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
- dehydration
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine
Colchicine isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
Steroids
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.
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What Foods Should You Avoid
If youre susceptible to sudden gout attacks, avoid the main culprits high-purine foods.
These are foods that contain more than 200 mg of purines per 3.5 ounces .
You should also avoid high-fructose foods, as well as moderately-high-purine foods, which contain 150200 mg of purines per 3.5 ounces. These may trigger a gout attack.
Here are a few major high-purine foods, moderately-high-purine foods and high-fructose foods to avoid (6,
- meats: These include liver, kidneys, sweetbreads and brain
- meats: Examples include pheasant, veal and venison
- Fish: Herring, trout, mackerel, tuna, sardines, anchovies, haddock and more
- seafood: Scallops, crab, shrimp and roe
- Sugary beverages: Especially fruit juices and sugary sodas
- Added sugars: Honey, agave nectar and high-fructose corn syrup
- Yeasts: Nutritional yeast, brewers yeast and other yeast supplements
Additionally, refined carbs like white bread, cakes and cookies should be avoided. Although they are not high in purines or fructose, they are low in nutrients and may raise your uric acid levels (
Summary: If you have gout, you should avoid foods like organ meats, game meats, fish and seafood, sugary beverages, refined carbs, added sugars and yeast.
Take Advantage Of Telehealth
Most primary care doctors and rheumatologists are offering telehealth visits as an alternative to in-person visits and theyre encouraging patients to reach out with any questions and concerns between visits, too. Its important to see your rheumatologist every three to six months and get regular lab work to monitor your disease and your medications, says Dr. Jasvinder Singh.
Not sure how remote care works? The American College of Rheumatology put together some guidance for patients on how to navigate telehealth and you can read more here about how some practices are implementing telehealth.
Read how to make your telehealth visit as successful as possible.
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Gout Attacks Can Cause Severe Joint Pain
Acute gout usually involves a single joint, and acute gout symptoms typically go away within a few days. People with acute gout may not experience another attack for several months, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Recurrent attacks of gout can lead to chronic gout. This is sometimes called recurrent gout or gouty arthritis. Chronic gout may involve more than one joint.
What Are Tophi And What Causes Them
Tophi occur when the persons blood uric acid level remains high over a long period of time. The uric acid deposits in joints and forms precipitates. These precipitates can become quite large, resulting in bumps and swellings on the joints. These swellings can occur on the knee, the elbow, the big toe, and many other joints. They can be quite painful. Sometimes they open up and leak white, chalky material that is composed of uric acid.
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Time To Call The Doctor
A gout attack will usually go away in about 3 to 10 days. But you can feel better sooner if you treat it. To be sure that you have gout, see your doctor. Theyâll examine you, and they might do some tests.
These test help your doctor know if you have gout, or something else with similar symptoms:
- Joint fluid test. Fluid is taken from the painful joint with a needle. The fluid is studied under a microscope to see if the crystals are there.
- Blood test. A blood test can check the level of uric acid. A high level of uric acid doesnât always mean gout.
- X-ray. Images of the joints will help rule out other problems.
- Ultrasound. This painless test uses sound waves to look for areas of uric acid deposits.
Getting Tested For Gout
Gout testing is ordered by a doctor or specialist when there are signs or symptoms consistent with gout. Gout testing may be performed during a flare of gout or based on a patients history of symptoms similar to gout.
A sample of synovial fluid can be obtained in a doctors office through a procedure called a joint aspiration or arthrocentesis. During a joint aspiration, a doctor uses a needle to withdraw a small sample of synovial fluid from the joint for analysis. If additional tests are needed to rule out other conditions, a blood sample can be drawn in a doctors office or other medical setting.
In some cases, uric acid testing may require a 24-hour urine sample. A 24-hour urine test requires that patients collect all of their urine produced over a 24-hour period.
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How Is Gout Treated
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.
Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions
The search strategy was designed by the Southern California Evidence-based Practice Center reference librarian in collaboration with our local content expert, who has participated in two systematic reviews on gout , the search strategy appears in . As recommended by the AHRQ EPC Methods Guide for Medical Test Reviews, the searches were conducted without filters specific for diagnostic tests instead we used the terms gout combined with the terms for the diagnostic tests. We searched PubMed , EMBASE , the Cochrane Library , and the Web of Science these dates were selected to replicate the searches conducted as the basis for the 2006 EULAR Guidelines on Diagnosis and Management of Gout. We also included any relevant studies identified in the searches we conducted for a simultaneous review on management of gout if not already identified in the searches for this review. Finally, we asked the TEP to assess our list of included studies and to provide references for any studies they believe should also be included.
An update search was conducted on 11/07/14 after submission of the draft report for peer review.
We transferred the output of the literature searches to DistillerSR for screening. Article titles and abstracts identified by the searches were independently screened by two literature reviewers using the predetermined inclusion and exclusion criteria, and those selected by either reviewer were accepted without reconciliation for further, full-text review.
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How Do I Get Ready For The Test
Typically, you donât need to do anything special. In some cases, your doctor may tell you not to eat or drink anything for 4 or more hours before the test. Your doctor will also let you know if you need to stop taking any medicines.
Make sure to tell your doctor about any medicines, herbs, and supplements you take, including over-the-counter, prescription, and illegal drugs. Any of these, including medications that make you pee more often , vitamin B-3, and aspirin, can affect your results.
Do Not Stop Taking Medications On Your Own
Heres what our experts have to say about common medications used to treat gout:
If you are otherwise healthy, you should not stop taking your gout medications. And, like always, treat gout flares quickly, says Dr. Fields. Its like a book of matches if the whole book is lit, its hard to put it out. One match is easier to put out, so start treatment early.
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Underexcretion Of Uric Acid
About two thirds to three fourths of all uric acid produced daily is excreted by the kidneys. The gastrointestinal tract eliminates the other one third to one fourth. Under normal conditions, uric acid is filtered in the glomeruli of the kidney, reabsorbed in the proximal tubule and secreted distally. Tubular secretion is almost entirely responsible for the excretion of uric acid. Renal management of uric acid is defective in approximately 98 percent of patients with primary hyperuricemia and gout.4
Other Diagnostic Options For Gout
Testing synovial fluid is the standard for diagnosing gout, but another option for getting a gout diagnosis is through a blood test. Your doctor would get a sample of blood to have the levels of creatinine and uric acid tested. While a viable alternative to joint fluid collection, this option does have its downsides. Some people can have high levels of uric acid but not enough to experience gout. At the same time, people with physical signs of gout may not have high levels of uric acid in their blood. In some academic centers with appropriate expertise, ultrasonography of the joint with guided aspiration may help to diagnose a dual-energy CT scan of the affected joint is also available in some centers to diagnose gout.
Some physicians may use other methods based on criteria developed by the American College of Rheumatology and adopted by the American Academy of Family Physicians.
For instance, doctors are likely to diagnose gout if you have six or more of the following symptoms:
- lopsided joint swelling on an x-ray
- blood test showing high uric acid levels
- joint fluid culture negative for organisms during a gout attack
- maximum joint inflammation developed within a day
- arthritis in only one joint
- more than one attack of acute arthritis
- painful/swollen first big toe joint
- redness over joints
- x-rays that identify subcortical cysts without erosions
- tophi
- a gout-like attack of on both big toe joints at the same time
- a gout-like attack on both ankle joints at the same time.
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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.
Prevention Of Recurrent Attacks
Hyperuricemic therapy should be initiated in patients with frequent gout attacks, tophi or urate nephropathy. A low dosage of an NSAID or colchicine is effective in preventing acute gouty attacks. Hyperuricemic drug therapy should not be started until an acute attack of gouty arthritis has ended, because of the risk of increased mobilization of uric acid stores. A reasonable goal is to reduce the serum uric acid concentration to less than 6 mg per dL .
Uricosuric Drugs. These agents decrease the serum uric acid level by increasing renal excretion. Probenecid and sulfinpyrazone are used in patients who are considered underexcretors of uric acid. Uricosuric drugs should not be given to patients with a urine output of less than 1 mL per minute, a creatinine clearance of less than 50 mL per minute or a history of renal calculi. The physiologic decline in renal function that occurs with aging frequently limits the use of uricosuric agents.
Probenecid, in a dosage of 1 to 2 g per day, achieves satisfactory control in 60 to 85 percent of patients.23 It is important to note that the drug also blocks the tubular secretion of other organic acids. This may result in increased plasma concentrations of penicillins, cephalosporins, sulfonamides and indomethacin.
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Who Should Get Testing
Gout testing may be recommended for patients experiencing symptoms of gout or with a history of suspected gout flares. Indications for gout testing include:
- Joint pain, swelling, and skin redness in one or multiple joints
- Severe pain in the joint at the base of the big toe
- Recurrent inflammation in the inner arch of the foot
- Previous symptomatic attacks that began quickly and resolved on their own
Accurately diagnosing gout is important to ensure appropriate treatment. Symptoms caused by gout are similar to symptoms of other inflammatory conditions, making it important to work with a medical team that specializes in diagnosing and treating gout. Patients concerned about gout may find it helpful to discuss gout testing with a doctor called a rheumatologist, who specializes in diseases of the joints, muscles, and bones.
Testing is also performed in patients who have been diagnosed with and are receiving treatment for gout in order to manage the disease as effectively as possible.
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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How Effective Are The Medications
Allopurinol and febuxostat are very effective at reducing uric acid levels. Studies on these medications showed that most participants were able to lower their uric acid levels to under 387 µmol/L .
Most experts believe that taking these medications can successfully prevent complications of gout. That wasn’t tested enough in the studies, though. So it’s not possible to say exactly what people with gout can expect from long-term treatment with these medications for instance, how many gout attacks can be avoided or how well the treatments can prevent joint damage.
What Are The Possible Side Effects
Rashes are a possible side effect of allopurinol, occurring in an estimated 1 out of 100 people. Most of these rashes are mild and don’t have any serious consequences. But in rare cases, a rash may be a sign of a hypersensitive reaction to allopurinol. That can lead to serious complications. People who have chronic kidney disease are especially at risk. So if they suddenly feel ill, develop a fever, cold-like symptoms or a rash, it’s important to seek medical attention quickly.
There’s not much good research on the side effects of febuxostat. The possible side effects include nausea and joint pain. Rashes and serious hypersensitivity reactions are also possible during treatment with febuxostat. Febuxostat is associated with a higher risk of cardiovascular disease than allopurinol is.
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