Friday, September 30, 2022

Complications Of Gout In Elderly

How Is Pseudogout Treated

Gout | ED more common in men with gout

There is no cure for removing the calcium deposits that cause pseudogout. It is a progressive disorder that can eventually destroy joints. Treatments for acute attacks of pseudogout are similar to those for gout and are aimed at relieving the pain and inflammation and reducing the frequency of attacks.

  • Nonsteroidal anti-inflammatory drugs are effective for treating inflammation and pain from pseudogout.
  • For acute attacks in large joints, fluid aspiration alone or with corticosteroids may help.
  • Colchicine may be used for acute attacks.
  • Magnesium carbonate may help dissolve crystals, but existing hard deposits may remain.
  • Surgery may be required for joint replacement.

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.

  • Talk to your doctor. You can play an active role in controlling your arthritis by attending regular appointments with your health care provider and following your recommended treatment plan. This is especially important if you also have other chronic conditions, like diabetes or heart disease.
  • Lose weight. For people who are overweight or obese, losing weight reduces pressure on joints, particularly weight bearing joints like the hips and knees. Reaching or maintaining a healthy weight can relieve pain, improve function, and slow the progression of arthritis.
  • Protect your joints. Joint injuries can cause or worsen arthritis. Choose activities that are easy on the joints like walking, bicycling, and swimming. These low-impact activities have a low risk of injury and do not twist or put too much stress on the joints. Learn more about how to exercise safely with arthritis.
  • Southern Cross Medical Library

    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.

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    When Should You Call Your Doctor

    if you have:

    • Severe pain in a single joint that comes on very quickly.
    • Swollen, tender joints with warm, red skin over them.

    It’s important to see your doctor even if the pain from gout has stopped. The uric acid buildup that caused your gout attack may still be irritating your joints and could eventually cause serious damage. Your doctor can prescribe medicines that can prevent and even reverse the uric acid buildup.

    Newer Agents Under Study

    Chronic tophaceous gout involving fingers and toes

    Recombinant forms of uricase catalyzes the oxidation of uric acid to soluble allantoin, decreasing the SUA. Rasburicase has a short half-life requiring repeated intravenous administration. Common side effects include allergic and anaphylactic reactions. Pegloticase is approved for treatment in chronic gout, not responding to conventional treatment. This is less antigenic and has a longer half-life than rasburicase. Common side effects include acute gout flares, infusion-related reactions, and antibody formation. Because antibody formation is associated with diminishing response to treatment and worsening infusion reactions, it is recommended that the SUA is monitored and infusions only proceed, if elevated. The use of recombinant uricases is limited by their expense.

    Management of gout in the elderly

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    Dealing With Gout Get Help Now To Avoid Permanent Joint Damage

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    If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.

    Gout is a common type of inflammatory arthritis, with sudden flares of joint swelling, pain, warmth, and redness, often in the big toe. Some patients may go months or even years between flares. Many gout sufferers assume that the gout is gone between flares and they dont need medication to treat it.

    These prolonged gaps between flares, when the patient feels fine, fuel the misconception that gout is no big dealbut that couldnt be further from the truth.

    Left untreated, gout can cause permanent joint damage, even between flares. As a rheumatologist, I see some of the worst outcomes from untreated gout: destroyed joints that cause significant, irreversible pain and disability.

    Over 9 million people in the U.S. have gout. Yet only one-third to half of them receive treatmentand less than half of those who seek treatment stick to their care plan.

    Patients consistently tell me, I wish I had taken my gout more seriously. Its incredibly disheartening because most of the negative outcomes are preventable with early recognition and consistent treatment.

    You can avoid permanent damage from chronic gout by learning its risk factors and symptomsand seeking treatment at the first sign of the condition.

    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:

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    What You Can Do

    If you think your condition is getting worse, talk to your doctor. They will give you medicine to keep your uric acid levels low and to try to prevent future attacks and complications.

    Allopurinol treats chronic gout by lowering the uric acid produced in your body.

    also lowers uric acid production but would be used with caution if you are at risk for heart or blood vessel disease.

    Once you start taking these medicines, youâll need to take them for life so that your uric acid stays at the right levels.

    Probenecid and lesinurad help the body get rid of more uric acid in your urine. Pegloticase and rasburicase can break down uric acid into a substance that your body can get rid of. They are only for very severe gout that doesnât get better with usual treatments.

    Scientists are also testing new treatments for chronic gout. At the same time, researchers are getting a better understanding of how the body makes and breaks down uric acid. Insights from this research could lead to new treatments in the future.

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    Chronic Untreated Gout Can Lead To Joint Damage And Deformity

    Gout

    W.D. Auer/Alamy

    For some people, gout can be chronic, which means multiple, severe gout attacks several times a year.

    Chronic gout, sometimes called gouty arthritis, can lead to a number of serious complications if left untreated.

    Complications of gout include:

    • Loss of mobility or range of motion
    • Bone loss
    • Chronic kidney disease

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    Gout Treatment And Long

    Dietary and lifestyle changes, such as the ones above, may help manage gout and reduce the risk of frequent gout flare-ups.

    To manage gout and help prevent flare-ups, people may need long-term management with low, regular doses of medication to control uric acid levels. Individuals may need to take colchicine along with one of the following:

    • allopurinol
    • probenecid

    If uric acid levels are still especially high and the above medications are not effective at their maximum recommended dosages, an intravenous dose of pegloticase every 2 weeks may work rapidly to reduce uric acid.

    When Gout Becomes A Long

    When uric acid levels in your blood stay too high, more and more crystals form around your joints. It can turn into a long-term condition, leading to painful and damaged joints.

    Gout will happen differently for everyone. But signs that it may be getting worse include:

    • Flares happen more often and last longer. Over time, the inflammation causes lasting damage to bone and cartilage.
    • Flare-ups in other parts of your body. About half of people with gout have their first attack in the joint at the base of the big toe. When gout gets worse, it can affect other joints, including the ankle and knee.
    • Bumps form under the skin. Uric acid crystals may start to collect in soft tissue, forming lumps called tophi. They often appear on the hands, fingers, elbows, and ears, but they can show up almost anywhere on the body.
    • Kidney problems. Your kidneys normally get rid of uric acid in your body. But too much of it can also damage the organs. Kidney problems linked with gout — and signs that gout is getting worse — include gouty kidney, kidney stones, and kidney failure.

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    Risk Factors For Gout & Complications Of Gout

    Gout may be a funny-sounding name for an ailment, but only those who have experienced gout pain are aware that this type of arthritis is a serious health concern. Gout is caused by excess uric acid crystallizing in one or more joints. Therefore, this ailment causes severe joint pain and inflammation. Know the risk factors for gout to be able to prevent it or treat the underlying causes, if they pose a risk.

    Here is a list of the number of risk factors for gout:

    The Link Between Gout And Kidney Stones

    Gout Arthritis Symptoms Diagnosis And Treatment In Men

    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.

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    Colin And Dulcies Story

    Dulcie is 100-years-old and lives with her son Colin, his wife Mary, and her Carer Sarah. She has dementia and has had full-time live-in care for six months.

    We talk to the family about the challenges of finding the right care solution for

    a fiercely independent woman and how the positive benefits of live-in care with Sarah has transformed all of their lives.

    Gout And Mental Health

    The chronic pain associated with repeated gout attacks can lead to stress, anxiety, and depression. Gout can cause severe pain that can make it tough for you to get around, go to work, and complete daily tasks. That impact on your daily life can impacts patients mental, social, and physical well-being.

    Its not just about functionality and disability, but also how patients view themselves, says Dr. Khanna. I talk to patients about the fact that gout is treatable, and its possible to stay completely flare-free if they take their medications.

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    How Is It Treated

    To stop a gout attack, your doctor can give you a shot of corticosteroids or prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.

    To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. But don’t take aspirin. It can make gout worse by raising the uric acid level in the blood.

    To prevent future attacks, your doctor can prescribe a medicine to reduce uric acid buildup in your blood.

    Paying attention to what you eat may help you manage your gout. Eat moderate amounts of a healthy mix of foods to control your weight and get the nutrients you need. Limit daily intake of meat, seafood, and alcohol . Drink plenty of water and other fluids.

    What Are The Signs And Symptoms Of Gout

    Pseudogout : Causes, Diagnosis, Symptoms, Treatment, Prognosis

    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

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    What Causes Tophaceous Gout And Tophi Deposits

    People with this kind of gout get tophi. Tophi are hard uric acid deposits that form beneath the skin. Tophi look like chalky lumps under the skin.

    They can be found on or near the elbow, finger, or toe joints. Tophi can also appear on the outer part of the ear.

    Tophi can destroy bone and cartilage, leading to joint damage and deformity, according to the Cochrane Database of Systematic Reviews.

    They can swell during a gout attack and pop through the skin and become infected.

    With treatment, tophi can dissolve and eventually disappear.

    Not everyone with gout develops tophi.

    Certain groups share a higher risk for tophaceous gout, according to the physician-run website UpToDate. Those at risk for tophaceous gout include:

    • Organ transplant recipients who receive certain types of medication to prevent transplant rejection
    • People who cant take uric-acid-lowering medicines
    • Postmenopausal women, especially those taking a diuretic.

    What You Can Do To Avoid Developing Gout

    During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

    • Keep your fluid intake high. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high fructose corn syrup.
    • Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
    • Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
    • Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types and how much seem to cause problems for you.
    • Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid 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

  • Nonsteroidal anti-inflammatory drugs or COX-2 inhibitorsExamples of : Naproxen 500mg twice daily, indomethacin 25mg three times daily. Example of COX-2 inhibitor: celecoxib 200mg twice a day. Possible side-effects: Elevation of blood pressure, ankle swelling, upset stomach, ulcer . Use with caution if kidney or liver problems.
  • Anti-Inflammatory corticosteroidsExamples of : Prednisone 40mg first day, 30mg 2nd day, 20mg third day, 10mg fourth day. Possible side-effects: Elevation of blood pressure, elevation of blood sugar, mood changes. Short-term use, as in gout, generally much better tolerated than long-term use. Use with caution if diabetic.
  • Medications For Acute Gout

    Risk Factors for Gout &  Complications of Gout
  • Non-steroidal anti-inflammatory agents and COX-2 inhibitors are the mainstay of therapy of acute attacks of gout in patients who have no contra-indication to them. These medications include such agents as naproxen , ibuprofen , celecoxib , indomethacin and many others. These agents reliably decrease the inflammation and pain of gout. However, patients with ulcers, hypertension, coronary disease, and fluid retention must be careful with these agents, even for the short courses needed to resolve a gout attack. The doses of non-steroidal anti-inflammatory agents needed to resolve a gout attack are on the higher side, since full anti-inflammatory effect is needed. See examples of dosage in Table 2. Over-the-counter dosage levels, for example, ibuprofen at 200mg, two tabs three times a day, are often insufficient.
  • Corticosteroids, such as prednisone and methylprednisolone , are anti-inflammatory agents that are quite effective against gout attacks. Anti-inflammatory steroids are very different in action and side-effects as compared to male hormone steroids. Anti-inflammatory steroids have long-term risks, such as bone thinning and infection, but their risk for short-term therapy is relatively low. These agents can raise blood pressure and blood sugar, so can be a problem for those with uncontrolled hypertension or uncontrolled diabetes mellitus.
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