Gout May Be Your Second Arthritis
Did you know that it is possible to have more than one form of arthritis? Get more information about gout, the inflammatory condition that can occur with osteoarthritis, rheumatoid arthritis and psoriatic arthritis.
It is possible to have more than one type of arthritis, and knowing what you have can help in treating your symptoms.Gout, which can occur with OA, rheumatoid arthritis and psoriatic arthritis , results when uric acid crystals are deposited in joint tissue. It causes sudden, severe pain, swelling and tenderness, usually in the big toe, but it also can occur in the feet, ankles, hands, knees, wrists, elbows or other joints. Its typically in only one joint, but chronic gout can affect multiple joints. Differentiating between gout and other forms of arthritis is critical because the treatments are very different. If you think you have gout, see your doctor. The sooner its treated, the sooner youll get pain relief.
How Gout may Affect Other Arthritis Conditions
Gout and RA
For decades, rheumatoid arthritis and gout were thought to be mutually exclusive. But some people with RA also get gout as both conditions share obesity as a common risk factor and may cause kidney problems. Diagnostic tools like synovial fluid analysis and dual-energy CT scans are especially helpful in making the correct diagnosis.
Gout and OA
Gout and PsA
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What Are The Signs And Symptoms Of Gout
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remissionweeks, months, or yearswithout symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Symptoms in the affected joint may include:
- Pain, usually intense
What Does The Future Hold For Gout
Active research is ongoing in a variety of fields related to gout and hyperuricemia. Scientists have found that high animal protein slightly increased the risk for gout. New drugs are being developed that may be more versatile and safe in treating the elevated uric acid levels in patients with chronic gout.
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How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
Who Is Affected By Gout
Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
- Obesity, or a lot of extra weight.
You are also more likely to develop gout if you:
- Consume a diet high in animal proteins
- Consume a significant amount of alcohol
- Are on water pills .
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If you havegout, youre all too familiar with the sudden, burning joint pain that a gout attack can bring on most commonly in the big toe.
Gout a type ofarthritis is caused by too much uric acid in the blood. Usually, having an excess of uric acid isnt harmful. In fact, many people with high levels in their blood never get gout. But when uricacid levels in your blood are too high, the uric acid may form hard crystals in your joints.
Osteoarthritis Prevalence Severity Higher In Older Men With Gout
A study published in Rheumatology suggests that osteoarthritis is more prevalent among older men who have gout.
Researchers looked at 75 men between the ages of 55 and 85 who had gout 25 had asymptomatic hyperuricemia, a condition that puts you at a higher risk for gout, and 25 had neither. Patients with inflammatory arthritis, inflammatory bowel disease, total knee replacement, or history of severe knee traumas were excluded.
Diagnosis was determined using a measurement set out by the American College of Rheumatology known as the Kellgren-Lawrence grading. Uric acid levels were also measured during visits with each participant. Gout occurs when the body forms crystals of uric acid. Uric acid is a substance that usually dissolves in the blood and then passes out of the body in urine. When these crystals build up in specific joins, it causes pain. Large buildups of crystals that can look like a lump under the skin are called tophi.
In the end, the assessment and comparison showed that osteoarthritis among older men with gout was more prevalent and more severe than those without gout.
The similarities between gout and osteoarthritis are mainly the joint pain and stiffness. While both conditions involve inflammation and come with periods of fatigue, there are many differences.
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Causes And Risk Factors
Gout occurs due to an excess buildup of uric acid, or hyperuricemia.
According to the National Institutes of Health , hyperuricemia is the main risk factor for developing gout. However, a quarter of those with hyperuricemia do not develop gout.
When the body breaks down purines, it produces uric acid. Typically, the kidneys remove a certain amount of uric acid in the urine. However, when they are unable to remove enough uric acid, uric acid crystals can form in the joints and soft tissues, causing swelling and pain.
Gout typically affects males more than females. However, females have higher levels of uric acid after menopause. NIAMS state that being older also the chance of developing gout.
Genetics can also increase the chance of developing gout.
According to the CDC , other factors that may increase the likelihood of gout include:
- Diet: Food can play a role in the development of gout symptoms. Eating seafood, red meat, and drinking alcohol raises uric acid levels in the body.
- Weight: Having overweight increases the chance of developing gout.
- Medications: Certain medications, including diuretics and low-dose aspirin, are associated with gout risk because they increase the level of uric acid in the body.
- Other medical conditions:High blood pressure, diabetes, and kidney disease can increase gout risk.
According to the National Health Service in the United Kingdom, some people with gout may develop complications, such as:
Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine
Colchicine isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
Steroids
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When To See A Doctor
Gout occurs without warning. Anyone experiencing intense pain on the big toe, followed by warmth, tenderness, redness or discoloration, should immediately seek medical attention.
If a person does not receive treatment for gout, it can lead to joint damage over time, including bone erosions and arthritis.
Osteoarthritis Of The Big Toe: Symptoms Causes And Treatments
What is osteoarthritis?
Osteoarthritis is the most common type of arthritis. It can affect joints anywhere in the body. When cartilage in the joints wears down, bones become exposed and rub against each other. This causes swelling and pain in the joint and can limit your range of motion.
OA generally starts slowly but usually worsens over time. The base of the big toe, known as the first metatarsophalangeal joint, is a common site for OA.
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Why Does Gout Target The First Metatarsophalangeal Joint
The studies discussed above provide clear evidence of an association between MSU crystal deposition and OA. Whilst further studies are required to definitively answer the questions of direction of association and causality, it appears that MSU crystals more readily deposit in osteoarthritic cartilage and that the presence of OA influences the distribution of joints affected by gout. However, OA cannot solely explain the typical distribution of joints affected by gout, as many joints commonly affected by OA such as the knees, finger IP joints, and hips are less frequently affected by gout than the first MTPJ, and other target joints for gout such as the ankle, wrist and elbow are infrequent sites for primary OA. Is it plausible therefore that the relationship between MSU crystal deposition and OA is of more relevance for the first MTPJ than other joint sites?
The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
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What Causes Big Toe Joint Arthritis
Arthritis of the big toe joint, also known as stiff big toe or hallux rigidus, is caused when the cartilage covering the ends of the bones in the big toe joint are worn down. As a result, the bones in the joint begin rubbing together, causing stiffness and pain.
Hallux rigidus is usually due to having a different foot anatomy that places increased pressure on the big toe, but it may also be caused by an injury to the big toe that damages the cartilage.
Fusion For Arthritis In Toes
This surgical procedure stimulates bone growth across the joint. The joint is fused together permanently with pins, screws, or a plate. When bone grows across the toe joint, it wont bend anymore. But since the joint is fused, pain is also relieved. Dr. Archer says that she rarely does this type of surgery. Its usually done in active laborers, like carpenters and mechanics, to give them a stable joint with no pain, says Dr. Geier.
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What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
Do Ra And Gout Have The Same Cause
Rheumatoid arthritis and gout both are types of arthritis, but the underlying causes are completely different. RA is an autoimmune condition. It happens when your bodyâs immune system attacks the tissue that lines your joints. This attack causes painful swelling, inflammation, and joint deformity. Since RA is an immune system disease , it can affect other parts of the body, too, including the skin, eyes, and heart.
Gout affects people with too much uric acid in their blood. Your body creates this type of acid when it breaks down certain foods, including meat. Your kidneys normally get rid of it when you pee. But when thereâs too much of it in your system, the uric acid can form crystals. These needle shaped crystals build up in joints and surrounding tissue where they can cause pain and inflammation.
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Acute Attack Pain Management
Home remedies. Reducing inflammation during an acute gout attack will provide pain relief.
- Ice. Apply ice to the affected area to reduce swelling. Do not apply ice directly to the skin. Use an ice pack or wrap a towel around the ice. Apply ice for about 20 minutes at a time.
- Elevate. Frequently raise and keep the affected area above the level of the heart.
- Rest. Move the affected area as little as possible while symptoms are present.
- Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs even the over-the-counter strength be sure to check with your doctor before taking them.
Prescription medications. Your doctor may recommend a prescription-strength non-steroidal anti-inflammatory medicine such as indomethacin.
Colchicine is also given to reduce inflammation during an acute gout attack. This drug has recently been approved by the Federal Drug Administration for treatment of gout. Like all medications, colchicine has side effects that you will need to discuss with your doctor.
Your doctor may also prescribe corticosteroids for acute gout attacks. These are strong anti-inflammatory medications that can be taken either in pill form, intravenously, or injected into the painful joint. Cortisone may improve the severe inflammation very quickly.
Does Gout Only Affect The Big Toe
Stereotypical presentations in popular culture of someone who suffers from gout usually depict a large, overweight, middle-aged man with one foot wrapped in a cast. From a broad perspective, thats pretty accurate youre more likely to get gout if youre man, postmenopausal woman, or are middle-aged.
But gout is a form of arthritis that can affect more than the joint of your big toe. And while being a man who eats rich foods is a risk factor for gout, you can get it no matter what your economic class or gender.
Our expert rheumatologists at the Rheumatology Center of New Jersey diagnose and treat all forms of arthritis and joint pain, including gout. Heres what you need to know about this misunderstood form of arthritis.
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Gout And Osteoarthritis Characteristics
The difference between gout and arthritis starts with the cause. It becomes confusing to some people because the term gouty arthritis is often used to describe uric acid buildup in the joints. However, typical arthritis or osteoarthritis is normally caused by aging, injury, wear and tear, or it is a hereditary factor. On the other hand, it is uric acid crystals that cause gout, not aging or typical tissue wear and tear.
Doctors classify gout as a metabolic disease. This means that a set of risk factors may exist within a persons body that could make them more prone to the particular ailment. This is not always the case with osteoarthritis, since it can be due to normal wear in the joints. When a person gets osteoarthritis, they do not experience chills and mild fever like people with gout can.
Here are some other differences:
Diagnosis
- Gout imaging tests, drawing fluid from the swollen joint for analysis, blood tests.
- Osteoarthritis x-ray, pain assessment, presence of deformity, evidence of muscle wasting, local inflammation, asymmetrical joints.
Joint symptoms
- Gout arthritic joint pain, swelling, redness, warmth, and extreme tenderness. Development of tophi possible. Acute onset more common.
- Osteoarthritis joints painful but without swelling, affects joints asymmetrically, affects bigger joints such as hips & knees.
Gender
Pattern of joints affected
The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
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How Is Gout Diagnosed
Your health care provider will get your complete medical history and do a physical exam. She may run these exams and tests to diagnose gout:
- Ajoint fluid analysis to see if uric acid crystals are present. This is the only certain way to diagnose gout.
- Tests to measure uric acid levels in blood and urine
There are many conditions with symptoms similar to gout. Be sure to see your doctor for a diagnosis.