How Bad Is Gout Pain

Why Do I Get Gout

You might think that gout is caused by drinking too much beer and fizzy drinks and eating too much meat and shellfish. In fact, gout is caused by having too much of a chemical called uric acid in your blood.

Your body makes uric acid when you eat food. It is normal and healthy to have some uric acid in your body. Most people get rid of uric acid through their urine.

Aspirin And Diuretics Significantly Increase Gout Risk

Not exactly foods to avoid with gout, but the ingestion of some common medications sharply raise the risk of a gout attack.

Specifically, low doses of aspirin, which one in three middle-aged Americans takes regularly to help prevent heart disease .

The emphasis is on low doses because aspirin has a dual effect on uric acid levels. Very high doses above 3,000 mg promotes excretion of uric acid , whereas low doses prevent excretion .

In a study of 49 elderly patients, just 75 mg of aspirin per day increased blood uric acid levels by 6% within one week. A daily dose of 150 mg kept levels high during the second week, before coming down with 300 mg doses in the third week .

Considering the typical dose for heart disease prevention is 81-325 mg per day, it is no real surprise this dosage is associated with a doubling in gout risk. In fact, even the use of a low-dose aspirin for two consecutive days increases risk of recurrent gout attacks .

Another type of medication known to trigger gout is diuretics. They are typically used to treat high blood pressure and oedema, and if feasible should be discontinued in gout sufferers.

Im by no means recommending you cease your medications if you have gout, but its important to understand the pharmaceutical triggers. First speak with your doctor and closely monitor uric acid levels before making any changes.

And if you need a temporary painkiller, choose paracetamol or ibuprofen. No aspirin.

Gout Myths And Misconceptions And The Facts

Gout was once called the disease of kings, because of its propensity to affect overweight, rich men throughout history. Famous gout sufferers have included Alexander the Great, Charlemagne, Henry VIII of England, and Benjamin Franklin.

While gout is no longer thought to be a disease of the wealthy, it is more common in men and people with weight-related health problems including high blood pressure and type 2 diabetes.

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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.

Risk Factors For Gout

You are Mori or Pacific

Many Mori and Pacific people have genes that make it harder to get rid of uric acid from their bodies.

Your doctor has told you you have high uric acid levels

Uric acid is a chemical that everyone has in their body. Some people have higher uric acid levels than others. High levels of uric acid can turn into gout.

You can reduce your uric acid levels by keeping active, staying fit, keeping your weight down, eating a healthy diet and not drinking beer and sugary drinks.

You have a family history of gout

If people in your family have gout then you have a higher chance of getting gout.

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The Excruciating Pain And Swelling During A Gout Flare Is Pretty Hard To Ignore

Whether youve been plagued by gout in the past or have never experienced it before, chances are that when a gout flare strikes youll quickly know something is very, very wrong: The excruciating pain and swelling, which often occurs in a single joint , is pretty hard to ignore.

If youve never had a gout attack and are thinking that people with gout must be exaggerating, consider this: 37 percent of people with gout said that theyd willingly give up a winning lottery ticket if they never had to experience a gout flare again, according to a patient survey.

Of course, making that sort of trade-off isnt an option. So what real-life choices do you have? Your best bet is to call your doctor stat. As soon as you feel a twinge, you need to get medical attention, says Joseph Huffstutter, MD, a rheumatologist with Arthritis Associates in Hixson, Tennessee. The sooner you treat a gout attack, the easier it will be to treat.

Heres a look at why gout flares happen and how to rein in the pain as quickly as possible.

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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Is There A Test For Gout

There is no one test for gout, and its symptoms are similar to several different conditions. To see if you have gout, your health care provider may:

• Ask you to provide your medical history, including:
• Your symptoms.
• Any other medical problems you have.
• Any medications you are taking.

The Cause Of Gout Is More Than Just Diet

While diet is critical, dont overlook other important factors that affect gout. These include family history, sleep apnoea, and lack of physical exercise to name a few.

Further discussion of best treatment for gout is outside the scope of this article. But there are foods thought to be protective namely dairy, cherries, and coffee, in decreasing order of evidence.

And as much as I prefer focusing on what you should eat to prevent health scares, there are just so many clear trigger foods for gout.

Its important to deal with these factors first and foremost.

About Joe Leech, Dietitian

Joe Leech is a university-qualified dietitian from Australia.

He graduated with a Bachelor’s degree in exercise science, followed by a Master’s degree in Nutrition and Dietetics in 2011.

Learn more about him on the About page.

Joe Leech, Dietitian

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Patients With Gout Need To Stay Active To Maintain Cardiovascular Health And Protect Joints From Long

Should I walk or engage in any exercise when I have gout? Many people with gout ask themselves this question. And the answer is yes except during a painful gout flare, according to Maura Daly Iversen, PT, MPH, DPT, SD, FAPTA, a physical therapist and behavioral scientist/clinical epidemiologist with a primary focus in rheumatology and Dean of the College of Health Professions at Sacred Heart University in Fairfield, Connecticut.

When in a gout flare, even the pressure of a bed sheet can be extremely painful, Dr. Iversen says. Most patients feel better by elevating their feet and resting and thats okay.

Signs Your Pain Is Likely Gout And Not Something Else

If you develop sharp sudden pain in a single joint or a couple of joints, if the pain is so debilitating that it is hard to walk or wear shoes, and if you have risk factors for gout , theres good reason to suspect gout as the culprit. However, its important to see a doctor for a thorough exam and proper diagnosis.

Dr. FitzGerald cautions that issues unrelated to gout can cause an angry, inflamed joint. Gout may be confused with several other conditions that can cause similar symptoms, including:

• Pseudogout
• An infected joint
• Bacterial skin infection
• Rheumatoid arthritis
• Psoriatic arthritis

Pseudogout is caused by a different kind of crystal, calcium pyrophosphate. A flare of pseudogout can resemble gout, but it more often affects your wrist and knee, and is unlikely to involve the big toe. Like gout, pseudogout is also considered a form of inflammatory arthritis. Its more likely to affect people over the age of 40 and those who have a thyroid condition, kidney failure, or disorder that affects calcium, phosphate, or iron metabolism, according to the Cleveland Clinic.

Its also possible to have gout without the classic presentation of red, hot, sharp, burning, sudden pain in the big toe, foot, ankle, or knee. Some patients may have joint pain that is less acute.

People can also have high levels of uric acid but not develop symptoms of gout.

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Avoid Foods That May Trigger Gout

Purines are found in certain high-protein foods, such as certain types of seafood ,and red meat and organ meat . Avoid drinks that may trigger gout:

• Alcoholic beverages
• Sugary drinks
• Coffee and other caffeinated beverages. While some studies show that caffeine can actually protect against gout pain, others find that sudden spikes in caffeine intake can trigger an attack.

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Diagnostic Evaluation Of Gout In Foot

What goes into a gout diagnosis? These procedures are options:

• Joint aspiration. Fluid is withdrawn from the joint and inspected for crystals and bacteria.
• Blood tests. White blood cell count, ESR , triglycerides, and kidney function may be elevated.
• X-ray. An x-ray of the affected joint is likely to appear normal during an initial acute episode, but in chronic gout, bone erosion and overhanging edges may be seen.

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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.

What To Do If You Think You Have Pain Due To Gout

The good news is that there are effective medications to treat gout, Dr. FitzGerald says. In some mild cases, gout can be self-managed with lifestyle changes, such as weight loss if needed and eating fewer high-purine foods .

However, many people with gout should be on a preventive medication to lower uric acid levels and stop flares from occurring. According to the 2020 gout treatment guidelines from the American College of Rheumatology, uric acid-lowering medication is recommended for people who:

• Have two or more gout flares a year
• Have gout tophi
• Have evidence on X-rays of joint damage due to gout

The guidelines, of which Dr. FitzGerald is a coauthor, recommend a treat-to-target strategy, which means treating gout with medication until a target uric acid level is reached.

Unfortunately, gaps in quality care for gout continue to persist and many patients do not take uric acid-lowering medication, which can leave people suffering the intense and persistent pain of gout without relief. This is why it is important to seek medical care if you experience pain that you think could be gout, Dr. FitzGerald stresses.

Gout can be diagnosed several ways, including:

• Removing fluid from the joint to identify urate crystals.
• Using ultrasound to identify several common characteristics of gout, such as collections of crystals in or around joints.
• Using dual-energy CT to detect urate crystal deposits in cases that are more advanced.

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How Much Alcohol Can People With Gout Drink

Each gout patient is different, so its hard to determine what the safe limit for alcohol is. Its best to monitor your alcohol consumption and limit yourself to amounts that work best for you.

Lifestyle is an important factor for living with gout along with diet, medical condition, family history, age, and sex. If you find that beer is a common trigger for you, consider lowering your dose to minimize instances of gout attacks.

• Gouty Arthritis Treatment

If taking alcohol out of your lifestyle is not an option, you should still lower it to avoid those crippling gout attacks. Thankfully, there are medications now that can help prevent and treat gout symptoms. Aside from maintaining a rigid diet low in purines, you should also be taking gout medications such as allopurinol.

Make sure to speak with your doctor about taking medications while drinking alcohol.

There is no hard evidence to prove that alcohol reduces the efficacy of allopurinol, but its still best to get the proper dosage to help you achieve low enough uric acid levels. If you still cannot lower your uric acid levels, then you may need to make drastic lifestyle changes such as cutting out alcohol altogether.

During a gout flare up, you should be avoiding alcohol as it could make it worse. Your gout is already experiencing a buildup of uric acid crystals. By drinking alcohol, you are only adding to the buildup and overworking your kidneys resulting in kidney stones and lumps under the skin.

Severe Gout Dangers By Christina Ray At Livestrongcom Excruciating Pain

Gout has been named as the cause of the worst pain ever experienced by two-thirds of gout patients interviewed in 2006, according to the University of Maryland Medical Center. The pain of gout can impair the ability to perform simple tasks such as walking or putting on shoes. Even the slight weight of a bed sheet upon a gout-inflamed joint can create extreme pain that wakes some gout patients in the middle of the night.

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Intense Big Toe Pain From Gout: A Classic Symptom Of An Attack

While the big toe is the most common place for a gout attack to happen, gout can also affect surrounding joints in the foot, ankle, and knee.

People with gout typically experience flare-ups, or attacks, of symptoms followed by periods with no symptoms. The attacks typically last 3 to 10 days. Some people go months or even years without a gout attack after having one. In other people, attacks may become more frequent over time.

Gout can be difficult to diagnose. Once its diagnosed, it can be treated with medication and lifestyle changes.

Ways To Deal With Painful Gout Attacks

Its difficult to focus on work or other daily activities when youre experiencing gout inflammation and pain. Symptoms can last for a few days or even weeks, with the worst pain usually occurring in the first day or two.

While the best thing to do is talk to your physician, there are several steps you can take right away ease your gout symptoms:

Excess uric acid in the bloodstream can lead to the formation of uric acid crystals in one or more joints, resulting in gout.Read:All About Gout – Symptoms, Diagnosis, Treatment

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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.

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
• Colchicine
• Glucocorticoids

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.

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