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
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.
When To Contact A Doctor
People who are experiencing symptoms they think might be due to gout should seek guidance from a doctor.
Gout tends to progress and worsen over time. However, early treatment can often help control gout and reduce the risk of severe complications, such as joint damage.
People with gout can also develop infections, which they need to treat as soon as possible. Those who have diabetes are more likely to develop infections with gout.
A person should seek emergency medical care if signs of infection are co-occurring with symptoms of gout.
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Take A Warm Bath And Stretch
Take a warm bath, and then gently stretch your muscles. If you have pain in the lower part of your leg, try pointing and straightening your toes when sitting or standing. If you have pain in the upper part of your leg, try to bend over and touch your toes.
You can do this while sitting on the ground or standing up. Ease into each stretch, holding each position for five to 10 seconds. Stop stretching if your pain gets worse.
It can sometimes be difficult to determine when leg pain warrants a trip to the doctor or the emergency room. Schedule a doctors appointment if youre experiencing:
- swelling in both legs
- varicose veins that are causing discomfort
- pain while walking
- leg pain that continues to get worse or persists beyond a few days
Go to the hospital immediately if any of the follow occurs:
- You have a fever.
- You have a deep cut on your leg.
- Your leg is red and warm to the touch.
- Your leg is pale and feels cool to the touch.
- Youre having difficulty breathing and you have swelling in both legs.
- Youre unable to walk or put any weight on your leg.
- You have a leg injury that occurred along with a pop or grinding noise.
A number of serious conditions and injuries may cause leg pain. Never ignore leg pain that doesnt seem to be going away or thats accompanied by other symptoms. Doing so could be dangerous. See your doctor if youre concerned about your leg pain.
Struggling With Gout Pain Dr Stuart Weisman’s Tips
- Boulder Community Health
Gout can strike suddenly causing excruciating pain and swelling in joints. It usually strikes a big toe, but can also affect the ankle, knee, foot, elbow or finger. The affected joint becomes so tender that even the slightest touch can be unbearable.
“Fortunately, an attack will clear in time, and there’s a lot we can do to prevent further attacks,” rheumatologist Stuart Weisman, MD, of Boulder Medical Center told a crowd of more than 120 people during a free health lecture held at the Boulder Jewish Community Center.
Gout Causes and Symptoms“Gout is a type of arthritis that occurs when you have high levels of uric acid in your blood,” explained Dr. Weismain. “Over time, the uric acid forms needle-sharp crystals that collect around your joints and soft tissues. Eventually, these crystals trigger a gout attack.” He said symptoms include:
- Sudden excruciating joint pain
- Fever
Gout Flare-Ups: How to Get ReliefGout attacks can be quite severe, so it’s good to know how to quell the pain as soon as possible. Dr. Weisman offered a few options:
- Over-the-counter drugs – Take nonsteroidal anti-inflammatory drugs early in an attack and at a maximum dose. For example, he said you could take a naproxen dosage of 500MG two times/day.
- Corticosteroids – Your doctor can prescribe a 5-to-14-day course of corticosteroids to reduce the inflammation.
- Colchicine – Best taken at the onset of an attack, prescription colchicine can help decrease the pain and swelling.
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Are Patients Being Overlooked
Dr. Fields says the back pain of an attack could be mistaken for something else and treated as such. But what the patient really needs is medication to lower their uric acid level.
Even though a doctor may know the patient has gout, they may assume the back pain is from a herniated disc or osteoarthritis, he explains. They have to do imaging or a biopsy to find the uric acid deposits in the spine.
Spinal gout is rare, but it may be worth talking to your doctor about if you have back pain and a history of gout. You should be even more suspicious if you use diuretics, have high blood pressure or are obese. Early diagnosis and treatment with uric acid-lowering drugs can prevent the need for surgical intervention.
What Are The Symptoms Of Gout In The Ankle
The main symptom of gout in the ankle is pain and discomfort in the surrounding area. Keep in mind that gout is often unpredictable, regardless of the joint its affecting. You might go weeks or even months without any symptoms, only to wake up with a burning pain in your ankle.
In some cases, gout starts out in one of your big toes before moving on to other areas, such as your ankle. Over time, these flare-ups may last longer than they previously did.
Other symptoms you might feel from gout in your ankle include:
- tenderness
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How Can I Manage My Gout And Improve My Quality Of Life
Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.
For gout in particular:
- Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.
How Can I Prevent Gout
If gout runs in your family, men in particular should limit alcohol, fats, and foods that are more likely to increase uric acid level in the body. Those include meat, sardines, bacon, mussels, and yeast. Beer, especially, can also bring on a gout attack. Drinking plenty of liquids may help minimize the risk of kidney stones. Your doctor can do blood and urine tests to figure out your potential risk of a gout attack. Itâs also a good idea for men who are at greater risk to keep an eye on their weight.
Medications can also help prevent gout attacks if you have them often. These drugs decrease the production of uric acid or increase the amount of uric acid you get rid of in urine. These medicines include allopurinol , colchicine , pegloticase , probenecid , and rasburicase .
If these medications arenât effective, your doctor may prescribe . If you have heart issues, be very cautious taking febuxostat.
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Pain That Happens At Night
The timing of the pain is important. As I wrote, leg pain at night has a set of causes that is not identical to pain that happens also at other times. The three main causes to think about are:
- Lack of blood flow to the muscles. This is probably the most severe option. For artery blockages to cause leg pain at night, they have to be very severe.
- Calf cramps at night. Muscle cramps are very common. They can be very painful.
- Neuropathy. Nerve pain is also very common and people tend to feel it mostly during the night.
Simple stretching exercises can prevent night-time cramping.
Are There Other Signs Or Symptoms
I left a very important point for last. Many medical conditions that are important to diagnose present with muscle pain and other symptoms. Sometimes the symptoms can be subtle. Also, it will not always be immediately apparent that they are related to the leg muscle pain. Examples of such symptoms include rash, fever, weight loss, nigh sweats, and neurological symptoms.
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When Gout Becomes A Long
When uric acid levels in your blood stay too high, more and more crystals form around your joints. It can turn into a long-term condition, leading to painful and damaged joints.
Gout will happen differently for everyone. But signs that it may be getting worse include:
- Flares happen more often and last longer. Over time, the inflammation causes lasting damage to bone and cartilage.
- Flare-ups in other parts of your body. About half of people with gout have their first attack in the joint at the base of the big toe. When gout gets worse, it can affect other joints, including the ankle and knee.
- Bumps form under the skin. Uric acid crystals may start to collect in soft tissue, forming lumps called tophi. They often appear on the hands, fingers, elbows, and ears, but they can show up almost anywhere on the body.
- Kidney problems. Your kidneys normally get rid of uric acid in your body. But too much of it can also damage the organs. Kidney problems linked with gout — and signs that gout is getting worse — include gouty kidney, kidney stones, and kidney failure.
Foods To Limit Or Avoid
Cutting out or limiting foods that contain purines may help further reduce the amount of uric acid in the bloodstream and the risk of developing gout or experiencing gout flare-ups in the future.
Some foods rich in purines are the following:
- alcohol, especially beer and spirits
- certain meats, such as turkey, bacon, veal, liver, venison, and organ meats
- some types of fish and seafood, such as haddock, trout, scallops, cod, mussels, anchovies, sardines, and herring
Foods moderately high in purines include:
- beef
- avoiding extreme diets, especially diets low in carbohydrates and high in proteins
- eating a healthy diet that reduces the risk of diabetes, high blood pressure, and obesity, such as one that includes a lot of fruits, vegetables, nuts, and plant proteins
People with joint damage or tophi from gout may require surgery.
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How Is Gout In The Ankle Diagnosed
If you think you might have gout but havent been diagnosed, try to see a doctor while youre having symptoms. Gout is easier to diagnose when youre in the middle of a flare-up thats causing swelling, redness, and other visible symptoms.
During your appointment, your doctor will likely ask you several questions about your diet, any medications you take, and whether you have a family history of gout. This can help to rule out other potential causes of your symptoms, including an infection or rheumatoid arthritis.
Your doctor may also order a blood test to check your uric acid levels. But some people have high levels of uric acid and dont develop gout. Others have typical uric acid levels but still develop gout. As a result, theyll want to do some other tests as well.
An X-ray, MRI, or CT scan of your ankle can also help to eliminate other possible causes of joint inflammation. Depending on your exam, they may also order an ultrasound to check for the presence of crystals in your ankle.
Finally, they might do a joint fluid test. This involves taking a small sample of joint fluid from your ankle with a small needle and looking at it under a microscope for any uric acid crystals.
Based on the results of your exam and tests, they may refer you to an inflammatory arthritis specialist called a rheumatologist for treatment.
Theres no cure for gout, but a combination of medications and home treatments can help to manage ankle pain and reduce the number of flare-ups you have.
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Lowering Blood Levels Of Uric Acid
A high level of uric acid in the blood causes problems for people with gout and may increase the risk of kidney disease in people without gout. Lowering the level of uric acid in the blood helps dissolve deposits of uric acid in the tissues and prevent flare-ups.
People with gout who especially need their blood level of uric acid lowered include those who have the following:
-
Frequent, severe flare-ups despite taking colchicine, an NSAID, or both
-
Tophi that are found on examination
-
Uric acid kidney stones
-
Conditions that make NSAIDs or corticosteroids more complicated to take
People taking drugs to lower the blood level of uric acid should know their level, just as people with high blood pressure should know their blood pressure. The goal of drug therapy is to decrease the level to less than 6 milligrams per deciliter . If the blood level is maintained below 6 , uric acid will stop being deposited in the joints and in soft tissues, and the existing deposits will eventually dissolve, although this may take several years. Most tophi on the ears, hands, or feet shrink slowly when the uric acid level decreases to less than 6 milligrams per deciliter .
is another drug that lowers blood levels of uric acid. It is especially useful in patients who cannot take or have not been helped by allopurinol. As with allopurinol, flare-ups can occur as the uric acid level in the blood first decreases.
What Are The Symptoms Of Gout
An episode of gout is called a gout attack. Gout attacks are very painful and can happen quite suddenly, often overnight. During a gout attack, symptoms in the affected joint may include:
- Intense pain.
- Tenderness, even to light touch, such as from a bedsheet.
- Warmth, or a feeling like the joint is on fire.
- How long does a gout attack last?
A gout attack can last a week or two. Between gout attacks, you may have no symptoms at all.
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Can Gout Cause Lower Leg Pain
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Arthritis / Acute Gout Attack
Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.
The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.
An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack takes approximately 7-14 days.
An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of gout:
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