There are three types of monitoring for people with gout:
1. Regular blood tests around once a month after starting daily ongoing treatment (e.g. allopurinol)
These tests are needed to check that uric acid levels are low enough (below 360µmol/L) to prevent attacks and long-term problems. If the blood test shows they are still too high, the dose of allopurinol will be increased and followed up by another blood test in about a month. This process may need to happen several times to get to the dose that keeps uric acid levels low enough. Blood count, kidney function and liver function should be tested at the same time.
2. Blood tests every one or two years to check uric acid levels and kidney function
Once attacks have stopped and it has been confirmed that the ongoing treatment has reduced uric acid levels to below 360µmol/L, the tablets should be continued every day. Blood tests should be done every one or two years to make sure that the uric acid levels are still low enough and to check kidney function.
3. Tests for other conditions
People with gout often have other health issues, like high blood pressure, high cholesterol, kidney problems, diabetes or heart problems. It is important to look for these conditions so that they can be treated as necessary.
A consultant rheumatologist explains why it is important to monitor people with gout for other health issues.
A consultant rheumatologist explains why it is important to monitor people with gout for other health issues.
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People with gout often have other health issues, such as being overweight, or having diabetes, having high cholesterol, or having kidney disease, and so it's important to look for and treat those conditions in people with gout.
People with gout are also more likely to have problems like heart attacks and strokes, and so because of that we monitor people with gout and keep an eye on blood pressure, cholesterol, blood sugar, so sometimes people with gout are asked to go for health checks in their GPs which they may not otherwise be asked to go for.
Several people asked for their uric acid levels to be checked when they had their regular blood tests for other conditions. Jeff knew that his doctor usually asked for his uric acid levels and cholesterol to be checked when he had blood tests. Hazel asks for her uric acid to be checked when she is having her blood tests for diabetes, but thinks that her doctor should be requesting uric acid tests because he knows she has gout.
Pat had her uric acid measured between adjustments to the dose of her allopurinol. She now has tests about once a year to check that her uric acid is within the normal range.
Pat had her uric acid measured between adjustments to the dose of her allopurinol. She now has tests about once a year to check that her uric acid is within the normal range.
Age at interview: 61
Sex: Female
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I asked my doctor to do a blood test, and the uric acid came back high. And because I had symptoms, he started me on a low dose of allopurinol. Sometime later, I had another test and it was still quite high so he did in the end put me on 300mg of allopurinol, which I’m still on, and I’ve taken ever since. I have had periodic tests, and it’s relatively normal range.
I do ask the doctor to do me a sort of fairly regular blood test, about once a year at least. And I just like to keep an eye on it.
Some people had blood tests during attacks that showed their uric acid levels were normal. They were frequently surprised by this, but it is possible for people with gout to have normal levels of uric acid, especially during an attack. This is often because the amount of uric acid removed by the kidneys increases during an acute attack.
A consultant rheumatologist explains why uric acid levels can be normal during an attack.
A consultant rheumatologist explains why uric acid levels can be normal during an attack.
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It sometimes causes confusion that when uric acid levels are measured during an attack of gout, they can come back as low or normal. The reason for this is that, at times when there’s a lot of inflammation around in the body – such as during an attack of gout – the kidneys actually pass more uric acid out into the urine, which means that the level in the blood drops. So the most important message from this is that if somebody is thought to have gout, but they are found to have a low or normal uric acid level during an attack of gout, the blood test should be repeated when the attack has settled down.
Not everyone we spoke to knew their uric acid levels were being monitored or that they were being tested for other conditions. Some people knew they had regular blood tests for other reasons and thought that their doctors probably checked their uric acid at the same time. A few felt that their doctors had been supportive when they were first diagnosed and prescribed treatments. Later, though, they did not follow this up with regular checks of uric acid levels, or ask them whether they were still having any symptoms. Some people did not mind that they were not being monitored regularly, but most felt that if they were told they were being monitored, it would reassure them that there was nothing to worry about (for more see ‘
Thoughts about the future and long-term effects’).
Shirley has not been told whether her uric acid levels are being monitored. She thinks they are probably checked when she has regular blood tests for other conditions.
Shirley has not been told whether her uric acid levels are being monitored. She thinks they are probably checked when she has regular blood tests for other conditions.
Age at interview: 77
Sex: Female
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Are you aware of whether you’re having any regular monitoring in relation to your gout now?
I don’t know in relation to the gout, but I have very regular monitoring. So I think they would pick up anything untoward. I mean I do have six-monthly blood tests, which seem to pick up on just about anything, so...
So, do you know whether your uric acid levels are being, sort of…?
I think occasionally they have looked at them. I don’t know whether they do it specifically. And I’ve just had a blood test, I ought to have said [laughs], “Check the uric acid while you’re about it”.
Jonathan bought a kit to measure his own uric acid levels so that he could make sure he was taking the correct dose of allopurinol. His GP has not offered any routine blood tests. Michael also bought a kit to monitor his uric acid levels but his GP had never heard of the kits.
Sam was having problems that her GP thought were related to her kidneys. She was told that it was important to keep an eye on her kidneys because high uric acid levels can sometimes cause kidney stones. Vic was worried when his doctor said he would have kidney function tests if he started taking allopurinol, but his GP did not explain why these were needed. There are no known side effects in later life for people who take long-term allopurinol, but many people were also worried about this.
Runibunar was reassured by his rheumatologist that the treatments he was taking were safe. He also has regular checks to monitor his kidney function.
Runibunar was reassured by his rheumatologist that the treatments he was taking were safe. He also has regular checks to monitor his kidney function.
Age at interview: 38
Sex: Male
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I probably was a bit worried at the time because you know for loads of medicines that I was taking, I was thinking that there would be an effect on my body as well, so I asked them really that, “For all these kind of medicines that I am taking is it still safe?” then they told me that, “Yeah, it's still safe because we are giving you very safe medicines for your illness”. And that’s why they just - every time that I went to - every time I go to them, they always check my - check my - my liver functions, my kidney functions, so that they will make sure that - because even the rheumatologist gave me a joke that, at the moment you’re still doing okay [laughs].
Some people were having regular blood tests that showed high uric acid levels, but their doctors had not yet recommended they start taking daily preventative treatment or increase the dose of allopurinol if they were already taking it. A few people had their allopurinol dose increased without any blood tests to check their uric acid levels. Some people felt that there was no opportunity for them to discuss managing their gout with their doctor because they did not have regular reviews, and the doctor never asked them about it.
Simon thinks doctors don’t always monitor uric acid levels. He has had his measured once.
Simon thinks doctors don’t always monitor uric acid levels. He has had his measured once.
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I listened to a programme actually about gout, it seems to be there, and somebody was saying that one of the criticisms of the medical profession is that they don’t monitor people’s uric acid levels. Interestingly, I’ve only had my uric acid level done once all the time I’ve had gout. I’ve had diagnoses of gout, but I’ve only had it done once. So you tend to think about it – which one of the criticisms of the medical profession is - well how do you know what you’re treating when you don’t monitor it? I’ve not been monitored. As I say, I’ve had it done once, which seems to be, when I listened to the programme, probably one more time than most people. It’s just done on – I think because the signs and symptoms are so obvious that people assume that you’ve got gout. I think last time I did have a conversation with a GP who thought – he excluded septic arthritis because he thought – and took my temperature and said that was a diagnostic answer if it was septic arthritis or gout, but I have been examined without taking anything off, my shoes and socks off. I’ve been told I’ve had gout without anybody looking [laughs] and didn’t seem to be interested in where it was. Because I’ve actually, I’ve talked about it being in my feet, but I’ve actually also got it in my hands. Not as much, but I’ve got it – especially in the joints of my left thumb. No-one has ever, ever, ever asked me about it.
Last reviewed December 2016
Last updated December 2016
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