Effective Medical Treatment For Gout
The American College of Rheumatology released gout management guidelines in 2012 and updated them in 2020. They recommend drugs classified as urate-lowering therapy for those who have experienced two or more gout attacks in a year as well as for those with joint damage from gout.
Specifically, the organization recommends allopurinol as a first-line treatment for all gout patients, even those with chronic kidney disease. Next in line is febuxostat both are a class of drugs called xanthine oxidase inhibitors.
In addition, the guidelines recommend use of anti-inflammatory medications including NSAIDs, prednisone, or colchicine along with the other medication.
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.
Pain That Wakes You Up
More often than not, gout flare-ups happen in the middle of the night, interrupting a peaceful slumber with intense pain.
“It’s true, gout attacks are more common overnight,” Dr. Seligman says. But exactly why is a bit of mystery.
One theory: “It has been postulated that this relates to cooler body temperature at night,” she says.
The foot is cooler because it is the farthest body part away from the heart.
At cooler temperatures, uric acid turns into crystals and could settle into a cool spot like the foot and ankle.
Other theories center on sleep disorders that cause less oxygen in the blood, such as sleep apnea.
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Build Muscle With Strength Exercises
Having strong muscles can protect your joint from wear and tear, especially for joints affected by gout. Beyond weight training, simple resistance exercises can be effective to build muscle. For example, try an elastic resistance band by holding each end and putting your foot in the middle, then repeat your flexibility exercises while pushing against the force of the band.
The key with any exercise after a gout flare is to go slow and listen to your body, Dr. Iversen stresses.
Does The Location Of The Gout Attack Affect Treatment
No matter the location of gout attacks, the treatment is the samelower uric acid levels so gout crystals disappear and tophi dissolve. Your doctor can test your urine and blood to determine your current levels. Normal uric acid levels typically range between 3.5 and 7.2 mg in men and between 2.6 and 6.0 mg in premenopausal women.
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Pain And Swelling Are Gouts Calling Cards
The most frequent signs of a gout attack are swelling, tenderness, redness, and a sharp pain in your big toe. These attacks are most common at night when you are sitting still and laying flat on your back. While gout usually manifests in the big toe, you may also experience gout attacks in your foot, ankle, or knees. The attacks can be short or long, anywhere from a few days to weeks and you may not have another attack may for months or years.
Gout In Your Big Toe: Practical Steps To Relieve The Pain
Nov 13, 2017 | General |
Imagine suddenly waking up in the middle of the night with excruciating pain in your big toe. Youd find it difficult to walk, and even the gentle pressure of a duvet resting on the affected foot would be agonising. It sounds like a nightmare, doesnt it? Sadly, this scary situation is a reality for many people who suffer from a type of arthritis known as gout. Thats why its crucial to understand what causes the problem, as well as how to manage and prevent it.
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Medications For Acute Gout
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.
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Gout May Be Your Second Arthritis
Did you know that it is possible to have more than one form of arthritis? Get more information about gout, the inflammatory condition that can occur with osteoarthritis, rheumatoid arthritis and psoriatic arthritis.
It is possible to have more than one type of arthritis, and knowing what you have can help in treating your symptoms.Gout, which can occur with OA, rheumatoid arthritis and psoriatic arthritis , results when uric acid crystals are deposited in joint tissue. It causes sudden, severe pain, swelling and tenderness, usually in the big toe, but it also can occur in the feet, ankles, hands, knees, wrists, elbows or other joints. Its typically in only one joint, but chronic gout can affect multiple joints. Differentiating between gout and other forms of arthritis is critical because the treatments are very different. If you think you have gout, see your doctor. The sooner its treated, the sooner youll get pain relief.
How Gout may Affect Other Arthritis Conditions
Gout and RA
For decades, rheumatoid arthritis and gout were thought to be mutually exclusive. But some people with RA also get gout as both conditions share obesity as a common risk factor and may cause kidney problems. Diagnostic tools like synovial fluid analysis and dual-energy CT scans are especially helpful in making the correct diagnosis.
Gout and OA
Gout and PsA
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Choose The Right Footwear
Because gout often affects the big toe, midfoot, and ankle, choosing good footwear is important. Dr. Iversen says a physical therapist can help evaluate the best footwear for a patient with gout based on evidence that shows specialized footwear provides benefits for patients by changing the alignment of the leg and foot, influencing the activity of the muscles of the foot, and your gait pattern . These modifications are designed to decrease the pressure on your joints.
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Why Choose University Foot And Ankle Institute For Your Foot And Ankle Care
If you are experiencing any type of foot, toe, or ankle problems, were always here to help. At UFAI, our mission is to provide the best available treatment techniques. We want our patients to be pain-free and back to their daily activities as soon as possible.
Our nationally recognized, board-certified Doctors of Podiatric Medicine and foot and ankle surgeons offer the most advanced care and the highest success rates in the nation. We are leaders in the research and treatment of all foot and ankle conditions.
For more information, or to schedule a consultation, please call 736-6001 or make an appointment online now.
At UFAI, we take our patients safety seriously. Our clinics and surgery centers Covid-19 patient safety procedures exceed all CDC recommendations during this coronavirus pandemic. Masks are required in our institutes at all times.
We are conveniently located throughout Southern California and the Los Angeles area. Our doctors are available at locations in or near: Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California.
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.
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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:
What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achilles’ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
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Lessen Your Risk Of Early Death
On average, having gout raises a persons risk of dying earlier than a similar person without gout by 25 percent. To lessen that risk, gout patients need to work with their doctor to lower uric acid levels to the target of < 6 mg/dl and keep it there throughout life, Dr. Edwards says. In addition, people with gout need to control medical conditions that go along with gout , such as hypertension, heart disease and kidney disease.
So if you have gout, heres what you need to do to ensure you live the longest, healthiest life you can:
- Take your gout medications and other medications as directed
- Get screened and treated for comorbid conditions
Soothing Your Foot When Gout Strikes
If a gout attack makes your big toe hurt, there are several things you can do to make your foot more comfortable, in addition to taking your gout medication.
- Avoid wearing shoes, slippers and restrictive hosiery. You could even cut off the top of a sock to avoid putting your big toe under pressure.
- Wrap an ice pack in a towel and apply it to your big toe for short periods. Doing so should soothe the area and reduce the swelling.
- When you lie down, elevate your foot with the aid of cushions or pillows, so that its slightly higher than your chest, as this can also keep the swelling at bay.
- Leave your foot uncovered overnight.
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How Does A Doctor Diagnose Ankle Gout
Whether gout is in the ankle joint, foot, or hand, it is diagnosed with a combination of medical history, symptoms, and physical exam.
“A doctor might an order an X-ray to look for fracture or other injury,” says Dr. Siaton. “In someone with untreated, long-standing gout, certain findings, such as bone erosion, can be seen on the X-ray.”
Doctors can order a blood test to check for elevated uric acid levels, but they probably won’t do the test during a flare-up.
“It is not as helpful to check uric acid during a flare, as it is lower when the uric acid deposits in a joint during a flare,” Dr. Seligman.
Occasionally, fluid is drawn from a needle from the ankle joint to identify urate crystals.
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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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
Reduce The Pressure Reduce The Pain
Gout cant be cured, but it can be managed effectively and ensuring that your feet receive expert care plays an important part in that process.
Our London podiatrists can help to relieve the pain caused by gout in your big toe with prescription orthotics. These custom-made shoe inserts are designed to make the affected area more comfortable by reducing the pressure its under. Whats more, we can offer expert advice on which shoes youll find most comfortable.
Podiatric padding and foot shields can be beneficial when gout strikes. In addition, if the swelling has led to sores, ulcers, calluses, etc., we can treat those issues too.
For expert help to relieve the foot pain caused by gout, please call Feet By Pody today on 0207 099 6657 or book a podiatry appointment online.
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How Gout Affects Your Feet
Whilst Gout is not specifically a condition of the feet, it often affects toes and can cause associated foot problems which need additional treatment from a Podiatrist. Simply put, Gout is a form of inflammatory arthritis caused by too much uric acid in the bloodstream. This doesnt always lead to an attack, but if uric acid crystals form in or around a joint the pain can be excruciating. Gout is often regarded as a problem caused by rich living but this is not always the case poor diet, lack of exercise and dehydration can also play a role.
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
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