Gout (mate waikawa kai kōiwi) is a common and painful form of arthritis. It causes severe joint pain and swelling, especially in your toes, knees, elbows, wrists and fingers. If left untreated, gout can cause serious damage to your joints, kidneys and quality of life.
If you have more than two attacks of gout per year, your doctor may prescribe a medication to prevent further attacks by lowering your uric acid levels. The key to preventing gout attacks is getting uric acid levels to below 0.36 mmol/L.
What causes gout?
Gout is caused by a buildup of uric acid in your body
Uric acid mostly (two-thirds) comes from the breakdown of cells in your body. The remainder (one-third) comes from chemicals called purines that are in your food.
Normally, your kidneys filter uric acid from your blood and flush it out of your body in urine (pee).
When uric acid levels in your blood are high, uric酸晶体形成your关节。These crystals cause pain, inflammation and lumps (called tophi).
What causes high uric acid?
The most common cause of high uric acid is due to your body not getting rid of it properly.
90% of this is due to your genes. Other factors can include certain medications and other health conditions.
Who is at risk of getting gout?
High uric acid levels are caused by the following factors:
Being overweight– carrying extra weight slows down the removal of uric acid by your kidneys.
年龄增加– in about 90% of cases, gout affects men aged over 40 years and women after menopause.
What you eat and drink– you increase your risk if you drink a lot of sugary drinks or alcohol, or eat too much food that is rich in purines, such as liver, meat or seafood.
Gout attacks are very painful. A gout attack usually begins suddenly, often at night. Within hours, the joint becomes red, swollen, hot and painful. This is due to uric acid crystals in the joint causing sudden inflammation.
In the early stages of gout, x-rays are not usually helpful in diagnosis, but in advanced gout x-rays can show any damage to your cartilage and bones.
How are gout attacks treated?
一旦攻击，请立即去看医生。With effective treatment the attack may be controlled within 12–24 hours and treatment need not be continued after a few days. There are also things you can do to help relieve the pain:
rest until your symptoms improve
raise the inflamed joint and put an ice pack on it
take pain relief medicines, for example non-steroidal anti-inflammatory drugs (NSAIDs) such asnaproxen(Naprosyn) ordiclofenac(Voltaren) can be very effective in reducing pain and inflammation. If you are unable to take NSAIDs, medication such ascolchicine或者强的松can help reduce the pain of gout.
If gout is not treated, it can cause permanent damage to your joints and harm your kidneys. Attacks will happen again and more joints will be affected. Lumps (tophi) can grow on your elbows, hands and feet. The lumps can become sore and swollen and they may cause skin ulcers. The natural padding between the bones will start to wear away and the joints will become sore and stiff. Kidney stones can form and cause pain and damage to your kidneys.
Preventing gout attacks
To prevent gout attacks and damage to your joints, your doctor may start you on long-term gout medication, called urate lowering medicines. They are most likely to do this if you:
already have evidence of damage from gout on joint x-rays
have tophi, chronic kidney disease or kidney stones.
The aim of these medicines is too keep your uric acid level below 0.36 mmol/L. This will help to prevent gout attacks, joint damage and kidney stones and will make your gouty lumps smaller.
You need to take uric acid medicines every day, even if you are having a gout attack.
当您开始服用降低尿酸medicine you might get a gout attack, as your body is getting rid of the extra uric acid. Your doctor will prescribe additional medication such as a low-dose非甾体类抗炎（NSAID）或者colchicineto reduce the chances of these attacks.
Winnard D，Wright C，Jackson G，Gow P，Kerr A，McLachlan A，Orr-Walker B，Dalbeth N. Gout，Aotearoa新西兰成年人的糖尿病和心血管疾病。NZ Med J. 2012年1月25日； 126（1368）：53-64。[抽象的][Full article]
Batt C, Phipps-Green AJ, Black MA, et al. Sugar-sweetened beverage consumption: a risk factor for prevalent gout with SLC2A9 genotype-specific effects on serum urate and risk of gout Ann Rheum Dis 2014;73:2101–2106 [abstract][完整的PDF]
Credits: Editorial team. Reviewed By: Professor Lisa Stamp, Rheumatologist, University of Otago Christchurch上次审查：2018年5月3日
It is important to treat gout attacks and prevent them from happening. If left untreated, gout can cause permanent damage to your joints and harm your kidneys.
Treating gout attacks
During a gout attack, you need to rest the inflamed joint. Try raising it and put an ice pack on it to ease the pain. Do not exercise during an acute attack. Rest until your symptoms improve. Start taking pain-relief medication straight away.通过有效的治疗，可以在12-24小时内控制攻击，几天后不必继续治疗。
Taking非甾体类抗炎药（NSAIDS）such as naproxen (Naprosyn) or diclofenac (Voltaren) can reduce the pain and ease the inflammation of gout.
NSAIDs have side effects and may not be suitable for people with stomach problems, asthma, heart, liver or kidney problems.
If you are unable to take NSAIDs, medication such ascolchicine或者强的松can help reduce the pain of gout.
To get the best results, take the pain relieving medicines as soon as possible at the first sign of an attack, and continue until the pain and swelling goes down.
If you have experienced more than 2 gout attacks in the past year, your doctor may recommend long-term use of urate lowering medicines to reduce your uric acid levels and prevent gout attacks. The goal of these medicines is to keep the uric acid levels in the blood below 0.36mmol/L. This causes the gout crystals to dissolve, and gradually reduces the risk of gout attacks and joint damage.
These medicines are usually started at a low dose and increased gradually, to reduce side effects.
You must take your降低尿酸每天都有医学，即使您感觉良好。在进行痛风攻击时，请继续服用它们。他们不会缓解疼痛，但它们将有助于控制您的尿酸水平。
降低尿酸medicines are an ongoing, long-term treatment that you have to continue taking for many years.
降低尿酸medicines take time to work
Medicines that lower uric acid levels will not start to work immediately. They may take a few weeks to months to work. When you start taking uric acid medicines, gout attacks can occur in the first few weeks or months, while you are increasing your dose. Your doctor will prescribe other medication such as a low-dose非甾体类抗炎（NSAID）或者colchicineto reduce the chances of these attacks.
用药物治疗痛风is really important, as it helps prevent对关节的永久损害并损害肾脏。Along with medication, there are some lifestyle changes you can make to help prevent gout attacks.
超重会增加您的痛风风险和certain foods or drinks may trigger gout attacks. Losing weight, r从饮食中散发出甜食和饮料，避免foods high in purinesmay help to prevent gout attacks.
How can losing weight help my gout?
超重会增加您的痛风风险becausecarrying extra weight slows down the removal of uric acid by your kidneys. Gout is caused by high uric acid levels in your blood – as your level of uric acid rises, your risk of gout increases. If you are overweight, gradual weight loss can help to lower your uric acid levels and reduce your risk of gout attacks.
Avoid fasting or crash diets, where you go without adequate food for long periods and lose weight rapidly. This type of dieting can increase uric acid levels and trigger a gout attack.
Examples of foods to include in your diet are low-fat dairy, soy-based foods, vegetable sources of protein and foods high in vitamin C.
Examples of foods that have high purine content are:
seafood, such as mussels and other shellfish, crab, fish roe, whitebait and trout
game such as venison and rabbit
offal such as liver, kidneys, heart and sweetbreads
Most people taking medicines to reduce uric acid levels find they can still eat purine-rich foods without attacks of gout by being careful with how much they eat.
Eat low-fat dairy products
Having 2 servings of low-fat dairy products every day can help protect you against gout. A serving is 1 glass of trim milk or 1 pottle of yoghurt or 2 slices of low-fat cheese (such as Edam) or one-third of a cup of cottage cheese. Avoid full-fat dairy products.
Avoid sweetened foods and drinks
Foods and drinks sweetened with artificial fructose increase the risk of getting gout. These are contained in fizzy drinks and fruit drinks and are usually seen on food labels as corn syrup or glucose-fructose syrup. Other examples of foods sweetened with fructose are bread, cereal and jam.
Drinking alcohol increases the level of uric acid in your blood and can increase your risk of a gout attack. Beers have a high purine content which can cause higher uric acid levels. Try to limit the amount of alcohol you drink and avoid binge drinking.
Being dehydrated can increase your risk of a gout attack. Try drinking the recommended 2 litres of water per day, unless you have heart or kidney problems – talk to your doctor about the right amount of fluids for you to drink.
Attending aself-management courseis a great way to find out what you can do to help yourself, meet new friends, support each other and make some healthier choices for yourself and your family. Ask your doctor for groups in your area.
Atlas of Healthcare Variation - Gout (HQSC) This Atlas domain presents information on gout by district health board (DHB) including prevalence by ethnicity and treatment.Click here to view the full atlas.
Diane Phone a pharmacist from Middlemore Hospital and Angela Moananu a primary care nurse, talk about their clinic's “own my own gout” programme, where patients connect directly with their pharmacist to manage their gout.
(Goodfellow Unit, NZ, 2017)
Goodfellow Unit Medtalk: Management of gout in Aotearoa New Zealand