Tuesday, May 17, 2022

Can Gout Affect Multiple Joints At Once

Top 10 Symptoms Of Gout

Gout, Pathophysiology, Causes, Symptoms, Risk Factors, Diagnosis and Treatments, Animation.

Gout forms into sharp, needle-like crystals which can cause serious pain in the joints, with the big toe joint being the most affected. However, that is not the only sign of gout. Here are the top 10 gout symptoms and signs to watch out for. If you experience any combination of these symptoms, you may have gout.

1. Toe Pain

Lets start with the most obvious, toe pain or podagra as doctors call it. This is probably one of the most known symptoms of gout. Its furthest from the heart making it the most prone for gout attacks. Flares usually happen in the middle of the night when the temperature is at its coldest.

If you are lucky, your toe will be the only joint that gets affected when you have gout. What happens is that uric acid builds up in this particular area causing the sufferer to feel immense pain during a gout flare. At this point, its best to rest and elevate the affected joint to promote circulation. Recovering from a gout attack will take anywhere between one to two weeks.

2. Swelling

Aside from pain, you will also experience swelling and sensitivity. You will notice that the area around the joint or even the whole lower limb becomes very swollen. It becomes so sensitive that even the lightest touch or vibration caused by a person walking in a room can cause immense pain. You would have to take NSAIDs to make the pain subside.

What Increases Your Chances For Gout

The following make it more likely that you will develop hyperuricemia, which causes gout:

  • Being male
  • Using certain medications, such as diuretics .
  • Drinking alcohol. The risk of gout is greater as alcohol intake goes up.
  • Eating or drinking food and drinks high in fructose .
  • Having a diet high in purines, which the body breaks down into uric acid. Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna.
  • What Else Should I Ask My Healthcare Provider About Gout

    Consider asking your healthcare provider:

    • What is causing the gout?
    • Do I have any joint damage?
    • What can I do to prevent future attacks?
    • Can any gout medications help me?
    • How long will I need to take gout medications?

    A note from Cleveland Clinic

    Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.

    Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.

    References

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    Pathogenesis Of Acute Gouty Arthritis

    Deposition of UA crystals in the joint cavity is the triggering cause of gout. These crystals initiate the inflammatory process by being engulfed by synovial phagocytic cells leading to release of lysosomal enzymes and production of inflammatory chemokines. Another mechanism is that UA crystals change the stability of cell membrane of phagocytic cells by direct crosslinkage with membrane lipids and glycoproteins. This involves the triggering of G protein, phospholipase A2, C and D, tyrosine kinase and other kinases such as mitogen-activated kinases and c-Jun N-terminal kinase. This interaction leads to increased IL-8 in phagocytes resulting in activation of neutrophils , .

    The pathogenesis of gouty arthritis involves initial activation of monocytes and mast cells followed by neutrophils. Before the first attack of gout and in the inter-critical period, macrophages engulf UA crystals. Well-differentiated macrophages have the capability to contain these crystals without inducing an inflammatory response. While less-differentiated monocytes produce abundant amounts of TNF, IL-1, IL-6 and IL-8 along with endothelial activation following phagocytosis of urate crystals. Also, mast cells are key players in inducing the acute gouty attack by producing histamine and IL-1. This results in increasing vascular permeability and vasodilatation. Interestingly, it is thought that may even end the inflammatory phase by engulfing the crystals and the inflammatory debris , .

    Differences Between Men And Women

    Symptoms and Treatments for Gout » Healthorigins

    Sex differences play a role in which joints are affected:

    • In men, about 85% of gout flare-ups affect joints in the lower extremities. About 50% of first-time gout attacks involve a big toe joint.8
    • In women, a gout attack is most likely to occur in a knee.10 In addition, women may be more likely to get gout in the upper extremities.9

    While women are less likely to get gout, they are more likely to have multiple joints affected by gout.13

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    Medications For Acute Gout

  • Non-steroidal anti-inflammatory agents and COX-2 inhibitors are the mainstay of therapy of acute attacks of gout in patients who have no contra-indication to them. These medications include such agents as naproxen , ibuprofen , celecoxib , indomethacin and many others. These agents reliably decrease the inflammation and pain of gout. However, patients with ulcers, hypertension, coronary disease, and fluid retention must be careful with these agents, even for the short courses needed to resolve a gout attack. The doses of non-steroidal anti-inflammatory agents needed to resolve a gout attack are on the higher side, since full anti-inflammatory effect is needed. See examples of dosage in Table 2. Over-the-counter dosage levels, for example, ibuprofen at 200mg, two tabs three times a day, are often insufficient.
  • Corticosteroids, such as prednisone and methylprednisolone , are anti-inflammatory agents that are quite effective against gout attacks. Anti-inflammatory steroids are very different in action and side-effects as compared to male hormone steroids. Anti-inflammatory steroids have long-term risks, such as bone thinning and infection, but their risk for short-term therapy is relatively low. These agents can raise blood pressure and blood sugar, so can be a problem for those with uncontrolled hypertension or uncontrolled diabetes mellitus.
  • The Different Types Of Gout

    Primary gout is due to an innate hereditary problem that results in the buildup of uric acid within the body. 90 percent of people who are diagnosed with primary gout are male the condition is virtually nonexistent in premenopausal women.

    Secondary gout develops as a result of acquired metabolic problems or medication. Certain types of chemotherapy, such as those used to treat some leukemias, increase the likelihood of gout development.

    The most common type of gout or crystal-induced arthritis is the monosodium urate type, which is characterized by uric acid crystals in the synovial fluid. Other kinds of gout arise due to the presence of various types of calcium crystals.

    Chronic gout, also known as gouty arthritis, affects several joints. Uric acid crystal deposits build up in multiple areas of the body: synovial fluids, tissues, tendons, vertebrae, elbows, between cartilage and bones, in the cartilage itself, and in the skin. The course of chronic gout is highly variable there may be chronic low-grade discomfort accompanied by mild flare-ups intermittently, or it may result from severe episodes, which create chronic deterioration of the involved tissues.

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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

    Myth: There Aren’t Effective Medicines For Gout

    Acute Gout Treatment – How You Can Relieve the Sudden Onset of Pain (5 of 6)

    Truth: Many medications put the brakes on gout. Some control pain and inflammation immediately and others get at the root cause by eliminating the deposited uric acid crystals.

    Colchicine is prescribed for acute gout flare-ups. A plant extract, it’s been used to treat gout for 2,000 years, says Reveille. Colchicine works within several minutes to several hours to block gout inflammation. The sooner you start it, the more likely the attack will resolve quickly. An injected steroid also tackles inflammation, usually controlling pain and swelling within 24 hours.

    Prescription drugs such as allopurinol , febuxostat and probenecid all alleviate gout by controlling blood levels of uric acid. Also, two years ago the FDA approved an intravenous drug for people with advanced gout pegloticase that lowers uric acid levels and reduces deposits of uric acid crystals in the joints and soft tissue.

    Most people who have gout will need to be on a uric-acid-lowering drug for life, usually just one or two pills a day, says George Washington University’s Baraf.

    Changing your diet can help reduce the frequency of gout attacks.

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    Be Aware Of The Common Signs And Symptoms Of Gout

    Gout, a form of inflammatory arthritis, is a particularly painful condition that affects millions of Americans. The pain is caused by inflammation in the joint induced by the deposition of sharp uric acid crystals. Uric acid is created when purines are metabolized or broken down by the body. Uric acid in and of itself is not harmful it only becomes worrisome when the body is unable to properly process the acid or if the body is experiencing unusually high levels of the acid.

    One of the most distinguishing signs of gout is its sudden onset in the middle of the night in the large joint of the big toe. Although, much less commonly, gout can occur at any time during the day and in a variety of other joints such as the ankles, knees, and wrists. Gouty arthritis is unique in that it primarily only affects a single joint at a time. However, if left untreated for long periods of time, multiple joints will likely begin to be implicated.

    Gout symptoms include intense joint pain, redness, swelling, warmth, and a limited range of motion at the affected site. Gout often causes the joint to become so sensitive that it is difficult to walk, wear shoes, or even have a sheet resting against it. Read on to learn more about gout signs and symptoms.

    Gout Is No Laughing Matter

    Gout is often used to comically depict a characters frailty or privilege. In the 2018 film The Favourite, Olivia Colemans Queen Anne is confined to a wheelchair and subjected to bizarre raw meat treatments for her gout.

    More than 100 years previously, a villain in a short 1917 Charlie Chaplin film called The Cure got his gout-ridden foot caught in a revolving door.

    But gout is excruciatingly painful and not funny at all when you suffer an attack. Gout also doesnt limit itself to afflicting the rich. In fact, the foods that make up the standard American diet are filled with a substance called purines, which can cause excess uric acid to build up in your body.

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    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.

      Get An Accurate Diagnosis And Treatment

      Gout

      While gout attack symptoms do resolve on their own, people are advised to seek medical treatment. If left untreated, gout can become chronic and cause lasting joint damage.

      Diagnosis begins with a clinical exam and interview. Patients are encouraged to be honest with their health care providers about their eating, drinking, and other lifestyle habits. This honesty can be helpful both for diagnosing gout and creating a treatment plan. Diagnosis may also involve blood tests, urine tests, and medical imaging, such as x-rays and ultrasound.

      See Gout Diagnosis

      Treatment typically involves advice to avoid alcohol and certain foods known to trigger gout, such as foods and drink high in sugar, seafood, red meat, and organ meats.19 Medications to lower urate levels in the bloodâwhich can lead to gout attacksâare often recommended. Losing excess weight is another effective way to reduce the risk of a gout attack and chronic gout.20

      See Gout Treatment

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      How Uric Acid Crystals Form

      Infographic

      The build-up of uric acid crystals begins with purines, a chemical compound found in many foods.

      • When the body metabolizes purines, it produces a substance called uric acid.
      • The uric acid enters the bloodstream.
      • The kidneys filter the blood and normally filter out excess uric acid. This uric acid is then excreted via urine or stool .10
      • If the kidneys cannot adequately filter out excess uric acid, or if the body produces too much uric acid, there will be too much uric acid in the bloodstream.
      • Too much uric acid in the bloodstream is called hyperuricemia.
      • In some people, hyperuricemia leads to the formation of uric acid crystals that collect in joint tissue, leading to painful symptoms.

      An inability to adequately process and excrete uric acid accounts for an estimated 90% of gout cases.9 Other cases occur because a body produces too much uric acid.

      What Causes Pseudogout

      Pseudogout occurs when calcium pyrophosphate crystals form in the synovial fluid in the joints. Crystals can also deposit in the cartilage, where they can cause damage. Buildup of crystal in the joint fluid results in swollen joints and acute pain.

      Researchers dont fully understand why the crystals form. The chance of them forming likely increases with age. Crystals form in about half of people over the age of 85, according to the Arthritis Foundation. However, many of them dont have pseudogout.

      Pseudogout can often run in families, so many medical professionals believe it to be a genetic condition. Other contributing factors may include:

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      Who Is At Risk Of Gout

      Gout is sometimes called the disease of kings because of a false link to overindulgence in food and alcohol. Anyone can get the condition, but certain factors can increase your risk:

      • Gender: Males are more likely to get gout than females.
      • Age: Middle-aged and older men and women after menopause are more at risk for gout.
      • Obesity
      • Family history
      • Diet: A diet high in purines, which are broken down into uric acid, can lead to gout. High purine foods include meats like bacon, turkey, veal, venison, and liver, and seafood like anchovies, sardines, mussels, codfish, scallops, trout, and haddock. High fructose foods and drinks such as soda pop also can increase your risk.
      • Alcohol use

      Impact Of Systemic Diseases On Uric Acid

      GOUT, Causes, Signs and Symptoms, Diagnosis and Treatment.

      Gout seems to affect osteoarthritic joints more often. This observation shows that cartilage damage resulting from OA induces formation of MSU crystals. Interestingly, UA crystals seem to affect the cartilage from its outer surface. Oppositely, pseudogout crystals appear inside the cartilage. Accumulation of UA crystals in the joint results from decreased vascularity and susceptibility of the synovial membrane to pass the crystals. Thus, gout tends to affect peripheral joints such as the big toe .

      Hypertension is known as a risk factor for hyperuricemia and gout. Increased systemic blood pressure results in reduced glomerular filtration rate leading to decreased glomerular blood flow and decreased excretion of UA . However, recent data suggest that hyperuricemia leads to increased blood pressure and that uric acid is a true modifiable risk factor for development of essential hypertension .

      Diabetes mellitus is also a significant risk factor for hyperuriceamia and gout. Failure of oxidative phosphorylation increases adenosine levels resulting in increased production of uric acid and reduction of its renal excretion. Insulin treatment increases SUA by increasing its renal reabsorption from renal tubules. Metabolic syndrome is also associated with hyperuriceamia and gout .

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      Specialist Answers On Gout Problems

      Q1. My husband seems to be suffering from a very drawn-out and complicated gout attack. The episode began in his left toe he has experienced gout before and was effectively treated with indomethacin, so his doctor prescribed it again. This time, though, he has seen no improvement. In fact, the gout has begun to spread, causing severe pain in his knee, hips, back, shoulder, and wrist. One physician felt he may have pseudogout and suggested that he continue with the indomethacin. Another doctor was concerned that he might be septic, but blood work revealed that this is not the case. The most recent doctor advised that he stop taking the indo and prescribed anti-inflammatory Apo-naproxen and Tylenol 3 for his pain. Do you believe it’s possible for gout to spread to so many other joints in the body? Where do we go from here?

      Noel, Louisiana

      Unfortunately, gout can spread throughout the body, and it can be most painful and unpleasant. Gout is known as the the disease of kings” or “a rich mans disease because it is thought to be linked to a diet that contains a lot of meat, seafood, and alcohol, which all increase uric-acid levels in the body. With gout, uric-acid crystals are deposited in the bloodstream, joints, tendons, and surrounding tissues, causing pain and stiffness.

      The usual treatment is to start on a drug, such as Zyloprim , that inhibits the conversion of purine in foods into uric acid instead the purine is eliminated through urine and feces.

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