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 in Arthritis 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 causes gout and what drugs are used for, so the lack of knowledge about a treatment goal stood out.”
Gout develops in people who have high levels of uric acid in the blood (called hyperuricemia). The acid can form needle-like crystals in a joint and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling.
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.
“It’s pretty hard for a patient to be engaged in their care if they don’t know the things that are so central to achieving good outcomes,” Dr. Mikuls says.
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.
Only about 50% of people who start a gout drug to lower uric acid get their levels checked again, says Jasvinder Singh, MD, a rheumatologist at the University of Alabama at Birmingham and an investigator involved in clinical studies in gout.
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.”
If you don’t know your level, Dr. Mikuls says you can start the conversation with two simple questions to your physician: “What is my uric acid level and what is my goal?”
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Author: Jennifer Davis for the Arthritis Foundation