Treating The Pain At Home
What Are The Risk Factors For Gout
Risk factors for gout include:
- being male
- taking medications that increase water excretion by the kidneys
- being overweight
- eating a diet with a lot of meat, offal and shellfish
- having kidney disease, high blood pressure, diabetes or abnormal levels of fat and cholesterol in the blood
- drinking a lot of alcohol, especially beer, port or spirits
- going on a crash diet or fasting
- being of Maori or Pacific Islander origin, which can predispose a person to high uric acid levels
Gout is more common in men than in women, and among women it’s more common after menopause. It’s more likely to occur in older people, but can affect anyone.
It can also affect people with certain types of blood disorder and people in treatment for cancer.
What Are The Treatments For Gout
Most physicians recommend managing gout with lifestyle and diet changes. There are also medical interventions available for controlling and preventing gout pain. Treatment and prevention approaches include:
- Topical creams, like Voltaren, often provide immediate pain relief during a gout attack.
- Prescription medications, including the anti-inflammatory drug colchicine for pain. Providers may also recommend different drugs that regulate uric acid production for patients with recurring cases of gout.
- Injections including cortisone to relieve pain and inflammation.
- Dietary restrictions to reduce high-purine foods. Replace those foods with a diet high in whole grains, fruits, vegetables, nuts, and legumes. Your doctor may recommend switching from red meats to poultry and low-fat dairy foods for protein.
- Hydration: drink plenty of fluids to help eliminate uric acid. Water, milk, and tart cherry juice are the best choices.
- Immobilize and elevate the foot to reduce swelling and inflammation.
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Symptoms That Indicate You Have Gout
When the body builds up too much uric acid, individuals often experience a number of gout-related symptoms. It is known to be one of the more painful forms of arthritis, often beginning in the big toe. Caused by a number of factors, including poor kidney function, its important to recognize the symptoms as early as possible. Although there is not currently a cure, painful symptoms can be alleviated and effectively managed. Anyone who has dealt with gout knows from experience that finding a treatment that works is of the utmost importance. A gout flare up can be extremely painful. However, there are treatments out there that can relieve the unwanted symptoms very quickly.
If You Are Having Repeated Attacks See Your Doctor
Some patients can go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some wont have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about escalating treatment. People think its normal to have flares every now and then, but its not. The gout can be doing damage to your joints. It means you still have too much uric acid, says Shakouri. In particular, ask about allpurinol. It wont help with an acute attack but will help prevent future attacks by reducing uric acid production.
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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.
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.
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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
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
References
Symptoms And Causes Of Hallux Limitus
Now youre left asking, how do I know that the pain in my big toe isnt gout?
Because gout is considered an inflammatory type of arthritis, it usually causes a warm, red, and swollen area around the joint of the big toe to appear, whereas hallux limitus is more of a persistent pain with limitation of motion.
As always, you should definitely seek medical care at the onset of any new symptoms. Generally, patients with hallux limitus report symptoms such as:
- Pain
- Loss of motion
- Trouble walking
Although hallux limitus is considered to be idiopathic, meaning it has no known cause, certain factors are known to contribute to the development of this condition:
- Trauma
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Why Does My Big Toe Hurt Suddenly
When we think of gout, we might think of Renaissance-era royalty and indulgent feasts. But gout is still very much with us in the 21st Century. Gout is actually a type of arthritis that can affect any joint in the body. But it often strikes first in the form of sudden pain in your big toe. Heres a look at what causes gout, how to treat and prevent it, and why our big toe is so susceptible.
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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Do I Have Gout What Are The Symptoms
This is one of the questions that we get most from the people visiting GoutBye! The very early symptoms may appear before any gout flares. A sign of gout might be the elevated uric acid levels or purine levels that might appear in your regular blood test results. You can also take our free anonymous assessment test to define how likely you might have gout.
Most often, however, the people get alarmed when they experience the so-called gout flare:
- The flares often occur by night.
- Intense and constant pain in your big toe or another joint. Gout usually affects your big toes large joint, but it can also affect your fingers, ankles, knees, elbows, or wrists.
- Inflammation. The affected joint or joints show inflammation symptoms swollen, tender, warm, and red.
- The first four hours are usually the worst. The pain is really great in the first hours of the gout flare. On some occasions, you cant step on or even touch the foot.
- The flare lasts around 12 hours, but some joint discomfort may last from a few days to a few weeks after the severe pain subsides.
You can read on how you can handle an unexpected gout flare attack or if youre experiencing such for the first time.
Our mission at GoutBye is to help you build precisely these habits and make your life easier. Make sure you will check out other articles on our site.
What Are Symptoms Of Gout
Chances are you wont even know you have gout until youve experienced your first painful attack, often at night. Symptoms may not develop for years, but these often include:
- Arthritis that develops quickly, resulting in a swollen, red, and warm joint with limited movement
- An arthritis attack in only one joint often the big toe, as well as a foot, ankle, or knee
- Bright red or purplish skin around the affected joint
- More than one attack of acute arthritis
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The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
Gout Is No Laughing Matter
Gout is often used to comically depict a characters frailty or privilege. In the 2018 film The Favourite, Olivia Colemans Queen Anne is confined to a wheelchair and subjected to bizarre raw meat treatments for her gout.
More than 100 years previously, a villain in a short 1917 Charlie Chaplin film called The Cure got his gout-ridden foot caught in a revolving door.
But gout is excruciatingly painful and not funny at all when you suffer an attack. Gout also doesnt limit itself to afflicting the rich. In fact, the foods that make up the standard American diet are filled with a substance called purines, which can cause excess uric acid to build up in your body.
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Treating And Preventing Gout Pain
Gout pain is generally treated in two ways:
- Medications to relieve gout attacks in the short-term
- Preventive medications taken regularly to lower uric acid and stop gout attacks from occurring
While inflammation-fighting drugs are used to relieve pain during gout flares, different medicines are used to lower uric acid levels to prevent future attacks. These include:
- Allopurinol
- Probenecid
Another medication called pegloticase may be recommended for people with chronic gout who have not responded to other uric acid-lowering medication.
While many people with gout can be treated by their primary care physician, if gout is not responding to medication or is progressing with worsening or frequent flares or developing tophi gout deposits, then your primary care physician may refer you to see a rheumatologist who specializes in treating diseases that affect joints, muscles, bones and the immune system.
Taking medication to reduce uric acid levels and reduce the risk of gout progression is important, Dr. FitzGerald stresses. If you have risk factors for bad gout, such as kidney disease, or are experiencing frequent attacks, early treatment is better.
What To Do During An Attack
You should:
- take any medication you’ve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
- rest and raise the limb
- avoid knocking or damaging the affected joint
- keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
- ensure you’re well hydrated
Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.
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