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.
Can Pseudogout Be Prevented Or Avoided
Treatment can relieve the symptoms of pseudogout and slow or prevent damage to your joints. Unfortunately, no treatment can get rid of the crystal deposits that cause pseudogout. Taking low doses of colchicine may help to reduce your risk of future attacks. Your doctor can talk to you about the risks and benefits of taking this medicine.
If another condition, such as a thyroid problem, caused your pseudogout, treating that condition may help to make the symptoms of pseudogout less severe. It may also make flare-ups less frequent.
How To Treat Gout Without Drugs
Gout is an acute form of arthritis usually affecting heels, ankles, wrists or elbows but it mainly targets the big toe with severe unbearable pain, swelling and soreness of joints. It may also affect the spine strongly enough to cause back pain. Gout attacks are normally sudden and occur at night or leisure times and lasting from 5-10 days. The pain, once gone, does not mean that it is not going to come back, it may reoccur at any time.
The main cause of gout is the excessive accumulation of uric acid crystals in the tissues especially joint tissues due to high levels of uric acid circulation in the blood. Thus causing loss of mobility during the period the pain lasts for.
Gout can be diagnosed by physical examination of the patient and going through his medical history like the symptoms of the disease or any other relevant or required information. But this is not sufficient enough to confirm the indication of gout rather the doctors need to take certain tests of the blood sample or more appropriately the fluid samples from the joints and test whether the urate crystals are there or not.
Alcohol has a direct linkage with the gout, not all types of alcohol, only those with purine like beer, contribute to rising levels of uric acid in the blood, it is therefore suggested to minimize the use of alcohol or only drink it in moderation is imperative to control uric acid levels in the body and cure gout.
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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.
Why Do Gout Attacks Happen More At Night
Gout attacks happen more at night and in the early morning rather than during the day. You may have an attack start during your sleep. The reasons this happens are not entirely known, but some of the leading ideas are dehydration, lower body temperature, and changes in hormone levels during sleep. Talk to your doctor about ways to prevent gout attacks during your sleep.
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Can It Lead To Any Complications
If left unmanaged, gout-related inflammation can cause permanent damage to your ankle joint, especially if you have frequent flare-ups.
Over time, lumps of uric acid crystals, called tophi, can also form around your ankle. These lumps arent painful, but they can cause additional swelling and tenderness during a flare-up.
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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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.
Myth: Women Aren’t Afflicted By Gout
Truth: Men and women alike can develop the disease, although men are more vulnerable earlier in life. “Gout is 10 times more common in men than in women, until women reach menopause. The incidence of new cases of gout in men and women tends to equal out after age 60 or so,” says Herbert Baraf, M.D., clinical professor of medicine at George Washington University Medical Center in Washington, D.C.
Throbbing pain on the tip of your big toe? You might have gout.
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How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
Pain Comes On Suddenly And Fiercely
Usually, when pain comes on suddenly, it’s something you can tracklike twisting your ankle or tripping. But there’s no rhyme or reason with gout.
You may feel perfectly healthy, and out of nowhere, gout strikes. “The symptoms usually come on fairly abruptly and worsen very quickly,” says Dr. Siaton.
The worst pain usually occurs within the first 24 hours. As mentioned, NSAIDs can relieve pain, but they are usually more effective if taken as soon as the pain hits.
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What Does Gout Look Like
Gout pain is the most common and noticeable symptom of gout.
Many, but not all, people experience their first gout attack or flare-up in their big toe. The pain often starts during the night and comes on suddenly.
The type of pain you feel with gout may vary depending on whether youre experiencing an acute gout episode or a flare-up of chronic gout.
Dont Confuse Pseudogout For Gout Theyre Not The Same
Have you ever heard of calcium pyrophosphate ? Unless youre having a specific type of joint pain, were guessing not.
Calcium pyrophosphate is a normal chemical in the body that helps your bones and joints function.
But in some people, the substance builds up into crystals in the cartilage, the connective tissue in your joints, over time and with age. As those crystals accumulate and make their way into the joint fluid, they can irritate or damage the joints, leading to an arthritis known by different names: calcium pyrophosphate dihydrate deposition disease , acute CPP crystal arthritis, or pseudogout.
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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.
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.
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How Will Gout Affect Me
Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.
Without medication attacks tend to happen more often and other joints can become affected.
Having high urate levels and gout for a long time can lead to other health problems, including:
- narrowing of the arteries – which can lead to an increased risk of stroke or heart attacks or other heart problems
- osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
- an increased risk of developing kidney disease or worsening of the condition if you already have it
- kidney stones
- an increased risk of some cancers, especially prostate cancer
- mental health problems, including depression
- underactive thyroid
- erectile dysfunction in men.
If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.
Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:
- treating the acute attack
- treatments to prevent future attacks.
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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Diagnosis Of Pseudogout Vs Gout
Youll need a physical exam to help diagnose gout and pseudogout. Your doctor will also look at your medical history. Tell your doctor about any symptoms you have and when you have them.
A blood test can show if you have high levels of uric acid in your body. This may mean that you have gout.
You may also have other blood tests to diagnose pseudogout or gout. Blood tests also help to rule out other conditions that cause joint pain. Your doctor might check:
- blood mineral levels, such as calcium, phosphorus, magnesium, phosphatase
- blood iron levels
- thyroid hormone levels
If you have any type of joint pain, your doctor will likely send you for an X-ray. You may also have an ultrasound or CT scan. Scans may show damage in the joints and help to find out the cause.
An X-ray may also show crystals in the joint, but not what kind of crystals. Sometimes, pseudogout crystals may be mistaken for gout crystals.
Joint fluid may be taken from an affected joint. This involves using a long needle. Your doctor may numb the area with a cream or injection first. The fluid is sent to a lab to check for any sign of an infection.
One way doctors can tell if you have gout or pseudogout is to look at the crystals. Crystals are removed from the joint fluid. Then, crystals are examined with a polarized microscope.
Gout crystals are needle-shaped. Pseudogout crystals are rectangular and look like tiny bricks.
Whats The Outlook For People With Gout
Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.
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What Are The Signs And Symptoms Of Gout
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remissionweeks, months, or yearswithout symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Symptoms in the affected joint may include:
- Pain, usually intense
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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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.