let’s speak gout for patients - arthritis foundation · let’s speak g want fewer or no gout...

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SPONSORED BY TAKEDA PHARMACEUTICALS U.S.A., INC.

OUTLET’S SPEAK

GWANT FEWER OR NO GOUT ATTACKS? THE KEY MAY BE A DIFFERENT CONVERSATION WITH YOUR DOCTOR

Are you one of the estimated 8.3 million adults in the U.S. affected by gout (sometimes called gouty arthritis)?1 If so, you know that gout attacks may occur without warning, may produce extreme pain, last hours or weeks, and limit your mobility.2-4

BETTER COMMUNICATIONS WITH YOUR DOCTOR

COULD IMPROVE CARE

Research suggests the importance of good communication between health

care professionals and patients. A doctor’s ability to explain, listen and empathize can greatly affect patient

care and satisfaction and improve treatment adherence and doctor

satisfaction with medical encounters.7-9

To help enhance the quality of care, the Arthritis Foundation collaborated with Takeda Pharmaceuticals, who sponsored new research with gout patients and doctors to understand

the language they use to talk about gout and to identify effective

communications practices that could enhance gout management.

AN ESTIMATED 8.3 MILLION ADULTS IN THE U.S. ARE AFFECTED BY GOUT1

Gout may be a manageable disease compared to other chronic diseases.5

Half of gout patients have multiple attacks per year. 6

If you are one of them, changing how you talk to your doctor about gout could be one way to help improve your care.

You and/or your doctor may sometimes give gout low priority during appointments compared to other conditions that may seem more serious.5 You may not tell your doctor about your gout attacks because you

.meht desuac evah thgim uoy taht gnikniht ,ytliug leefBut your doctor is your partner in managing gout and reducing the number of attacks you have. So talking honestly about gout with your doctor is important.

FOR PATIENTS

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“LET’S SPEAK GOUT” RESEARCH REVEALS INSIGHTS ABOUT DOCTOR/ PATIENT CONVERSATIONS ABOUT GOUT:5

Many patients don’t bring up gout at their appointments even when they have been having multiple flares.

• “I don’t want to face my doctor. I want to keep my dignity. So I say everything is fine, even when I’ve been having flares. I feel like gout is my fault.”

• “I never bring [gout] up any more and neither does my doctor, even though I’m having flares and maybe there are new things I should try.”

Many gout patients don’t have a good understanding of gout.

• “Tell me why I got gout. Give me specifics. Don’t just say, ‘eat right and exercise.’”

• “I want to know why this is happening. I’m doing everything I’m supposed to.”

MANY PATIENTS DON’T KNOW ABOUT URIC ACID, HOW IT IS MEASURED OR WHAT THE MEASUREMENT MEANS.• “We need to understand the implications of high uric acid levels and what our goal should be.”

• “Why does my body make that uric acid?”

• “I don’t know what a ‘healthy level’ of uric acid is.”

MANY PATIENTS DON’T UNDERSTAND THAT UNMANAGED GOUT MAY HAVE LONG-TERM CONSEQUENCES.11

• “I did not know that gout could have a permanent impact on my joints.”

• “No one told me that having gout and high uric acid levels can have serious consequences.”

Many patients don’t realize that genetics may contribute to their risk of gout.10

• “I think gout is hereditary but I don’t know. Never been told that but my whole family has gout.”

• “If I were told this was in part genetic, it would be liberating. I wouldn’t blame myself all the time.”

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WAYS TO CHANGE THE CONVERSATION AT YOUR NEXT APPOINTMENT

Based on these insights from the “Let’s Speak Gout” research, the following sections provide ideas for how you can change the way you talk to your doctor to help better manage gout.5

DOCTOR: We’ve checked and discussed your blood sugar, blood pressure and cholesterol levels. So, I’ll see you next time.

PATIENT: Thanks, doc.

INSTEAD OF THIS…

TRY THIS…

PATIENT: Actually, doc, I’d like to also discuss my gout. Can you check my uric acid level too? I want to see if it’s

lower than last time. What is my target uric acid level?

DOCTOR: How’s your gout? Had any trouble since last time I saw you?

PATIENT: No. I’ve got it under control. If I have any problems, I just take some medicine for the pain and I’ll be fine.

INSTEAD OF THIS…

TRY THIS…

PATIENT: Actually, doc, I have had a few flares since last time. I take my medication and

usually follow a pretty good diet but, even then, I still get flares. Is there anything different I can do?

How can I reduce the number of attacks I have? How many flares per year is too many?

DOCTOR: As long as you’ve got something to control your gout flare pain when needed, you should be ok.

PATIENT: Thanks, doc.

INSTEAD OF THIS…

TRY THIS…

PATIENT: I’m glad to have something for the gout flare pain but, what are the long-term effects of high uric acid

levels? Do I need to keep it below a certain number?

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TIPS TO KEEP IN MIND

QUESTIONS TO ASK YOUR DOCTOR

• Talk about gout during each doctor visit. If you’re having attacks, talk about solutions. If you’re not, talk about what’s working well. Make a list of questions you want to ask at each visit.

• Keep a record of how many attacks you’ve experienced since your last visit and bring it to your appointment.

• Communicate honestly about how many attacks you’ve experienced since your last visit.

• Discuss the level of pain of each attack on a scale of 1 to 10, from mild discomfort to excruciating pain.

• Speak up if you are not happy with your current treatment; there may be other options.

• Ask for help with reducing purines in your diet. Your doctor may refer you to a nutritionist or recommend information sources, such as the Arthritis Foundation.

• Go to the Arthritis Foundation website, www.arthritis.org/lets-speak-gout, for more information and Let’s Speak Gout resources.

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What causes gout?

What is happening in my body when I have gout?

What are the potential long-term consequences of gout for me?

How is uric acid connected to gout attacks?

Can you check my uric acid level?

What can I do to lower my uric acid level?

Do I need to make changes to my diet to lower my uric acid level?

Do I need medication to lower my uric acid level?

What are your gout treatment goals for me?

How will you monitor progress towards those goals?

How frequently will you test my uric acid levels?

What happens when I reach my uric acid target?

Besides controlling my uric acid level, what medications can I take for pain due to a gout attack?

36% of participants with gout had a family

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ABOUT GOUT

GOUT IS A TYPE OF ARTHRITIS Gout is a painful form of arthritis commonly found felt in a big toe.12 Gout is caused by a build up of uric acid in the blood that crystallizes in joints. This can cause inflammation and lead to painful gout attacks.13

If uric acid levels in your body remain high over time, gout attacks can happen more often, last longer, and affect more than one joint.3 The most common place for a gout attack is the big toe, but they may occur in other joints, such as the ankle, knee, elbow or wrist.12

Gout is a chronic condition that has a genetic component. Many people with gout have a family history of the disease.11 In a study carried out in the United States, researchers found that more than

history of it.14

A HEALTHY URIC ACID LEVEL MAY HELP REDUCE OR ELIMINATE GOUT ATTACKS

The uric acid in your body comes from purines, substances that are naturally produced by your body and that are also found in many foods. People with gout have high uric acid levels because either they produce too much of it or because they have a difficult time getting rid of it.15

While limiting alcohol and certain high-purine foods is important, diet changes alone may not be enough to maintain a healthy level of uric acid.17 Genetics plays a greater role than diet in your level of uric acid, based on how much your body is prone to produce.10,18 This is because about two-thirds of your uric acid is produced naturally by your body, while the other third comes from your diet.10 A low-purine diet lowers uric acid only by about 1 mg/dL.18 Uric acid lowering medication may be required.

GENETIC FACTORS MAY CONTRIBUTE TO THE DEVELOPMENT OF GOUT

Gout can permanently damage your joints if not treated properly.11 Uric acid crystal deposits, called tophi, may form in and near your joints. This can cause them to become disfigured and limit movement.3,15

Gout patients often have other comorbid conditions, including chronic kidney disease, heart disease, and diabetes.16 You may want to ask your doctor if there are other health issues that should be explored.

UNTREATED GOUT MAY HAVE LONG-TERM CONSEQUENCES

What is Uric Acid?

Excess uric acid can form crystals in joints, which can cause inflammation and lead to painful gout attacks.3 The most effective way to reduce or stop these attacks is to work with your doctor to keep your uric acid at a healthy level. This may include following a low-purine diet and taking medication. For most patients, the target uric acid level is less than 6 mg/dL.17 Uric acid levels should be managed on an ongoing basis.

How Is Uric Acid Related to Gout Attacks?

What Affects Uric Acid Levels?

Ask your doctor for a simple blood test to regularly check your uric acid level. A blood test will help you see if your uric acid level is above or below the goal of 6 mg/dL.17

How Is Uric Acid Monitored?

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GOUT ATTACKS TRACKERWhen you have a gout attack, print this tracker and record relevant details. Take it to your next doctor’s appointment to help you and your doctor identify patterns or triggers that might have caused the most recent attacks. Save all your Gout Attack Trackers for future reference.

The research for Let’s Speak Gout was done in collaboration with, and sponsored by, Takeda Pharmaceuticals U.S.A., Inc.USE THE BACK OF THIS SHEET TO LIST ANY ADDITIONAL QUESTIONS YOU MAY HAVE FOR YOUR DOCTOR.

DATE OF GOUT ATTACKONSET & DURATION: Date began: ___ / ___ / ___ AM or PM Date ended: ___ / ___ / ___ AM or PM

JOINT(S) AFFECTED:

SYMPTOMS:19 Swelling

Tenderness

Redness

Heat

Pain

Other

mild ________________________________________________________________ severePAIN SEVERITY:How quickly did your pain become severe?

1 2 3 4 5 6 7 8 9 10

POSSIBLE TRIGGERS:20 (check all that apply)

Joint injury or trauma

Drinking too much alcoholEating large amounts of purine-rich foods

hard liquor

beerOther (please explain):

MEDICATIONS TAKEN:

List the medications you have taken to relieve this gout flare:

List medications you take for lowering uric acid levels and ongoing gout management:

List other medications, vitamins and supplements you take:

Date of last doctor visit: _____ / _____ / ______Date of last serum uric acid test: _____ / _____ / ______Serum uric acid level: ________

ADDITIONAL INFORMATION:

GOUT ATTACK MANAGEMENT TACTICS:

List anything you did to cope with pain, such as using ice and elevating or resting joints:

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REFERENCES1 Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition

Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10): 3136–3141.

2 Gout. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/arthritis/basics/gout.html. Accessed April 1, 2016.

3 Burns CM, Wortmann RL. Clinical features and treatment of gout. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR, eds. Kelley’s Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:1554-1575.

4 Mandell BF. Clinical manifestations of hyperuricemia and gout. Cleve Clin J Med. 2008;75(suppl 5):S5-S8.

5 Let’s Speak Gout Web site. http://www.arthritis.org/lets-speak-gout. Accessed May 17, 2016.

6 Lee SJ, Hirsch JD, Terkeltaub R, et al. Perceptions of disease and health-related quality of life among patients with gout. Rheumatology (Oxford). 2009;48(5):582-586.

7 About healthcare communication. Institute for Healthcare Communication Web site. http://healthcarecomm.org/aboutus/impact-ofcommunication-in-healthcare. Accessed February 19, 2016.

8 Zolnierek KBH, DiMatteo MR. Physician communication and patient adherence to treatment: A meta-analysis. Med Care. 2009;47(8):826–834.

9 Suchman AL, Roter D, Green M, Lipkin M Jr. Physician satisfaction with primary care office visits. Med Care. 1993;31(12):1083-1092.

10 Fam AG. Gout, diet, and the insulin resistance syndrome. J Rheumatol. 2002;29(7):1350-1355.

11 Doherty M, Jansen TL, Nuki G, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765-1770.

12 Questions and answers about gout. National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. http://www.niams.nih.gov/Health_Info/Gout. Accessed April 13, 2016.

13 Schumacher HR Jr. The pathogenesis of gout. Cleve Clin J Med. 2008;75(suppl 5): S2-S4.

14 Singh JA, Sarkin A, Shieh M, et al. Health care utilization in patients with gout. Semin Arthritis Rheum. 2011;40(6):501-511.

15 Doherty M. New insights into the epidemiology of gout. Rheumatology (Oxford). 2009;48(suppl 2):ii2-ii8.

16 Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007-2008. Am J Med. 2012;125(7):679-687.

17 Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken).2012;64(10):1431-1446.

18 Hahn PC, Edwards NL. Management of hyperuricemia. In: Koopman WJ, Moreland LW , eds. Arthritis and Allied Conditions. 15th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:2341-2355.

19 Gout symptoms. Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/gout/basics/symptoms/con-20019400. Accessed April 13, 2016.

20 Gout risk factors. Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/gout/basics/risk-factors/con-20019400. Accessed April 13, 2016.

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