What Can Increase Your Risk
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it’s still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don’t.
Other factors that may increase your risk of developing gout are outlined below.
How Does Gout Affect The Feet And Ankles
Feb 16, 2019 | Conditions
Gout is a painful form of inflammatory arthritis which affects the joints. Although it can impact the joints of your wrists, fingers, and elbows, it is the joints at the base of the big toe and the ankles which are mainly affected.
Gout attacks happen suddenly, and in mostcases, the affected joint is tender, red, and swollen, and can be extremelypainful.
If left untreated, a person can sufferfrom repeated attacks of gout. Men and obese adults over the age of thirty areat a greater risk of developing gout.
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.
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Where Does A Gout Attack Occur
Gout often attacks the largest joint in your big toe. However, it can also attack the foot, ankle knees, hands, or wrists. Intense pain, redness, and swelling can start with no warning, although you may have warning signs of an impending attack. If you start to feel tingling, burning, or itching in a joint, your body is giving you a warning signal that a flare-up is imminent.
Differences Between Men And Women
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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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.
Tophus Formation And Bony Erosions
After five or more years of recurrent flares, people with gout may develop tophi under the skin and around joints. While generally not painful, tophi can be disfiguring and interfere with normal joint function. The presence of tophi close to bones can lead to bone and cartilage destruction creating further deformities in the affected joints.
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When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
The End Of Gout Your Fast Track Plan
Shelly Mannings The End of Gout is not only a fascinating read its also refreshingly practical.
Shelly gives you two simple quick-starts:
Eat more of these
Eat fewer of these
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Which was pretty easy the plan is full of options so you can try different foods and see what you like best.
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Can You Have Gout In Your Knee Can You Have Gout In Your Knee Joint
Majority of people get their first gout attack in their toes, but as it gets worse it may reach to your knee.
Deposition of uric acid crystals in the knee joint leads to a condition commonly known as gout knee and it can virtually paralyze you during its attack. The knee joints have severe and intense pain with swelling which makes the joint stiff and difficult for you to use it at all. When a gout attack happens in your knee joint, it gets very tender and hot and you cannot even fold your leg.
It can be clinically diagnosed by the examination of synovial fluid for deposition of uric acid crystals and can be treated accordingly.
Treating Your Gout And Gout Symptoms
Thanks to modern science, there are now drugs you can take to help manage your gout symptoms. They can be classified into two types: medicine for treating gout attacks and medicine for preventing gout complications. Medicine for treating gout attacks can help relieve pain and control the inflammation.
If gout isn’t treated or managed properly, gout complications may appear, this may include:
- Severe joint pain and deformity may arise.
- Large tophi may cause dramatic changes in the appearance, particularly of the hands or feet.
- The disease can be so severe as to render the hands and feet virtually unusable.
- Osteoarthritis may arise.
- Tophi may cause breaks in the skin if they enlarge greatly, which can cause infection.
- Mobility, independence and body image may be altered.
- Living with chronic pain and debility can cause serious emotional distress.
- Elevated uric acid levels and crystal formation may result in kidney disease.
- Kidney stones and damage to the filtration system of the kidneys can occur.
To avoid gout complications, certain drugs are taken to help manage uric acid levels in the body. There is medications like allopurinol and febuxostat which block the production of uric acid while there are medications that improve the excretion of uric acid. This includes uricosuric drugs like probenecid and lesinurad which help improve the kidneys ability to remove uric acid.
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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.
What Part Of The Foot Does Gout Affect: You Need To Know This
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During A Foot Gout Flare
If you are experiencing a gout flare-up and are unable to reach your doctor, there are a few things you can do to help reduce the symptoms:
- At the first sign of symptoms, take ibuprofen or naproxen
- Drink plenty of water
- Rest and elevate your foot immediately
- Place cold compresses on the affected area
Risk Factors For Gout
Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, diabetes, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels in patients with gout.
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Who Should Diagnose And Treat Gout
The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.
Arthritis In The Toes
Arthritis in the toes is often the result of wear and tear of the cartilage in the toe joints or inflammation of the toe joints. The big toe is most often affected by arthritis, but other toes can also be involved.
Common symptoms of arthritis of the toes may include pain that can take hours or days to resolve and swelling and inflammation in and around the toe joints. Both RA and PsA can cause significant pain and swelling. However, with PsA, the toes become so swollen that they can resemble sausages .
Additional symptoms of arthritis in the toes might include:
- Restricted range of motion due to swelling or cartilage damage
- Development of bone spurs, which can further restrict movement
- Difficulty and pain with bending the toes
- A toe that might bend permanently downward
- Pain that worsens with weight-bearing activityrunning, walking, climbing stairs, etc.
- A bump formation or sore
- Pitted, separated, thickened toenails
- Curling of toeshammertoe or claw toe
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Treating And Preventing Gout Pain
Gout pain is generally treated in two ways:
- Medications to relieve gout attacks in the short-term
- Preventive medications taken regularly to lower uric acid and stop gout attacks from occurring
While inflammation-fighting drugs are used to relieve pain during gout flares, different medicines are used to lower uric acid levels to prevent future attacks. These include:
- Allopurinol
- Probenecid
Another medication called pegloticase may be recommended for people with chronic gout who have not responded to other uric acid-lowering medication.
While many people with gout can be treated by their primary care physician, if gout is not responding to medication or is progressing with worsening or frequent flares or developing tophi gout deposits, then your primary care physician may refer you to see a rheumatologist who specializes in treating diseases that affect joints, muscles, bones and the immune system.
Taking medication to reduce uric acid levels and reduce the risk of gout progression is important, Dr. FitzGerald stresses. If you have risk factors for bad gout, such as kidney disease, or are experiencing frequent attacks, early treatment is better.
Gout In Shoulder: Can Gout Affect Your Shoulder
For many people, the first symptom of gout is unbearable pain and swelling in the big toe which often occurs after a trauma, such as an illness or injury. Later attacks may occur in other joints, typically the feet, ankles, knees, hands, wrists, and elbows.
Attack on shoulder is less common but can happen.
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How To Prevent Complications And Future Flares
Uric acid levels can be lowered in a number of ways. Your doctor may prescribe medication that reduces the intensity and duration of a gout attack and also breaks down the buildup of uric acid crystals. There are supplements that lower uric acid levels. And, these lifestyle changes also can help keep uric acid in check: avoid alcoholic beverages, stick to a healthy diet that limits foods high in purines, keep hydrated, and maintain a healthy weight.
Most Common Gout Attack Sites
The most common site for a gout attack is what is known as the bunion joint on the big toe. It is typically the first joint affected by gout. As gout worsens, the ankle, mid-foot, knee, and elbow can become common sites of gout attacks. Uric acid crystals can also collect in soft tissues and form lumps called tophi, most typically on the hands, fingers, elbows, and ears.
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Gout Symptoms: 10 Most Common Symptoms
With contributions from Patricia.
Gout is not the result of just one condition there are several causes of the disease. Some are classified as primary while others arise as a result of other health problems, but all are characterized by joint pain.
Gout is a condition caused by high levels of uric acid in the blood and uric acid is the byproduct of the breakdown of purines and serves no useful function in the human body. A regular, healthy person is able to excrete uric acid through urine but for some people , this is not possible.
There are two reasons why this is: there is too much uric acid in the bloodstream or the body is not able to excrete enough uric acid, hence the buildup. These two causes are interrelated with each other. Genetics and certain lifestyle choices cause uric acid levels to rise as well as inhibit the bodys ability to excrete uric acid.
Once the correct condition is identified, an effective treatment plan may be developed. Until these techniques were perfected, many people were diagnosed incorrectly with gout.
Careful examination of the synovial fluid offers healthcare providers with opportunities to rule out infectious diseases with joint pain that may resemble symptoms of gout. Health care providers are also able to determine whether or not the joint is inflamed or not, which provides further clues to the origin of the problem.
Gout Symptoms To Be Aware Of
3. Fever
Gout can also occur in the whole body in the form of a mild fever. This is when you have chills and shivers which get more intense as the pain in the affected joint gets stronger. You may also feel muscle ache and fatigue.
This combination of symptoms almost resembles the flu which is caused by the inflammation during a gout flare. However, it doesnt last as long and will gradually subside after reaching maximum intensity.
4. Tenderness
After the initial pain of a gout attack has subsided , you may notice that the affected joint feels tender. Usually this tenderness climbs up slowly past the ankle and the leg. You may have difficulties walking in the next few days or weeks as your joints recover from the attack.
When the affected joint is tender, your doctor may prescribe you to use a crutch otherwise, you will be limping –not the best way to go about your daily activities. It can be hard to function so be sure to get treatment right away.
5. Reddish, Purple Shiny Skin
As the swollen area becomes larger, you may notice that the skin around the affected joint will turn reddish purple, and shiny. It almost looks as if youre having an infection under the skin.
6. Skin Peeling
In certain cases, a gout flare can cause skin to peel and shed, almost as if you have a bad sunburn. When the skin swells from the inflammation, it stretches, turns red, and becomes flaky and itchy, sometimes even cracked.
7. Elbow Gout
8. Kidney Stones
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