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
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.
When Should Someone Seek Medical Care For Gout
Anyone who has a sudden onset of a hot, red, swollen joint should seek medical care, either with a primary care physician, at an emergency department, or with a rheumatologist . These symptoms can also be due to an infection, loss of cartilage in the joint, or other reasons. It is important to make an accurate diagnosis of gouty arthritis for optimal treatment.
If one has been diagnosed with gout and has had more than one attack of arthritis, take the medication prescribed by a physician for these attacks. The individual should be seen by a physician, in the emergency department, or urgent care center if the attack does not respond to this treatment. The individual may need regular medications to prevent further arthritis flares.
Attacks of abdominal pain due to kidney stones may be related to uric acid kidney stones from gout.
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What Does Gout Look Like
Gout pain is the most common and noticeable symptom of gout.
Many, but not all, people experience their first gout attack or flare-up in their big toe. The pain often starts during the night and comes on suddenly.
The type of pain you feel with gout may vary depending on whether youre experiencing an acute gout episode or a flare-up of chronic gout.
How You Can Reduce The Risk
There are steps that can be taken to diminish the possibility of experiencing gout, and it should be understood that they largely involve making a conscious effort to avoid the items that were just mentioned as risk factors for this painful condition. That begins with a recommendation to maintain a healthy diet. and to abstain from eating foods that contain high levels of uric acid. This involves items that contain purines, which were listed previously . Considering that the consumption of alcohol raises the potential for experiencing gout, it is logical to recommend that managing alcohol intake will also reduce the risk. Remaining active through a regular exercise regimen is also critical, as physical activity will not only provide you with numerous benefits both physically and mentally, but remaining active is also essential in helping with weight control. Retaining a healthy weight will decrease the strain on your joints, knees, and hips, while also making it easier for you to sustain an effective exercise regimen that can be essential toward avoiding this condition.
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Assessment Of Methodological Quality Of Individual Studies
Risk of bias of individual included studies was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies -2 tool,, and assessments were reconciled, with any disagreements mediated by the project lead. We used the Assessing the Quality of Systematic Reviews tool to assess the quality of existing systematic reviews that we included AMSTAR assessments were also conducted independently by two reviewers and reconciled.
Who Should Get Testing
Gout testing may be recommended for patients experiencing symptoms of gout or with a history of suspected gout flares. Indications for gout testing include:
- Joint pain, swelling, and skin redness in one or multiple joints
- Severe pain in the joint at the base of the big toe
- Recurrent inflammation in the inner arch of the foot
- Previous symptomatic attacks that began quickly and resolved on their own
Accurately diagnosing gout is important to ensure appropriate treatment. Symptoms caused by gout are similar to symptoms of other inflammatory conditions, making it important to work with a medical team that specializes in diagnosing and treating gout. Patients concerned about gout may find it helpful to discuss gout testing with a doctor called a rheumatologist, who specializes in diseases of the joints, muscles, and bones.
Testing is also performed in patients who have been diagnosed with and are receiving treatment for gout in order to manage the disease as effectively as possible.
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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
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.
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Getting Tested For Gout
Gout testing is ordered by a doctor or specialist when there are signs or symptoms consistent with gout. Gout testing may be performed during a flare of gout or based on a patients history of symptoms similar to gout.
A sample of synovial fluid can be obtained in a doctors office through a procedure called a joint aspiration or arthrocentesis. During a joint aspiration, a doctor uses a needle to withdraw a small sample of synovial fluid from the joint for analysis. If additional tests are needed to rule out other conditions, a blood sample can be drawn in a doctors office or other medical setting.
In some cases, uric acid testing may require a 24-hour urine sample. A 24-hour urine test requires that patients collect all of their urine produced over a 24-hour period.
Uric Acid Urine Testing
Kidneys filter uric acid out of the bloodstream and dispose of it through the urine. If the kidneys are unable to do this well, uric acid accumulates in the blood leading to elevated blood uric acid levels.
- Uric acid urine testing is a secondary test, used in addition to the primary blood testing. The urine test helps your doctor to evaluate whether your kidneys are excreting enough uric acid.
- The uric acid urine test is a simple process. You will be asked to collect all of your urine over a 24-hour period in a storage jug provided by the lab. When complete, return the jug to the laboratory for analysis.
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How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
Gout Attacks Can Cause Severe Joint Pain
Acute gout usually involves a single joint, and acute gout symptoms typically go away within a few days. People with acute gout may not experience another attack for several months, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Recurrent attacks of gout can lead to chronic gout. This is sometimes called recurrent gout or gouty arthritis. Chronic gout may involve more than one joint.
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When To Call A Doctor
if you have:
- Severe pain in a single joint that comes on very quickly.
- Swollen, tender joints with warm, red skin over them.
It’s important to see your doctor even if the pain from gout has stopped. The uric acid buildup that caused your gout attack may still be irritating your joints. It could cause serious damage over time. Your doctor can prescribe medicines that can prevent and even reverse the uric acid buildup.
Cherry Juice To Help Manage Gout
Many people with gout or experiencing a gout attack drink cherry juice or consume cherries. The use of cherry juice for gout has been around since the 1950s, based on a study of 12 patients with gout. Since that time, several studies in animals have pointed to a role for cherries and cherry products in lowering uric acid levels. More recent studies showed that people with gout who consumed cherry juice concentrate experienced fewer flares, but there was no effect on uric acid levels. Overall, evidence supporting cherries for gout is weak. Larger, more controlled studies are necessary to confirm the absolute effectiveness of cherries and cherry compounds with gout, and the correct therapeutic dose.
The American College of Rheumatology advises against consuming cherry juice or extract for a gout attack. If you are interested in non-medication therapy, talk with your doctor about eating cherries, drinking cherry juice concentrate, or taking cherry-containing supplements. Daily cherry juice concentrate may be appropriate as an add-on therapy for people who are also on urate-lowering therapy to prevent gout attacks.
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Gout May Lead To Kidney Disease
This connection is less established, but there is evidence that gout can lead to kidney disease. The belief that gout leads to kidney disease is common among many doctors who specialize in the disease.When you have gout, you have too much uric acid in your blood. As your blood is filtered through your kidneys, uric acid can build up and form urate crystals. As the urate crystals pass through your kidneys, they can cause damage and scars. This kidney damage is thought to lead to kidney disease and failure over time, especially if your gout is left untreated.NSAIDs, some of the most common pain relieving medicines for gout, can also lead to kidney disease over time. Talk to your doctor about how to manage your use of NSAIDs.
What Are Causes Of Gout
Uric acid is generated as we metabolize the food we eat and as the body’s tissues are broken down during normal cell turnover. Some people with gout generate too much uric acid and are medically referred to as “over-producers.” Other people with gout do not effectively eliminate their uric acid into the urine and are medically referred to as “under-excreters.”
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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
What Happens During A Uric Acid Test
A uric acid test can be done as a blood test or a urine test.
During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
For a uric acid urine test, you’ll need to collect all urine passed in a 24-hour period. This is called a 24-hour urine sample test. Your health care provider or a laboratory professional will give you a container to collect your urine and instructions on how to collect and store your samples. A 24-hour urine sample test generally includes the following steps:
- Empty your bladder in the morning and flush that urine away. Record the time.
- For the next 24 hours, save all your urine passed in the container provided.
- Store your urine container in the refrigerator or a cooler with ice.
- Return the sample container to your health provider’s office or the laboratory as instructed.
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How Can Doctors Tell If I Have Gout
Doctors suspect gout based on your symptoms and an exam.
To tell for sure, doctors will do tests, such as:
)doctors will look at the fluid under a special microscope to see if it has uric acid crystals
An x-ray of your joint to look for bone changes that are common in gout
An ultrasound to look for uric acid crystals inside your joint
Doctors may also do a blood test to check the level of uric acid. But your level may not be high even though you have gout.
What Is The Pain Equivalent To Giving Birth
While the experience is different for everyone, labor usually feels like extremely strong menstrual cramps that take your breath away and make you unable to talk. As labor continues and the pain worsens, the pregnant person tunes out stimuli and adopts a tunnel vision, focusing on the labor and getting the baby out.
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Can I Get Gout Pain Relief Without A Doctor
You can get temporary pain relief by taking anti-inflammatory medications. Some common over-the-counter anti-inflammatory medications are aspirin, ibuprofen and naproxen. The best way to relieve gout pain and prevent future gout attacks is to consider dietary and lifestyle changes to help reduce uric acid production in the body.
Other Diagnostic Options For Gout
Testing synovial fluid is the standard for diagnosing gout, but another option for getting a gout diagnosis is through a blood test. Your doctor would get a sample of blood to have the levels of creatinine and uric acid tested. While a viable alternative to joint fluid collection, this option does have its downsides. Some people can have high levels of uric acid but not enough to experience gout. At the same time, people with physical signs of gout may not have high levels of uric acid in their blood. In some academic centers with appropriate expertise, ultrasonography of the joint with guided aspiration may help to diagnose a dual-energy CT scan of the affected joint is also available in some centers to diagnose gout.
Some physicians may use other methods based on criteria developed by the American College of Rheumatology and adopted by the American Academy of Family Physicians.
For instance, doctors are likely to diagnose gout if you have six or more of the following symptoms:
- lopsided joint swelling on an x-ray
- blood test showing high uric acid levels
- joint fluid culture negative for organisms during a gout attack
- maximum joint inflammation developed within a day
- arthritis in only one joint
- more than one attack of acute arthritis
- painful/swollen first big toe joint
- redness over joints
- x-rays that identify subcortical cysts without erosions
- a gout-like attack of on both big toe joints at the same time
- a gout-like attack on both ankle joints at the same time.
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