Arthritis / Acute Gout Attack
Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.
The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.
An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack takes approximately 7-14 days.
An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of gout:
Points To Remember About Gout
- Gout is a type of arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then go away.
- With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
- The most common symptom of gout is pain in the affected joint, such as the big toe.
- Your doctor may recommend taking medications to manage the cause of your gout and treat active gout flares, and making changes to your diet and lifestyle.
Common Myths About Gout
Drinking too much alcohol and eating too much rich food were once considered the prime suspects in causing gout. Although eating certain foods and drinking alcohol may cause uric acid levels to spike, these habits alone may not cause gout.
A recent study indicates that our DNA is a key factor in gout flare-ups. Researchers found that diet was less important than genetics in determining whether or not patients would develop high levels of uric acid.
If you suspect you have gout, make an appointment with your doctor to be tested and learn how to prevent or reduce future gout attacks.
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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.
What Causes Gout In Toes
Gout occurs due to the clustering of uric acid in the bloodstream and the formation of urate crystals in the joint space. The metabolism of purines gives rise to a waste product, uric acid.
It is processed in the kidneys and then eliminated through urine. If uric acid is produced in an extremely high amount, then it is not possible for the kidneys to flush it out.
Consumption of foods high in purines is responsible for elevated levels of uric acid in the body. If kidney functioning is affected due to renal conditions, then also the kidneys cannot eliminate uric acid.
Excessively increased uric acid gets accumulated in the blood to form crystals, which form deposition in the space around the joints of toes. It results in pain and inflammation in the affected joint.
Middle-aged people with a family history are more prone to develop gout. Obesity and excess alcoholism can also trigger gout attacks.
Certain health conditions, such as kidney disorders, thyroid diseases, hypertension, and diabetes, are found to be associated with gouty arthritis. Foods that contain rich amount of purines such as pork, organ meat, beef, seafood as well as alcoholic beverages can cause hyperuricemia, resulting in gout in toes.
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What Are The Signs And Symptoms Of Gout
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
Differences Between Ra And Gout
Both diseases cause redness, swelling, and pain in the joints. Both can cause serious disability and disrupt your quality of life.
However, a close look at initial signs and which joints are involved will clearly differentiate these two diseases. The best way to know whether you have RA or gout is to make an appointment with your doctor for a diagnosis.
Specific signs that distinguish the diseases:
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How Long Gout Pain Lasts
Characteristically, gout pain comes on rapidly and the joint becomes red and swollen, with the swelling reaching a peak within the first 24 hours of the attack, Dr. FitzGerald explains.
At first, gout usually affects just one joint, but can affect more than one joint, sometimes adjacent joints. Flares typically resolve on their own over the next seven to 14 days. Treating a gout flare with medications can help it resolve faster. Medications for gout flares typically include:
- Non-steroidal anti-inflammatory drugs , such as ibuprofen or naproxen
A gout attack may occur only one or two times a year or even only a few times ever. However, gout can become chronic, leading to frequent attacks and flares that occur at least a few times a year or never completely resolve. Chronic gout can damage and deform joints and can sometimes be mistaken for other inflammatory diseases like rheumatoid arthritis.
How Do I Know If Its Gout Or Something Else
There are many other conditions that affect the big toe joint, as well as other joints in the feet, that cause redness, swelling and pain so this is a great question. Other common causes of pain in this joint include:
- Other arthritis like rheumatoid arthritis, osteoarthritis or septic arthritis
- Trauma to the big toe joint
A key characteristic of gout is that it presents in painful flares although other inflammatory arthritides do too. The only definitive way to know is to come in for an assessment and diagnosis. At My FootDr, well conduct a comprehensive assessment, review your history, and rule out the other possible causes of joint pain. If we suspect you have gout, well refer you appropriately, while setting to work in helping to relieve your painful symptoms by reducing pressure away from the affected joints.
Book your appointment with us online here or call us on .
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Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
What Procedure Is Used To Diagnose Gouty Arthritis
Gout is usually diagnosed by a doctor based on the location of the inflamed joint and a history of having similar non-traumatic attacks of pain and swelling. The most reliable test for confirming gout is an arthrocentesis. Arthrocentesis is a procedure where fluid is withdrawn from an inflamed joint with a needle and syringe, using a sterile technique and a local anesthetic such as lidocaine. The fluid is sent to a lab where it is analyzed for the presence of uric acid crystals.
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Who Is At Risk For Gout
Anyone can be affected by gout.
Gout is most common in middle-aged men, especially those with a family history of the disease. Women can get gout, too, most often after menopause.
Your chances of developing gout are higher if you:
- Are overweight
- Drink too much alcohol, especially beer
- Eat a diet rich in meat and fish, which can be high in chemicals called purines
- Take certain medicines, like water pills , that can trigger an attack
Recent research also indicates that genetics may play a big role in determining who gets gout. Ask your doctor if you have questions about your risk for developing this condition.
What To Do During An Attack
- 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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How To Eliminate Gout In Toes
Intense pain, swelling, and inflammation in the joint are the symptoms that can appear in gout. Gout is a type of inflammatory arthritis characterized by elevated levels of uric acid. Men are more prone to gout, and they tend to develop gout in their middle age. Gout is also associated with heredity or certain medical conditions.
The big toe is the most common site affected by gout, although other joints like knees, ankles, feet, heels, hands, elbows, wrists, and fingers can also be affected. The condition can be treated with medications as well as home remedies.
When To See A Foot Doctor About Gout:
- Sudden intense pain in a joint in your feet
- Lingering, discomfort from a few days to a few weeks
- Inflammation and redness the affected foot joint becomes swollen, tender, warm and red
- Limited range of motion in your feet
Gout that goes untreated can lead to worsening pain and joint damage
Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.
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Excess Uric Acid Leads To Gout Attacks
Gout is not only unpredictable and debilitating but also relatively common. According to the UK Gout Society, one in 14 men and one in 35 women will develop this joint disease. The problem occurs mainly in the lower extremities the knees, ankles and feet with big toe joints at the greatest risk. The NHS website includes a the skin looks extremely red and swollen.
People develop gout as a result of hyperuricemia, i.e. high levels of uric acid in the bloodstream. Uric acid crystals build up around the joint at the base of the big toe and other joints, ultimately tricking your body into thinking its under attack. White blood cells try to defend you by surrounding the crystals, leading to the severe joint pain and inflammation familiar to gout sufferers.
Gout pain can last for more than a week and often returns. To reduce the likelihood of permanent joint damage, urgent medical treatment is vital. Your doctor may prescribe medicine to lower uric acid levels, as well as anti-inflammatories.
The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
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Medications For Acute Gout
What Causes Gout Pain
Picture a collection of glass shards pressing outward like needles. This is what it can feel like during a gout flare, when a buildup of uric acid in the blood forms microscopic crystals that grow in and around a joint. As the build-up increases, the immune system responds to these crystals, causing inflammation that leads to visible swelling, redness, and debilitating pain.
In some cases, a gout flare can even lead to a fever and look like an infected joint, Dr. FitzGerald notes. The treating doctor may need to look for possible source of infection, often by removing fluid from the joint to send to the lab to look for crystals or bacteria.
Uric acid is a byproduct of the body breaking down proteins called purines from your own cells and from certain foods such as red meat and shellfish. Alcohol and drinks sweetened with high fructose corn syrup are also high in purines. Normally, uric acid dissolves in your blood and is filtered out through your kidneys, but when your body produces too much uric acid or your kidneys fail to filter it, either due to familial causes or kidney disease, then the uric acid builds up and creates the needle-like urate crystals that cause gout and can also form kidney stones, according to the Mayo Clinic.
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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:
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.