be reluctant to bring up uric acid levels because they think their bad dietary habits are at fault, says Dr. Singh. But they might be surprised by the benefits of discussing this topic.

“A lot of patients think they have to give up some foods permanently and that is not always true. Some things may be okay in moderation so this test can be used … to show them what they can have. Perhaps they can still have wine or beer every now and then. It can be a positive feedback to patients.”

米库尔斯博士说，如果你不知道自己的尿酸水平，你可以先问医生两个简单的问题:“我的尿酸水平是多少?我的目标是什么?””

Related Resources:

• Learn more about Gout
• Does Coffee Help or Hurt Gout?
• Wine Implicated in Gout Flares
• For more content like this, subscribe toArthritis Today Magazine

Author: Jennifer Davis for the Arthritis Foundation