What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.
Diagnosis Treatment And Prevention Of Gout
BARRY L. HAINER, MD ERIC MATHESON, MD and R. TRAVIS WILKES, MD, Medical University of South Carolina, Charleston, South Carolina
Am Fam Physician. 2014 Dec 15 90:831-836.
Gout is the most common inflammatory arthropathy, affecting more than 8 million Americans.1 Gout accounts for approximately 7 million ambulatory visits in the United States annually at a cost of nearly $1 billion.2 Risk factors include genetics, age, sex, and diet.2,3 These factors may contribute to a high serum uric acid level, which is currently defined as a value of at least 6.8 mg per dL .4,5
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Oral corticosteroids and nonsteroidal anti-inflammatory drugs are equally effective in the treatment of acute gout.
To prevent recurrent gout, patients should reduce their consumption of high-fructose corn syrupsweetened soft drinks, fruit juices, and fructose-rich vegetables and fruits . Reducing consumption of meat and seafood, and increasing consumption of dairy products help reduce the frequency of gouty symptoms. Consumption of low-fat or nonfat dairy products may help reduce the frequency of flares.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
Who Can And Cannot Take Allopurinol
Allopurinol can be taken by adults and sometimes children.
Allopurinol is not suitable for certain people.
Talk to a doctor or pharmacist if you:
- have ever had an allergic reaction to allopurinol or any other medicine
- are of Han Chinese, Thai or Korean origin
- have problems with your liver or kidneys
- currently have an attack of gout
- have thyroid problems
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The Excruciating Pain And Swelling During A Gout Flare Is Pretty Hard To Ignore
Whether youve been plagued by gout in the past or have never experienced it before, chances are that when a gout flare strikes youll quickly know something is very, very wrong: The excruciating pain and swelling, which often occurs in a single joint , is pretty hard to ignore.
If youve never had a gout attack and are thinking that people with gout must be exaggerating, consider this: 37 percent of people with gout said that theyd willingly give up a winning lottery ticket if they never had to experience a gout flare again, according to a patient survey.
Of course, making that sort of trade-off isnt an option. So what real-life choices do you have? Your best bet is to call your doctor stat. As soon as you feel a twinge, you need to get medical attention, says Joseph Huffstutter, MD, a rheumatologist with Arthritis Associates in Hixson, Tennessee. The sooner you treat a gout attack, the easier it will be to treat.
Heres a look at why gout flares happen and how to rein in the pain as quickly as possible.
What About Prp Injections For Gout
PRP injections for gout are only reserved for special cases. Just like cortisone injections, PRP injections are anti-inflammatory and will have a beneficial effect. This effect is probably better if the injected joint has underlying degenerative changes such as osteoarthritis. Nevertheless, the effect of PRP is less than cortisone. Overall, we would only consider PRP injection for gout if the risks of a cortisone injection are too great.
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How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
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Using Tart Cherry Juice For Gout
Tart cherry juice may help decrease uric acid levels and inflammation in gout. Research is limited, with often small numbers of study participants and short-term follow-up.
Nevertheless, a 2019 review of six studies that looked at the effect of cherry juice or cherry extract intake on gout concluded that cherry intake was associated with a reduced risk of gout attacks. Researchers did note that larger, more long-term studies are needed to clarify this association.
When choosing tart cherry juice, be sure to look for unsweetened varieties to help reduce the amount of added sugar in your diet.
Cautions With Other Medicines
Certain medicines can interfere with the way colchicine works. Some can make you more likely to get serious or life-threatening side effects.
Speak to your doctor before starting on colchicine if you take:
- medicines that can affect your kidneys, your liver or your blood
- clarithromycin or erythromycin
- ritonavir or atazanavir
- ketoconazole, itraconazole or voriconazole
- verapamil or diltiazem
Your doctor may need to adjust your dose if you are taking any of these medicines.
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The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
How To Take Colchicine
- Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about colchicine and will provide you with a full list of the side-effects which you may experience from taking it.
- You must take colchicine exactly as your doctor tells you to. Most doctors will recommend that when a gout attacks starts, you should take one tablet 2-4 times a day until the pain eases. It is important that you do not take more than 12 tablets of colchicine as a course of treatment during any one gout attack. It is also important that you leave at least three days between courses of colchicine. If you find you are having frequent attacks of gout, please let your doctor know about this.
- If you have recently been prescribed a medicine to prevent gout attacks and you have been given colchicine to prevent a flare-up attack of gout, the usual dose for this is one tablet twice each day.
- Take colchicine tablets with a drink of water.
- If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a forgotten dose.
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How Much Will I Take
The usual dose is 1 tablet , taken 2 to 4 times a day.
You’ll usually take colchicine for just a few days. Your doctor will tell you how long to take it for.
For familial Mediterranean fever
Doses can vary between 1 and 4 tablets , taken once a day.
Your doctor will probably recommend taking this medicine long-term.
How And When To Take It
Follow your doctor’s instructions about how many tablets to take, and how many times a day.
It’s important to stick to your prescribed dose. This is because there is only a small difference between a correct dose and an overdose.
Colchicine comes as 500 microgram tablets. The word microgram is sometimes written with the Greek symbol followed by the letter g . A microgram is 1,000 times smaller than a milligram .
If you have kidney or liver disease, your doctor may prescribe a lower dose. You will also have regular blood and urine tests.
Swallow your tablet whole, with a glass of water.
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How To Handle Your First Gout Attack
After a first attack of gout, its OK to try to stave off another one with dietary changes alone. But if you have another attack, its important to start taking preventive gout medications on a regular basis. Long-term medications for gout include allopurinol and febuxostat, both of which limit uric acid production.
Some patients, says Dr. Fields, treat each attack as a separate event and dont talk to their doctors about doing a preventive approach. He uses the analogy of lighting a book of matches. If you have one match lit, its easy to put out, but if you have the whole book lit, its a lot harder.
Risk Factors For Gout
Gout is more likely to occur in:
- Men. Men have a seven to nine times higher risk of gout than women, although the risk increases for women after menopause
- People with a diet high in purine-rich foods such as red meat, organ meats , seafood . Processed foods , refined carbohydrates and beverages high in fructose or sucrose also contribute to gout
- Certain ethnicities
- People who overindulge in alcohol, particularly beer and spirits
- People with certain medical conditions , and with some medications or treatments .
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Home Remedies For Long
The American College of Rheumatology recommends a couple of lifestyle modifications for preventing future attacks of gout:
1) Lose weight if you need to. Being overweight can increase uric acid levels as well as put pressure on the joints.
2) Follow a low-purine diet. Another effective way to reduce uric acid levels is to follow a low-purine diet. Purines are organic compounds that break down into uric acid. Following a low-purine diet means avoiding the big four alcohol, shellfish, red meat, and high fructose corn syrup.
Limiting these foods is also beneficial for heart health and people with gout are at higher risk for heart disease.
But dont go overboard with dietary changes to relieve gout pain though, advises Dr. Fields. You can find lists of thousands of different foods youre not supposed to have if you have gout. Those recommendations are impossible to follow and can make you crazy.
Immediate Gout Pain Relief: What Are Your Options
Generally, you can take simple steps to get the pain and swelling under control. Examples include ice, compression of the joint, and rest from sport. Also, you need to keep well hydrated and avoid alcohol.
Medications from your doctor can help. Anti-inflammatory tablets such as ibuprofen can stop an acute attack if taken early. Similarly, a drug called colchicine can stop gout in its tracks if taken in the first 24 hours. Often, the dose of colchicine is one tablet three times a day decreasing to twice a day after a week as the pain settles.
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How To Take It
Swallow the allopurinol tablets with water, ideally after food. You’ll usually take it once a day, but if you’re on a high dose, your doctor may advise you to split the dose and take it twice a day.
If your doctor has recommended you take allopurinol with lots of fluid, try to drink 2 to 3 litres of fluids every day.
You can take allopurinol at any time of the day, however, try to take your doses at the same time of day each day.
Who Can And Can’t Take Colchicine
Colchicine can be taken by most adults aged 18 and over.
It can sometimes be prescribed for children by a specialist doctor.
Colchicine is not suitable for some people. To make sure it’s safe for you, tell your doctor if you:
- have ever had an allergic reaction to colchicine or any other medicines
- have a severe blood disorder
- have severe kidney or liver problems
- have problems with your heart or digestive system
- are pregnant, think you might be pregnant or are trying for a baby
Women who could become pregnant will usually only be prescribed colchicine if they are using suitable contraception.
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When Is It Okay To Get Off Uric Acid Medication
So I had a gout flare up after I had a few pints and red meat for almost 3 consecutive days about 6 months ago.
I was also training regularly and was on a high protein, high fat and low carb diet. I had just started taking BCAAs.
It was bad and I immediately stopped having dairy, red meat and alcohol. I am a smoker though .
The uric acid peaked to 12.27 after when I got tested right before another flare up 2 months back. I started taking allopathy and homeopathy in December and I got tested again for uric acid and the serum levels dropped to 5.25.
I did have alcohol and red meat one night after the results came in, and the gout affected joint felt slightly sore the next day.
My doctor has asked me to stay on meds until March , as I continue minding my diet. Im just too conscious about having excessive medication in my system, but if someone has been in the same boat, when did you come off meds, just curious and howd it feel? Did the uric acid levels fluctuate as you switched your diet?
Soz for too much text! Thanks!
Celery Or Celery Seeds
Celery is a food traditionally used to treat urinary issues. For gout, extract and seeds of the vegetable have become popular home remedies.
Experimental use is well-documented, though scientific research is scant. Its thought that celery may reduce inflammation.
Adequate celery amounts for treating gout arent documented. Try eating celery many times per day, especially raw celery sticks, juice, extract, or seeds.
If purchasing an extract or supplement, follow label directions closely.
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Medications Used For Treating Gout Flares
Gout attacks, or gout flares, usually occur when there is an excess build-up of uric acid in your blood. When the human body breaks down purines, it leads to the formation of uric acid. The level of uric acid in your body becomes harmful when your kidney is not able to remove it from your body through urine. When the uric acid level increases, it may lead to gout. This inflammatory disease mainly affects your joints, causing severe pain, inflammation, and swelling.
Doctors prescribe several medications to prevent gout flare-ups. You should note that these medications cannot cure gout but can alleviate gout symptoms. In this article, we will take a look at some of the short-term and long-term gout medications.
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
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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 .