Arthritis New Zealand advocates for:
- All District Health Board (DHBs) to implement measures relating to gout arthritis.
- Gout arthritis training for primary care practitioners and across all DHBs.
- Ensuring that people who have had two or more gout arthritis attacks in a year are prescribed preventative medication.
- Reductions in numbers of people presenting to the Accident and Emergency Departments of hospitals with gout arthritis related problems.
- More consumer education in high risk areas. Arthritis New Zealand has developed a Continuing Professional Development (CPD) endorsed educational resource for health practitioners on gout arthritis.
New Zealand has the highest per capita prevalence of gout arthritis in the world and gout arthritis is now the second most common form of arthritis in New Zealand. Māori and Pacific people have a greater genetic predisposition to develop gout arthritis than other ethnicities.
Gout arthritis is caused by a build-up of uric acid in your blood, which forms sharp crystals in the joints. Gout is an easily managed form of arthritis – effective medications are already funded by the Government. Research evidence shows most gout arthritis is genetic in origin, although diet and other lifestyle factors can precipitate or exacerbate attacks in people with gout arthritis.
Gout arthritis is underdiagnosed and undertreated. In primary care there is currently a lack of effective/inadequate management of gout arthritis:
- Māori and Pacific peoples have higher rates of gout arthritis than other ethnicities. Māori and Pacific men are affected at a younger age than other groups.
- The most at-risk populations (Māori and Pacific men) have the lowest rates of use of medicines that work to prevent gout attacks.
- Gout contributes to unemployment and time off work.
Most gout arthritis can be managed in primary care with effective medication that lowers the amount of uric acid in the body. For example, allopurinol is an effective preventative treatment that works for most people and is already subsidised by PHARMAC. Gout arthritis is a life-long condition therefore treatment must be long term, like the treatment of high blood pressure or diabetes. The aim of treatment is to have people with gout reduce their uric acid level to the 0.36mmol/L uric acid target to prevent further gout attacks.
Impact of Gout Arthritis
Gout is more than an intensely painful condition that can lead to joint damage and prevents people from working and participating in their communities. People with gout are also more likely than those without gout to die at a younger age due to cardiovascular and renal complications. Research has shown that those with hyperuricaemia (too much uric acid in their blood) and chronic kidney disease, that are taking urate lowering medicine, have significantly reduced risk of cardiovascular events and renal failure, compared to those not taking the medication. Another study found that patients with gout and diabetes who were taking urate-lowering medicine had significantly lower risk of heart attacked or stroke.
In New Zealand, 40% of people with gout have diabetes and/or cardiovascular disease. Despite this, many patients consider gout to be a condition that merely requires analgesics (pain killers) to control and are not aware of the potential long-term consequences. Raising community awareness about gout is an important role for health professionals in primary care.
One of the challenges of prevention is supporting people to maintain their treatment, even when they are asymptomatic. While diet and lifestyle changes such as maintaining a healthy weight are helpful in reducing risks associated with gout (as with diabetes and cardiovascular disease), urate-lowering medication is usually required to prevent future episodes.
Benefits of treating gout arthritis:
- Prevention of gout arthritis attacks reduces the impact on health system spending in both primary and secondary care due to less frequent GP visits and reduced hospital admissions.
- Social and economic benefits due to higher social and