Ngā tohu o te waikawa uric teitei me te kauti (gout): ngā tohu, ngā taumata, me te wā me kite i te rata

Ko te waikawa uric (uric acid) he para. Ka hangaia e te tinana ina wāwāhia e ia ngā purine, he matū māori kei roto i ō ake pūtau, i ētahi kai me ētahi inu hoki. I te tikanga ka memeha ia i roto i te toto, ā, ka tukuna atu e ngā whatukuhu mā te mimi.

Ka kohi ia ina nui rawa tā te tinana hanga, ina kore rānei e rawaka te tango a ngā whatukuhu. Ko te taumata teitei ka kīia ko te hyperuricaemia. He mea noa, ā, he tokomaha o te hunga he taumata teitei tōna kāore rawa e raru.

Engari ina teitei tonu te taumata, ka taea e te waikawa uric te hanga tioata iti rawa, rite ki te ngira, i roto, huri noa hoki i ngā hononga, i ngā whatukuhu hoki. Nā aua tioata ngā tohu: ko te kauti (gout) i ngā hononga, ko ngā kōhatu whatukuhu hoki.

He aha te teitei? Ka tāia e ia taiwhanga tōna ake awhe noa ki te pūrongo, ā, i mua i te menopause he paku iti iho te taumata o ngā wāhine i tō ngā tāne. Ko te tau e whai ana ngā rata i te aratohu o Peretānia (UK) ko te 360 micromol/L (6 mg/dL): ki taua tau, ki runga ake rānei, he nui ake te tūpono o te kauti i te tangata he tohu ōna, ā, ko te whāinga o te maimoatanga kauti kia noho te taumata ki raro iho. Hei whakatairite i ngā waeine, ko te 1 mg/dL he tata ki te 60 micromol/L.

I te nuinga kāore he tohu. Ko te waikawa uric teitei anake, i te nuinga kāore e puta he tohu, ā, he maha ngā wā ka kitea nōhanga noa i tētahi whakamātautau toto auau. Ko ngā tohu kāore i te mārama pērā i te ngenge, i te mamae huri noa i te tinana, ehara i te tohu noa o te waikawa uric teitei, nō reira me tirotiro mō ētahi take kē.

Ko ngā pānga kauti te tohu tino noa:

• he mamae ohorere, taumaha i tētahi hononga kotahi, i te nuinga ka tīmata i te pō, ka kaha haere i roto i ngā hāora torutoru
• ko te pūtake o te matimati nui o te waewae te mea auau rawa, engari ka pā anō ki ētahi atu hononga o te waewae, ki te pona waewae, te turi, te kawititanga ringa, te ringa, te tuke rānei
• he wera, he pupuhi, he whero, he waiporoporo rānei te hononga, he piataata te kiri, ā, he tino tairongo, ahakoa te hīti moenga ka mamae
• ka mauru te pānga i roto i te 1 ki te 2 wiki te nuinga, ahakoa kāore he maimoatanga, engari ka hoki mai anō ngā pānga, ā, ka auau ake i te roanga o te wā

Ngā kōhatu whatukuhu: he mamae i te taha o te puku, i raro rānei o te tuarā, ka hora pea ki te kūwhā (groin), ka haere ngaru mai, me te hiahia ruaki, te auau o te hiahia mimi, te mimi pōkere rānei.

I muri i ngā tau o te waikawa uric teitei:

• he puku mārō, rite ki te tioka, i raro i te kiri (tophi), i ngā matimati, ngā matimati waewae, ngā tuke, ngā taringa rānei
• ngā hononga e mārō tonu ana, e mamae tonu ana i waenga i ngā pānga, me te tūkino o ngā hononga

I ngā wāhine: he iti iho te kauti, he onge i mua i te menopause, nā te mea ka āwhina te taiaki (hormone) oestrogen i ngā whatukuhu ki te tango i te waikawa uric. I muri i te menopause ka piki te tūpono, ā, he ōrite ngā tohu ki ō ngā tāne.

Ka piki te waikawa uric ina nui ake te hanga a te tinana, ina iti iho rānei te tango a ngā whatukuhu. Ngā mea e whakapiki ana i a ia, e whakanui ana rānei i te tūpono o te kauti:

• Te waipiro, me ngā inu kua whakarekahia ki te huka, tae atu ki ērā he high fructose corn syrup kei roto
• Ngā kai nui te purine: te mīti whero, ngā whēkau pērā i te ate me te whatukuhu, me ētahi kaimoana
• Te taumaha nui, te pēhanga toto teitei, te cholesterol teitei, te mate huka me te mate whatukuhu
• Ngā rongoā: ngā pire wai (diuretics), te aspirin inenga iti, ētahi rongoā pēhanga toto (ACE inhibitors), te ciclosporin me te niacin inenga nui. Kaua e whakamutu i tētahi rongoā kua tuhia e koe anake: pātai ki te rata nāna i tuhi.
• Ō ira me tō pakeke: ka heke iho te kauti i roto i ngā whānau, he auau ake i ngā tāne, i te nuinga ka tīmata i te pakeke waenga, ā, ka nui ake te tūpono i ngā wāhine i muri i te menopause
• He onge ake, ētahi mate pukupuku toto me ō rātou maimoatanga (chemotherapy)

Ngā mea e whakaoho ana i tētahi pānga: te inu nui i te waipiro, he kai tino nui, te kore e inu kia rawaka te wai, he māuiui me te kirika, he whara, he pokanga rānei, me te tīmata, te panoni rānei i ētahi rongoā.

He whakamātautau toto waikawa uric (ka kīia anō ko te serum urate) e ine ana i te taumata. I te tangata he tohu kauti noa ōna, ko te taumata 360 micromol/L (6 mg/dL), neke atu rānei, e tautoko ana i te whakatau mate. Ka heke pea te taumata i te wā o te pānga, nō reira mēnā he iti iho, ā, he kauti tonu pea, ka mahia anō te whakamātautau 2 wiki neke atu i muri i te mauru o te pānga. Ko te hua teitei anake, kāore he tohu, ehara i te tohu he kauti tōu.

Taumata waikawa uric	Te tikanga i te nuinga
360 micromol/L (6 mg/dL), neke atu rānei	E tautoko ana i te kauti i te tangata he tohu noa ōna; he tokomaha i tēnei taumata kāore rawa e pāngia e te kauti
Raro iho i te 360 micromol/L (6 mg/dL)	Te whāinga maimoatanga noa mō te hunga he kauti tōna
Raro iho i te 300 micromol/L (5 mg/dL)	He whāinga iti iho mō te hunga he puku (tophi), he tūkino hononga pūmau, he pānga e hoki tonu mai ana rānei

He whakamātautau wai hononga: mēnā kāore e mārama te whakatau mate, ka tangohia e te rata he wai iti mai i te hononga ki tētahi ngira kikokore, ka titiro mō ngā tioata i raro i te karu whakarahi (microscope). Ka tirotiro anō mō te pokenga.

Ngā matawai: he hihi-X (X-ray), he matawai oro (ultrasound), he matawai CT motuhake rānei (dual-energy CT) mēnā kāore e taea te tango wai.

Ētahi atu tirotiro, nā te mea he maha ngā wā ka haere tahi te kauti me ētahi atu mate: te mahi whatukuhu (creatinine me te eGFR), te huka toto (HbA1c), te cholesterol me te pēhanga toto. Ka āwhina pea he whakamātautau mimi mō te waikawa uric ina ko ngā kōhatu whatukuhu te raruraru. Ka whakamārama tā mātou aratohu mate whatukuhu i te wāhi o ngā whatukuhu.

Te waikawa uric teitei kāore he tohu: he tokomaha kāore rawa e raru. Mēnā kāore anō koe kia pāngia e te kauti, e te kōhatu whatukuhu rānei, pātai ki tō rata mēnā me mahi tētahi mea; i te nuinga ko te tohutohu kia mahi i ngā take, pērā i te taumaha, te waipiro, ngā inu huka me te pēhanga toto, kaua ko te kai rongoā.

He rerekē te kauti. Ki te kore he maimoatanga whakaheke waikawa uric, ka hanga tonu ngā tioata hou, ā, i te roanga o te wā:

• ka auau ake ngā pānga, ka roa ake, ka hora ki ētahi atu hononga
• ka hanga ngā tophi i raro i te kiri
• ka tūkinotia pūmautia pea ngā hononga (chronic gouty arthritis)
• ka nui ake te tūpono o ngā kōhatu whatukuhu

He maha anō ngā wā ka haere tahi te kauti me te pēhanga toto teitei, te mate whatukuhu, te mate huka me te mate manawa, nō reira ka tirotiro anō ngā rata mō ēnei. Ina pai te maimoatanga, ka mutu ngā pānga mō te nuinga o te hunga he kauti tōna, ā, ka mimiti ngā puku.

I te wā o te pānga:

• whakatāria te hononga, hikitia ake, kaua e tukua te hīti moenga kia pā, ā, whakamātaotia ki tētahi pēke tio kua tākaia ki te tauera
• inu kia nui te wai
• tērā pea ka tukuna e te rata he rongoā mamae whakaheke kakā (he NSAID), he colchicine, he wā poto rānei o ngā pire steroid; ko te tere o te tīmata, ko te pai ake o tana mahi

Te whakaheke i te waikawa uric mō te wā roa: ka tukuna e ngā rata he rongoā whakaheke urate, i te nuinga ko te allopurinol, ko te febuxostat rānei, ki te hunga e hoki tonu mai ana, e raru ana rānei i ngā pānga, he mate whatukuhu, he tophi, he tūkino hononga, e kai ana rānei i ngā pire wai, ā, ka kōrerotia ki ia tangata kua pāngia e tētahi pānga. I te nuinga ka tīmatahia 2 ki te 4 wiki i muri i te mauru o tētahi pānga, ka whakapikia haeretia, me ngā whakamātautau toto, kia tae te taumata ki te whāinga, ā, ka kainga mō te wā roa, i te nuinga mō te roanga o te ora. Ka puta pea he pānga i ngā marama tuatahi, nō reira tērā pea ka tāpiri te rata i tētahi rongoā hei ārai i ēnei: kaua e mutu te kai i te rongoā whakaheke urate.

Ngā tikanga e āwhina ana:

• kia ora tonu te taumaha, ā, mēnā me heke, kia āta heke
• whakaitia te waipiro me ngā inu huka, ā, kia whai rā kāore he waipiro
• inu kia rawaka te wai puta noa i te rā
• kia korikori tonu i ngā huarahi māmā ki ngā hononga mamae, ā, kaua e kai paipa

Kāore he "kai waikawa uric" kotahi kua whakamātauria e ārai ana i ngā pānga, e whakaheke ana rānei i te waikawa uric; ko te kai ora, taurite hoki te tohutohu.

Ko tēhea rongoā, ā, kia hia te nui, mā tō rata e whakatau. Kāore ngā rongoā mamae whakaheke kakā i te haumaru mō te katoa, hei tauira i te mate whatukuhu, ngā tunga o te puku (stomach ulcers), ētahi mate manawa rānei, nō reira pātai i te tuatahi ki tētahi kaiwhakarite rongoā (pharmacist), rata rānei. Kia tūpato ki ngā paura, ngā tī me ngā pire āpiti "whakaora waikawa uric" e hokona ana i te ipurangi: pātai ki te rata, kaiwhakarite rongoā rānei i mua i te whakamātau.