Your Gout Questions Answered
People typically have a lot of questions about Gout Knee and how best to manage and prevent flare-ups.
We’ve compiled a list of commonly asked questions and answers to help – check out our article Gout Knee: Your Questions Answers
Whilst gout knee pain is not particularly common, it should alwaysbe considered with any sudden incidence of knee pain associated with swelling andredness.
Page Last Updated: Sept 15, 2020Next Review Due: Sept 15, 2022
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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.
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.
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Symptoms And Signs Of Gout In Foot
An attack of gout is often sudden. Symptoms:
- It may present with excruciatingly painful swelling of joints in the big toe, it is known as Podagra. The joint may be stiff and appear red or purple, very swollen, and tender to even light touch. Other gout sites include the instep, wrist, ankle, fingers, and knee.
- Skin may peel and itch as healing begins.
- An attack often begins at night the acute phase lasts up to 12 hours. If untreated, the inflammation may last up to two weeks. In 10 percent of people, acute episodes present in more than one joint.
- Kidney stones precede the onset of gout in 14 percent of patients.
- Chronic gout may develop, and it may affect more than one joint, mimicking rheumatoid arthritis.
- Tophi are soft tissue swellings caused by urate buildup in chronic gout. They may be found in the ear, fingers, toes, kneecap, and elbow.
Some people have a single attack of gout, others are affected intermittently, often when they have overindulged or experienced dehydration.
COMPLICATIONS OF GOUT IN FOOT
Its rare for complications of gout to develop, but they do happen and can include severe degenerative arthritis, secondary infections, kidney stones and kidney damage, nerve or spinal cord impingement, and joint fractures.
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
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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
Gout Knee Recovery Time
A common question with gout in knee is how long does it last? Most cases of gout knee are acute, sudden and short-lived. Left untreated, most episodes of gout knee settle down after a couple of weeks.
Unfortunately, repeat episodes are common and most people will suffer a recurrence of gout knee pain anywhere from 6 months to 2 years later. 60% of gout sufferers will have a recurrence within 1 year.
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Suffering From Goutpain For More Than 6 Years
Hi,Im new here. Ive been suffering from gout pain for more than 5 years. It attacks on the joint of my big toe of my left leg. I cant even put on shoes comfortably. I visited doctors several times before. They just advised not to take meat. Recently I have visited a doctor, who prescribed faboxtat 40. Now Im on this medicine. I have been taking this for about one month. But the pain is not improving so much. Ive got my uric acid test which is 398.
Now can you help me to get out of this.
Thank you very much.
The blood was taken before starting febuxostat. Seeing the test report, the doctor prescribed me the above drug.
I will definitely follow your food plan. However, would you please tell me, as you said febuxostat doesnt destroy the uric acid which are already burdened, how can I destroy it?
I understood. You are really helpful. Thank you a lot. I will get a new test and will let you know the result. One thing, should I stop taking medicine before getting blood test?
Ohh.. Creatinine. I did this test before taking drug. The test result was good. 71 umol/L. Besides this I also did Hemogram/CBC and glucose test. All test results were good according to the doctor. Should I need to test ALT and AST?
The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
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What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
Leading A Gout Free Life
In order to avoid gout attacks, your gout physician may prescribe a medication to reduce the buildup of uric acid in your blood. In most cases patients take this medicine for their entire life, but there are things that you can do reduce the chances of needing a lifetime of medication. Pay special attention to what you eat. This can help you manage the buildup and uric acid and reduce the frequency and duration of your gout attacks. Eating appropriate amounts of a healthy variety of foods to keep your weight under control and to get the nutrition you need. Try to avoid frequent or daily meals consisting of meat, seafood, and alcohol. As always you should drink plenty of fluids, especially water.
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How Long Does Gout In The Knee Last
Gout flare-ups can last for several hours at a time, but you may feel pain in your knee for days or weeks. Some people only have one flare-up in their life, while others have them several times a year.
Keep in mind that gout is a chronic condition, meaning it lasts for a long time and requires ongoing management. Dietary changes and medications can make a big difference, but youll also be at risk of having a flare-up.
Keep in mind that it can also take some time to find the right combination of diet changes and medication that works for you. Dont be discouraged if things dont seem to be improving right away.
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.
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Where Does A Gout Attack Occur
Gout often attacks the largest joint in your big toe. However, it can also attack the foot, ankle knees, hands, or wrists. Intense pain, redness, and swelling can start with no warning, although you may have warning signs of an impending attack. If you start to feel tingling, burning, or itching in a joint, your body is giving you a warning signal that a flare-up is imminent.
Why Do I Suffer From Gout
One word: hyperuricemia. Or, in other words, increased uric acid in your blood. This is the reason why your joints are painful and inflamed. Uric acid is a normal product in your body it is a substance that breaks down purines in your body which are found in certain foods that we eat, in addition to being found in human cells. When your body overproduces uric acid, youre at risk for developing gout. But, why would your body overproduce uric acid?
The triggers of hyperuricemia include:
- Injury
- Excessive alcohol consumption
- Eating large amounts of red meat and shellfish
- Dehydration
- Drinking sugary sodas
It is these types of triggers that can create the hyperuricemia, which can result in gout. When you overproduce uric acid, your kidneys have to work harder to flush out the extra uric acid out of your bloodstream, as they would normally do.
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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.
Management Of Knee Gout Flares
The definite diagnosis of gout is made by needle aspiration of the joint fluid, which is studied to detect urate crystals. The aspirate from the knee joint contains crystals, even during the asymptomatic stage after an acute attack. Treatment should include lifestyle modifications to decrease the production of uric acid, weight management, and reductions in the intake of alcohol.
Local ice packs are used to decrease the signs of inflammation. For acute episodes, NSAIDs are used as the drug of choice, but joint aspiration can also relieve the pain. To decrease the inflammation, corticosteroid injection can be administered directly into the joint, and allopurinol and colchicine can be used to decrease inflammation. The patient is given a urate-lowering therapy in cases of recurrent gouty attacks, when there is evidence of joint damage, very high uric acid levels, and renal problems.
References:
Soloway, S. . Tophaceous gout in a knee with total joint replacement. JCR: Journal of Clinical Rheumatology, 17, 48.
Ko, K. H., Hsu, Y. C., Lee, H. S., Lee, C. H., & Huang, G. S. . Tophaceous gout of the knee: revisiting MRI patterns in 30 patients. JCR: Journal of Clinical Rheumatology, 16, 209-214.
Schlesinger, N., Schumacher, R., Catton, M., & Maxwell, L. . Colchicine for acute gout. Cochrane Database of Systematic Reviews, .
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What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.
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 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.
Purines And Uric Acid
The crystallized uric acid that causes gout pain is created by the breakdown of a substance called purines. Purines are part of every cell that make up all plant and animal food sources. Purines are also produced by the human body itself.
Some foods, namely proteins like meats and beans, are higher in purine content that others. One way that high levels of uric acid accumulate in the blood is by eating these types of foods. Another way is by consuming drinks and foods that are made with a generous amount of high fructose corn syrup.
However, the true problem is that the kidneys are temporarily not able to balance the pH of the body chemistry as they normally do. Kidney function can become impaired for a number of reasons in addition to consuming certain types of foods toxic environmental chemicals in the air and water, stress hormones, dehydration, skin contact with toxic substances, physical over-exertion, and others.
When the kidneys are overloaded, the uric acid may not be properly processed and excreted. Normally, uric acid is produced and used by the body as a protective antioxidant, but when over-abundant, its corrosive nature can become problem.
The alternative that nature has provided is to allow the excess uric acid to crystallize in a joint far from the vital organs to protect them this is the fundamental point to understand when the question, what is gout? comes up.
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