How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
Veggies And Dip For Osteoarthritis
Heres an easy one. Who doesnt like to dip veggies in Ranch? The catch here is that it does matter which veggies youre eating. Broccoli is the best healthy snack because its stocked with sulforaphane, a compound that hinders the joint deterioration caused by osteoarthritis, as found in a study noted by arthritis.org. Other great and tasty options include tomatoes, red peppers, carrots, onions, and other veggie rich in Vitamin C and fiber.
Can I Drink Alcohol
Drinking alcohol can increase your risk of a gout attack as it can raise the level of uric acid in your blood. While it is possible to control gout attacks without completely cutting out alcohol, try to reduce the amount of alcohol you drink and avoid binge drinking . Talk to your doctor or read the Australian government guidelines on recommended alcohol intake.
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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
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Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in one or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
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How To Prevent Arthritis And Other Joint Pains
To date, there is no cure for arthritis. However, getting the right treatment approach coupled with eating the right food can help control the symptoms of arthritis from worsening.
There are a lot of medical approaches in alleviating the pain and discomfort caused by arthritis. The best approach for osteoarthritis and rheumatoid arthritis is interventional pain management.
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 Achillesâ 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.
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What Are The Best Foods To Eat When You Have Gout
While eating particular foods wont be enough to make gout go away, studies suggest that certain foods and drinks may help reduce uric acid in your body. For example:
- Milk. Some early research suggests that drinking skim milk may help reduce uric acid and gout flare-ups. It speeds up the excretion of uric acid in your urine and also reduces your bodys inflammatory response to uric acid crystals in your joints.
- Cherries. Scientists are currently researching the benefits of cherries and cherry juice for managing gout symptoms, and early results are promising. Cherries have known anti-inflammatory properties, and they may also help reduce uric acid in your body.
- Coffee. You may have heard that coffee is acidic, but the type of acid in coffee is very different from uric acid. In fact, drinking coffee daily can reduce your uric acid levels by several means. It slows the breakdown of purine into uric acid and speeds the rate of excretion.
- Water. People who drink five to eight glasses of water a day are less likely to experience gout symptoms. This makes sense since your kidneys use water to excrete uric acid in your urine. Water is also good for kidney health. Impaired kidney function is one factor that can contribute to gout.
However, many healthcare providers prefer to focus on general dietary guidelines rather than particular foods. They suggest that you:
What Can You Drink If You Have Gout
Foods arenât the only thing that can affect uric acid. What you drink matters, too.
Itâs a good idea to drink lots of fluids — 8 to 16 cups a day. At least half of what you drink should be water. Vitamin C also can help lower uric acid, but studies also show that the high fructose in OJ may boost uric acid levels, so drink it in moderation. Caffeinated coffee can cut uric acid, too, as long as you donât overdo it.
Donâts
Stay away from sugary drinks like soda and fruit juice. You also may need to limit or avoid alcohol as well. Talk with your doctor to find out whatâs right for you.
While a healthy diet can help control how much uric acid is in your system, you may still need medicine to prevent future attacks. Talk with your doctor about all your treatment options.
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Sugar And Refined Carbohydrates
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Limit the use of sugar intake during arthritis as it is one of the worst foods for arthritis. Candy and ice creams are strictly restricted foods to avoid for arthritis.
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Refined carbohydrates cause an increase in blood glucose, which will increase inflammation in the body. Refined carbohydrates may cause trouble for joints specifically during rheumatoid arthritis.
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Should I Drink Lots Of Water
Dehydration may be a risk factor for gout although this is not well proven in research. Drinking 1 1.5 litres of fluids a day is recommended for general health benefits. However if you are taking diuretics or have heart or kidney problems, talk to your doctor about the right amount of fluids for you to drink.
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Best And Worst Foods For Arthritis In Seniors
Besides osteoarthritis, ankylosing spondylitis, and rheumatoid arthritis, many other diseases can affect the joints, including Lyme disease, lupus, Sjogren disease, etc. Despite the different types of arthritis in seniors, they all cause similar symptoms. These include joint pain, swelling, and stiffness. The intensity of the symptoms may vary from day to day, making it frustrating to live with. But in addition to exercises and other targeted treatments, you can eat to relieve symptoms and live your best life. What are the best foods for arthritis? And which are the worst?
What Is A Low Purine Diet
Purines are chemicals that are naturally found in certain foods and drinks. When your body breaks down these chemicals, uric acid is the byproduct. A low-purine diet reduces the foods and drinks with the highest purine content to reduce uric acid. It also encourages some select foods that may reduce uric acid levels in your body.
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What Is The Latest Research On Gout
Research is being done on using medications that block a chemical signal known as interleukin-1 to treat gout flares in patients who do not respond to other therapies. Anakinra and canakinumab are two medications that block interleukin-1. They are currently used for other conditions and are under investigation for use in gout flare-ups.
There is ongoing research in using a specialized CT scan known as a dual energy CT scan to diagnose gout. There is also a great deal of research investigating the various uric acid transporter genes that are responsible for uric acid metabolism.
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Getting Rid Of Uric Acid With Watermelon
The connection between watermelon and gout is fairly simple to understand. Most doctors will recommend keeping hydrated. You must drink lots of water forget about those eight glasses a day. Get at least a dozen glasses daily. You need to flush the uric acid out of your body. Since watermelon is mostly based on water, it will inevitably keep you hydrated. It will also flush your kidneys, which is extremely important, as too much uric acid will also lead to kidney stones.
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Weight Management And Exercise
The Arthritis Foundation emphasizes how important it is for people with gout to manage their weight.
Obesity is a risk factor for developing gout. If a person with gout has excess weight, losing a few pounds can help them:
- reduce pressure on painful joints
- lower the risk of heart disease
- build strength and flexibility
To achieve this, the person should ask a doctor about a suitable diet to help them manage their weight and an exercise plan.
Anyone who smokes should also ask a doctor to help them with a plan to quit.
The Mediterranean diet contains plants, grains, and healthy fats. It may help people manage their weight while encouraging them to eat healthily.
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Food And Drinks To Avoid
To temper gout flare-ups, its best to avoid certain food and drinks that are known to contain higher purines. These includes:
Organ and game meats: Organ meats such as kidneys and liver and game meats like venison and wild-caught birds are extremely high in purines.
Seafood and fish: Crab, shrimp and other shellfish can cause gout flare-ups, but some fish like trout, anchovies and mackerel can increase uric acids levels too. However, oily fish like salmon do have some excellent health benefits and contain lower levels of purines compared to other fish, so eating them in moderation can be healthy.
Alcohol: Alcohol tends to increase uric acid levels, and some types of alcohol are worse than others. Higher alcohol consumption can also make it harder for your kidneys to filter out uric acid. This not only increases uric acid in your body, but it also makes it harder for the body to get rid of it. Its best to avoid beer, wine and liquor.
Sugary drinks: Uric acid levels tend to be higher in people who regularly drink sugar-sweetened drinks. Avoid beverages with high-fructose corn syrup, sodas and fruit juices.
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Should I Cut Out Purine
There is very little scientific proof that avoiding the purine-rich foods listed above can successfully reduce gout attacks. You may miss out on important nutrients and vitamins by completely cutting these foods from your diet.
If you notice certain foods trigger your gout attacks, you may benefit from cutting down the amounts of those foods in your diet. However not all purine-rich foods are thought to cause gout. For example, a number of vegetables are also rich in purines but appear less likely to cause gout than diets containing meat and shellfish.
Dairy foods, which can contain purines, actually appear to lower the risk of gout. For most people with gout, a healthy balanced diet is all that is needed, alongside medicines to reduce uric acid levels. Most people taking medicines to reduce uric acid levels find they can still eat purine-rich foods without attacks of gout by being careful with the quantity they eat.
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the bunion joint, represent a gouty tophus.)
Figure 3: Progression of Gout
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What Is Uric Acid
Uric acid is a waste byproduct of purine breakdown in the body. Purines are naturally produced in the body, as well as found in some foods. As purines are broken down, uric acid is created. Normally uric acid is either reabsorbed in the body or excreted via the urine and feces.
When there are more purines in the body than it can process, uric acid builds up in the bloodstream. This is called hyperuricemia. Hyperuricemia can cause gout and/or kidney stones in some people, while others have no signs or symptoms at all.
Verywell / Alexandra Gordon
Treatment for gout often includes medications, diet modification, and lifestyle changes, such as managing weight and quitting smoking. The foods you eat can have a direct impact on gout flares.
During a gout attack, modifying your diet may help decrease the length of the flare. Continuing to follow a gout-friendly diet, specifically a low-purine diet, may help prevent the risk of future gout attacks up to five fold.
Which Foods Are Safe For Gout
Find out which foods to eat and which to avoid if you have gout.
Question: I havegout. Can you tell me which fruits, vegetables, meats or seafoods I should eat or avoid? Is there any type of alcohol wine, beer, spirits that is better or worse for me than others?
Answer: Dietary management of gout is very restrictive and doesnt always work to control gout, so a combination of medication and diet may be the best way to treat your gout. In addition to medications that treat the inflammation and other symptoms that occur during a gout attack, medications exist that can treat the underlying metabolic condition of hyperuricemia too much uric acid in the blood.Hyperuricemia can occur either when the body produces too much uric acid or when the body does not excrete enough uric acid. Drugs exist to treat both causes.
Purine compounds, whether produced in the body or from eating high-purine foods, can raise uric acid levels. Excess uric acid can produce uric acid crystals, which then build up in soft tissues and joints, causing the painful symptoms of gout. Dietary management focuses on reducing the amount of uric acid in the system and attaining and maintaining a healthy bodyweight.
The primary dietary modification traditionally recommended is a low-purine diet. Avoiding purines completely is impossible, but strive to limit them. You can learn by trial and error what your personal limit is and which foods cause you problems.
High-Purine Foods Include:
Nutrition
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