Treating Gout And Tophi With Surgery
Uric-acid-lowering drugs can reduce the size of tophi over time. Some people may opt to have tophi surgically removed for cosmetic reasons.
Your doctor may recommend surgical removal for tophi if they are causing mechanical problems with your joints.
Surgery for gout can help to reduce joint problems caused by tophi, including difficulty walking or nerve damage from tophi pressing against a nerve.
Tophi can erode through the skin, causing chronic ulcers that can become infected. These may require surgical removal.
Tophi removal is a relatively simple procedure. Your doctor will make a small incision on the skin over the tophi, remove the mass, and then suture the wound.
People with severe joint damage or bone loss around the joint may need additional joint replacement surgery.
Can You Die From Gout
Yes and no. The yes applies where having gout increases the risk of death from the chronic risk factors or health conditions that may develop. The no applies whereby, if you suffer from gout and keep it under control through medication, it can be treated, and you wont die from it. Gout will not directly kill you. However, it can lead to serious health problems that increase your risk of dying. Choosing to leave your gout untreated and not focusing on lowering the bloodstreams uric acid levels also raises your death risk.
Follow Up With Your Doctor As Directed:
You may be referred to a rheumatologist or podiatrist. Write down your questions so you remember to ask them during your visits.
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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Can Gout Be Prevented
The good news is that gout can be prevented. The goal of treatment is to lower uric acid levels to a level that prevents gout attacks. Your uric acid level can be checked with a blood test. For most people with gout, the target uric acid level you are aiming to achieve with treatment is:
Less than 0.36 millimoles per litre
For some people with more severe gout, the target uric acid level will be less than 0.30 millimoles per litre . Talk to your doctor about treatments that can help you reach your target uric acid level, including:
Medicines: There are medicines that can lower uric acid levels in your blood. These medicines need to be taken every day, whether you are having an attack or not.
Alcohol: Cut down the amount of alcohol you drink and avoid drinking a lot of alcohol at one time . Talk to your doctor or visit www.alcohol.gov.au for Australian Government guidelines on recommended alcohol intake.
Weight loss: If you are overweight, lose weight gradually. Make sure you have a healthy diet as crash or starvation diets can actually increase uric acid levels. See a dietitian for advice.
Purine-rich foods: See the Gout & Diet sheet for more information.
Untreated gout can cause permanent damage to the joints. Know your target uric acid level and learn ways to prevent gout attacks.
Download this information as a PDF document: Gout
For further information, contact our Arthritis Infoline on 1800 011 041
Causes Of Gout In The Knee
High uric acid levels in the blood can cause gout.
The body produces about 66% of uric acid naturally. Uric acid also forms when the body processes purines, which are organic compounds found in some protein-rich foods.
The kidneys usually help control the levels of uric acid by filtering it out of the blood.
This may occur if the kidneys do not filter out uric acid properly or if the body produces too much of it.
When a person develops hyperuricemia, excess uric acid may leave the bloodstream and form microscopic uric acid crystals in soft tissues or joints. These crystals may form around or in the joints because the temperature in these areas tends to be lower.
The immune system recognizes uric acid crystals as foreign particles, causing inflammation that looks and feels similar to that from an infection.
However, not everyone with high uric acid levels develops gout. Around 66% of people with hyperuricemia do not experience the condition.
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Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
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
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How Are Gout Attacks Treated
See your doctor as soon as you have an attack. With effective treatment the attack may be controlled within 1224 hours and treatment need not be continued after a few days. There are also things you can do to help relieve the pain:
- rest until your symptoms improve
- raise the inflamed joint and put an ice pack on it
- do not exercise during an acute attack
- take pain relief medicines, for example non-steroidal anti-inflammatory drugs such as naproxen or diclofenac can be very effective in reducing pain and inflammation. If you are unable to take NSAIDs, medication such as colchicine or prednisone can help reduce the pain of gout.
- to get the best results, take your NSAIDs as soon as possible at the first sign of an attack, and continue until the pain and swelling goes down.
Read more about medicines for gout
Can It Lead To Any Complications
If left unmanaged, gout-related inflammation can cause permanent damage to your knee joint, especially if you have frequent flare-ups.
Over time, lumps of uric acid crystals, called tophi, can also form around your knee. These lumps arent painful, but they can cause additional swelling and tenderness during a flare-up.
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When To Contact A Doctor
If people have a gout flare-up, they can contact a doctor to discuss optimal treatment options. Treatments that lower inflammation are most effective within 24 hours of a gout flare-up.
People need to contact a healthcare professional if they have any signs of gout complications. And if they have any symptoms of a cardiac event, such as stroke or heart attack, they will need immediate medical attention.
Gout Can Go Awayor Return Again And Again
Gout attacks almost always result in stabbing pain, redness, and swelling in a joint. In men, about 50% of first-time gout attacks involve a big toe joint.1 Other commonly affected joints include the instep, heel, ankle, and knee.2
See Gout Symptoms
After the first gout attack, the condition can affect people differently:
- Some people will go months or even years without having another gout attackor very rarely, they may never have another one again.
- Other people will begin to experience gout attacks regularly. Eventually, these flare-ups may become frequent and longer-lasting. Chronic gout can lead to permanent joint damage and result in disability. Thankfully, early and appropriate treatment of the underlying cause of gouthigh levels of uric acid in the bloodcan prevent joint damage.
Experts cant predict who will have a one-time attack versus chronic gout. If youve had an attack, its worth your time and effort to make changes that can help you avoid another painful flare-up.
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The Link Between Gout And Kidney Stones
Excess uric acid can build up in the blood and form painful, spiky crystals. This may happen if the body is making too much uric acid or if the kidneys are having a hard time filtering it out.
In people with gout, the joints are the most commonly affected part of the body.
These spiky, urate crystals may also cause a stone to form in the kidney or other parts of the urinary tract.
Kidney stones can get stuck in the urinary tract and cause severe pain in the side of the abdomen or back. They pass out of the body in urine.
Kidney stones caused by uric acid crystals occur in about 15 percent of people living with gout.
Uric acid gets excreted by the kidneys. Some medications aim at lowering uric acid levels by increasing the amount of uric acid excreted by the kidneys. These medications may increase the risk of kidney stones in some people.
Talk with your doctor if you are using a uric-acid-lowering drug and are developing kidney stones. Your doctor may opt to put you on a different medication.
How Is Gout Treated
The following can make your symptoms stop sooner, prevent attacks, and decrease your risk for joint damage:
- NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
- Gout medicine decreases joint pain and swelling. It may also be given to prevent new gout attacks.
- Steroids reduce inflammation and can help your joint stiffness and pain during gout attacks.
- Uric acid medicine may be given to reduce the amount of uric acid your body makes. Some medicines may help you pass more uric acid when you urinate.
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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:
- 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.
What Will Happen To Me
Without treatment, a gout attack usually lasts about one week. Another attack may not happen for months or even years. If gout is not managed well, the time between attacks may get shorter, the attacks more severe and the joints can be permanently damaged. Sometimes gout can progress into a chronic condition, causing:
- constant mild pain and inflammation of the affected joints
- tophi solid lumps of urate crystals, especially on the toes, ears, fingers, hands, forearms, knees and elbows
- kidney stones.
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The First Twinge Of Stiffness Or Dull Ache
Gout ankle starts with a twinge of pain or a dull ache. Then along with the pain, stiffness starts to set in these are the first signs of gout and the alarm to take action. These gout symptoms in the ankle will only quickly get worse if left unattended.
The reason that an attack grows slowly, is because more and more uric acid continues to crystallize. Taking measures to alkalize neutralize the acidity helps to dissolve the crystals that have already formed, but more importantly, helps to keep the uric acid in solution and keep it from crystallizing in the first place.
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Myth: Gout Pain Always Attacks The Big Toe
Truth: Gout occurs when uric acid builds up in the blood, forming crystals that lodge in and inflame joints. It’s true that gout often first attacks the joints of the big toe, but it can also occur in the knees, ankles, feet and hands. In women with osteoarthritis, for example, gout pain commonly starts in the small joints of the hands. Although the first attacks often involve only one or two joints, over time multiple joints become affected. If the disease isn’t treated, it can cause permanent damage.
Avoiding alcohol may reduce your chance of getting gout attacks.
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Help Prevent Gout Attacks:
- Do not eat high-purine foods. These foods include meats, seafood, asparagus, spinach, cauliflower, and some types of beans. Healthcare providers may tell you to eat more low-fat milk products, such as yogurt. Milk products may decrease your risk for gout attacks. Vitamin C and coffee may also help. Your healthcare provider or dietitian can help you create a meal plan.
- Drink liquids as directed. Liquids such as water help remove uric acid from your body. Ask how much liquid to drink each day and which liquids are best for you.
- Maintain a healthy weight. Weight loss may decrease the amount of uric acid in your body. Ask your healthcare provider what a healthy weight is for you. Ask him or her to help you create a weight loss plan if you are overweight.
- Control your blood sugar level if you have diabetes. Keep your blood sugar level in a normal range. This can help prevent gout attacks.
- Limit or do not drink alcohol as directed. Alcohol can trigger a gout attack. Alcohol also increases your risk for dehydration. Ask your healthcare provider if alcohol is safe for you.
More Severe Complications Of Gout
All of which I have mentioned by now are less-severe complications gout can cause. They are almost harmless and there wont be any more complications with the mentioned issues. But, I also know that there are more severe issues, which must be mentioned as well. Keep in mind that these complications may cause permanent damage to your body and they will have to be treated as soon as possible.
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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.
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Reach And Maintain A Healthy Weight
Tips for weight loss:
- Eat less fatty and high sugar foods.
- Small meals eaten at regular times are best avoid eating large meals or going for many hours without eating.
- Eat a sensible breakfast, every day .
- Remember to drink plenty of fluids, at least 8 glasses per day if possible.
- Avoid fizzy drinks .
- Regular exercise, such as a brisk walk for 30 minutes five times a week, will reduce your weight and have other good effects on your heart, blood pressure and blood sugar levels.
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How Can An Attack Of Gout Be Treated
The management of an acute attack of gout is very different from the prevention of subsequent attacks.
Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.
There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.
If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.
Table 2: Medications to treat acute attacks of gout