Gout

Monitoring gout

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.
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. 
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.
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’).
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.
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. 



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Last reviewed December 2016
Last updated December 2016

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