Why Do I Get Gout Attacks
Gout occurs when theres too much uric acid in your blood . The resulting crystals of uric acid build up inside and around joints like your big toe or fingers. These crystals cause an inflammatory reaction that leads to sudden attacks of intense pain and swelling called acute gout flares as well as long-term problems such as joint destruction .
How Is Gout Diagnosed
Gout is diagnosed using a number of tests including:
- medical history
- physical examination
- blood test to measure urate levels although this cannot confirm gout
- removing a sample of fluid from the joint if you have gout, uric acid crystals can be seen under a microscope. This is the most definitive test
- ultrasound scan can identify early crystal formation in the fluid between your joints.
Early diagnosis and treatment is very important. The main goal for everyday management of gout is to reduce the level of uric acid in your blood so it cant form crystals in the tissues or joints and cause joint damage.
How Can I Self
The methods of managing an acute attack of gout differ from the ongoing methods for managing gout. If youve been diagnosed with gout, youll benefit in the long term from making healthy changes to your lifestyle, such as:
- maintaining a healthy body weight. If you do need to lose weight, make sure your weight loss is gradual as crash diets can increase uric acid levels
- drinking alcohol in moderation and avoiding binge drinking
- drinking plenty of water, and staying hydrated
- avoiding, or eating in moderation, foods that are high in purines. Talk with a dietitian for tips and advice
- exercising regularly aim to complete at least 30 minutes of physical activity most days of the week
- working closely with your GP to prevent further attacks and actively manage your condition.
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Is There A Test For Gout
There is no one test for gout, and its symptoms are similar to several different conditions. To see if you have gout, your health care provider may:
- Ask you to provide your medical history, including:
- Your symptoms.
- Any other medical problems you have.
- Any medications you are taking.
Treatments For Gout On The Foot
Pro Tip
Because the symptoms of gout and joint infection can be very similar, get medical attention if you experience severe joint pain, redness, swelling, and stiffness. Depending on your symptoms, your provider may draw fluid off of the affected joint to confirm the diagnosis and rule out an infection. Dr. Schwartz
If you suddenly feel pain, redness, swelling, and stiffness in a joint, see your doctor. A gout attack can look similar to an infection inside the joint. But that needs urgent treatment. So getting proper diagnosis is important.
The doctor may diagnose you based on your symptoms, but they may also use a needle to draw fluid from the joint. This is sent for analysis to confirm the diagnosis.
Then, gout is treated with a combination of medications and other procedures, depending on how severe it is.
The pain usually gets better in 4 to 12 hours. But the swelling and discomfort might stay around for a few days to a few weeks. If it still hurts after taking medication or getting injections, call your doctor.
Your doctor might also order lab work if you start a new medication to treat your gout. People who get frequent flare-ups might need X-rays to look at the damage in their joints.
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The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
Risk Factors For Gout
Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, diabetes, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels in patients with gout.
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How Do I Know If I Have Gout
The symptoms and signs of gout are usually acute, they appear suddenly without warning. A lot of the time the attack will occur at night. There are many symptoms of gout:
- Sharp, severe pain in the joints: This pain can be experienced in the hands, wrists, ankles, knees or feet. The big toe is most commonly affected. Sometimes patients describe the area as being warm or hot. Inflammation can also occur.
- Gradual decrease in pain: This type of arthritis can last for over a week if its untreated, then usually goes away within the next week or two.
- Peeling, itchy skin: As gout gradually subsides, the skin near the affected area may begin to itch and peel.
- Inflammation and redness: Gout usually causes tender, swollen and red joints in the area thats experiencing the most pain.
- Purplish or red colored skin: This may cause the patient to think he or she has an infection.
- Fever: In some cases, gout can cause body temperature to elevate.
- Decrease in flexibility: The joint affected could feel harder to use, or have limited movement.
How To Treat Gout In The Ankle
The following are various remedies for gout in the ankle. By addressing gout in ankle symptoms before they get out of control, it can help mitigate pain and swelling. It is recommended to speak to your doctor about particular distressing pain caused by gout as they can provide better-tailored gout ankle treatment.
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How Do You Get Gout
There are a few risk factors that increase your chances of getting gout or of triggering a gout attack. They include:
- Diet high in purines, including red meat, organ meats, and seafood
- Drinking a lot of sugary beverages
- Alcohol consumption
- Medical issues such as high blood pressure, kidney disease, and diabetes
- Medications diuretics and low-dose aspirin
- Family history of gout
- A recent surgery or injury
Pro Tip
One of the first places gout attacks is the great toealthough it can be just about any joint. Certain foods like red meat, seafood, sugary beverages, and even beer can help set it off. Gout attacks can become chronic and lead to destruction of the joint, so its important to avoid risk factors and manage attacks as they occur. Dr. Schwartz
Gout Frequently Flares In Your Knee But You May Not Always Know That Your Knee Pain Is Due To Gout Heres How To Tell Since Prompt Treatment Can Reduce Your Risk Of Complications
Knee pain can be a common symptom of several types of arthritis, as well as many other conditions or injuries. If your knee stiffness is accompanied by a burning pain and is warm to touch, you may have a gout flare in the knee.
Though gout is most often associated with the big toe, gout tends to flare in areas that already have arthritis, says Robert Keenan, MD, a rheumatologist with Articularis Healthcare in Summerville, South Carolina. Although gout can strike in many different joints, as a general rule, gout works its way up the body. If its not treated, it works its way up from the big toe, through the ankle, to the knee, and then to the lower spine and so on.
Gout can affect both knees, but typically is felt more strongly in one knee say, where you may have arthritis wear-and-tear to begin with.
Learn more about what causes gout in the knee, as well as ways to treat the pain and prevent it in the future.
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Risk Factors And Potential Causes Of Gout
Gout strikes men more often than women until women undergo menopause, and then women experience increased risk. Being overweight or obese, having recent surgery, and experiencing a trauma also increase your risk, as well as your family history.
Your body produces uric acid when it breaks down purines a substance found naturally in your body, and also in high-protein red meat, organ meat, and certain types of seafood. In addition, alcoholic drinks, beer, and beverages sweetened with fructose can raise your natural uric acid levels. When your body either creates too much uric acid or excretes too little, it can lead to gout. Hundreds of years ago, gout was called the disease of kings because the average peasant couldnt afford such rich food and drink.
Medical conditions like untreated high blood pressure, diabetes, heart disease, and kidney disease can also increase your chances of developing gout, as does taking certain medications, such as thiazide diuretics and low-dose aspirin.
What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
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How Is Pseudogout Treated
The type of pseudogout treatment depends on several factors, including your age, other medications youâre taking, your overall health, your medical history, and how severe the attacks are. Drugs to treat pseudogout include:
- Anti-inflammatory painkiller drugs, also calledNSAIDs, generally are prescribed to treat sudden and severe pseudogout attacks. NSAIDs — like ibuprofen and naproxen — usually reduce inflammation and pain within hours.
- Corticosteroids may be prescribed if you canât take NSAIDs. Steroids also work by decreasing inflammation. They can be injected into the affected joint or given as pills.
- Colchicine, a gout drug, is sometimes used in low doses for a longer period of time to reduce the risk of repeated attacks of pseudogout.
Anti-inflammatory medications are usually continued until the pseudogout attack goes away. Symptoms are often better within 24 hours after treatment begins.
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What Does The Future Hold For Gout
Active research is ongoing in a variety of fields related to gout and hyperuricemia. Scientists have found that high animal protein slightly increased the risk for gout. New drugs are being developed that may be more versatile and safe in treating the elevated uric acid levels in patients with chronic gout.
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The Pathology Of Gout
Gout is primarily a metabolic disorder in which uric acid accumulates in blood and tissues. When tissue levels reach saturation, needle-like crystals form, causing inflammation. This occurs most commonly in the cooler joints, notably the metatarsophalangeal joint of the big toe.
Many people with hyperuricemia never develop gout, but those with the highest levels are most likely to suffer episodes. Hyperuricemia may also lead to kidney stones.
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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Lifestyle Changes To Help Foot Gout
Treating foot gout in the long-term requires a combination of lifestyle changes and medications. After you have taken the right medication to treat your gout flare and manage uric acid levels, you should be taking steps to correct your lifestyle. Theres only so much pills can do so its important to accompany it with habits that support your condition.
Start with your weight. You probably have gout because you are overweight or obese. You want to lose the excess fat since that contributes to the strain you feel on your feet. Exercising regularly and cutting back on food intake can significantly help with your goal of losing weight.
Only go for real whole foods and avoid items that trigger your gout such as processed foods. I recommend the 80-10-10 diet where 80 percent of your daily calories consists of complex carbohydrates, 10 percent as protein and the final 10 percent as fat.
Its important that you learn how your body reacts to each food item as every person has a different physiology. What may trigger an attack on you may do nothing for the other person. Start by eliminating common culprits such as sugar, alcohol, seafood, and organ meats.
You may need to keep a diary to track your food and medication. That way whenever you have a gout attack in your foot, you can trace back what you ate and learn what caused the trigger.
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Gout Attack Vs Chronic Gout
It is possible to have a gout flare-up and never experience another. Repeated instances of acute gout are called chronic gout17.
The treatment goals for a gout attack are different than those for chronic gout. When treating a gout attack, the goal is to relieve pain and inflammation. When treating chronic gout, the goal is to prevent future gout attacks and long-term joint damage.
While some people with chronic gout may get frequent gout attacks, others may have years in between attacks. If chronic gout is not treated, attacks may become more frequent and/or last longer.
Left untreated, a gout attack will usually resolve itself within a few days or weeks. Chronic gout can permanently damage a joints tissues and decrease its range of motion. For this reason, it is important to recognize symptoms, understand risk factors, get an accurate diagnosis, and treat and prevent gout.
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The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. For more articles go to the Medical Library index page.
Causes And Risk Factors
Gout occurs due to an excess buildup of uric acid, or hyperuricemia.
According to the National Institutes of Health , hyperuricemia is the main risk factor for developing gout. However, a quarter of those with hyperuricemia do not develop gout.
When the body breaks down purines, it produces uric acid. Typically, the kidneys remove a certain amount of uric acid in the urine. However, when they are unable to remove enough uric acid, uric acid crystals can form in the joints and soft tissues, causing swelling and pain.
Gout typically affects males more than females. However, females have higher levels of uric acid after menopause. NIAMS state that being older also the chance of developing gout.
Genetics can also increase the chance of developing gout.
According to the CDC , other factors that may increase the likelihood of gout include:
- Diet: Food can play a role in the development of gout symptoms. Eating seafood, red meat, and drinking alcohol raises uric acid levels in the body.
- Weight: Having overweight increases the chance of developing gout.
- Medications: Certain medications, including diuretics and low-dose aspirin, are associated with gout risk because they increase the level of uric acid in the body.
- Other medical conditions:High blood pressure, diabetes, and kidney disease can increase gout risk.
According to the National Health Service in the United Kingdom, some people with gout may develop complications, such as:
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