How Do You Get Diagnosed With Gout

How Can I Manage My Gout And Improve My Quality Of Life

Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.

For gout in particular:

• Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .

CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.

Is It Normal For Serum Urate To Be Elevated During Gout

Serum urate concentrations are often normal during acute gout 48 and many patients with hyperuricaemia never develop acute gout. Thus, a raised serum urate concentration favours gout, but is not diagnostic. Plain radiographs are unhelpful in patients with acute gout and might show only soft tissue swelling.

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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Can It Lead To Any Complications

If left unmanaged, gout-related inflammation can cause permanent damage to your ankle joint, especially if you have frequent flare-ups.

Over time, lumps of uric acid crystals, called tophi, can also form around your ankle. These lumps arent painful, but they can cause additional swelling and tenderness during a flare-up.

Who Should Diagnose And Treat Gout

The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.

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The Role Of Medication In Prevention Of Gout

Table 3: Medications to pevent attacks of gout

Standard medications in preventing gout attacks

i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8

ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.

Table 4: Reasons to use medication to lower uric acid

Review Of Key Questions

AHRQ posted the key questions on the Effective Health Care Website for public comment. The EPC refined and finalized the key questions after review of the public comments, and input from Key Informants and the Technical Expert Panel . This input is intended to ensure that the key questions are specific and relevant.

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The Role Of Gout Tests

Gout testing can be used to diagnose the cause of a persons symptoms, help doctors plan treatment, and monitor the treatment of gout:

• Diagnosis: Testing for gout helps doctors to identify gout, distinguish it from other conditions, and investigate the cause of increased uric acid concentrations in the blood.
• Determining treatment: For many patients, urate-lowering therapy is the first approach to treating gout. Human leukocyte antigen testing is recommended for patients of certain ethnic backgrounds to determine their risk of severe side effects while taking urate-lowering medications.
• Treatment monitoring: Patients being treated for gout may have their uric acid concentration in their blood continuously monitored. Tracking the level of uric acid in the blood can help doctors ensure that the medication is working appropriately.

So What Exactly Is Gout

This is a chronic inflammatory condition affecting mainly the joints to cause painful experiences. In worse cases when gout attacks the same joint repeatedly, it leads to gouty arthritis which is a severe form of arthritis. In most cases, gout comes and goes, with worse symptoms referred to as flares while mild or no signs referred to as remissions. No known cure has been found for gout to date. However, with effective treatment and maintenance, you can efficiently manage the condition using medication and other self-management remedies.

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Can You See Gout On Xray

Plain film radiography may be used to evaluate gout however, radiographic imaging findings generally do not appear until after at least 1 year of uncontrolled disease. The classic radiographic finding of gout late in disease is that of punched-out or rat-bite erosions with overhanging edges and sclerotic margins.

Time To Call The Doctor

A gout attack will usually go away in about 3 to 10 days. But you can feel better sooner if you treat it. To be sure that you have gout, see your doctor. Theyâll examine you, and they might do some tests.

These test help your doctor know if you have gout, or something else with similar symptoms:

• Joint fluid test. Fluid is taken from the painful joint with a needle. The fluid is studied under a microscope to see if the crystals are there.
• Blood test. A blood test can check the level of uric acid. A high level of uric acid doesnât always mean gout.
• X-ray. Images of the joints will help rule out other problems.
• Ultrasound. This painless test uses sound waves to look for areas of uric acid deposits.

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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.

Is Knee Pain Due To Gout Or Something Else

Most people with gout in the knee experience intense pain during a gout attack. Swelling may also be noticeable during an active flare, as well as redness and warmth.

The pain may develop in the night and hurt continuously for up to two weeks before the flare subsides, with the most intense pain in the first 24 hours. But if gout is not treated, typically with medication to lower uric acid levels, gout flares will recur and over time and affect more joints, including the knee.

Doctors cant say for sure why gout flares occur more often at night but, according to a 2015 study, it might be because your body temperature goes down at night, which could make uric acid more likely to crystallize.

Although the pain of a gout attack is distinct, there may be other reasons for your knee pain you should be aware of.

Pseudogout

Your knee pain could be caused by buildup of different kinds of crystals called calcium pyrophosphate . Doctors can examine fluid in your inflamed knee to determine if the crystals are uric acid or calcium pyrophosphate.

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Grading The Strength Of Evidence For Major Comparisons And Outcomes

We will assess the overall strength of evidence by using guidance suggested by AHRQ for its Effective Health Care Program.16 This method is based loosely on one developed by the GRADE Working Group and classifies the grade of evidence as High, Moderate, Low, or Insufficient. The evidence grade is based on five required domains: study limitations, consistency, directness, precision, and publication bias. Publication bias will be assessed using the Begg adjusted rank correlation test17 and Egger regression asymmetry test18 selective outcome reporting bias will also be assessed as part of the risk of bias assessment for individual studies. Three additional domains can also be included if appropriate. Assessing the SOE of diagnostic test studies is challenging because of the difficulty in identifying studies that include long-term, clinical outcomes and in applying standards of precision to these studies. Assessing the SOE of the body of literature on gout diagnostic methods may be especially challenging, given the limitations of the oldest, gold standard method, the newness of most methods that rely on imaging, and the heterogeneity of studies that employ clinical signs and symptoms . To the extent possible, we will focus on risk of bias and consistency among studies and will narratively describe particular strengths and limitations.

What Are The Causes And Triggers Of Gout In The Ankle

The buildup of uric acid in the body is known as hyperuricemia. Your body produces uric acid when it breaks down purines. These are compounds found in all your cells. You can also find purines in several types of food, especially red meat and some seafood, as well as alcohol and some sugar-sweetened drinks.

Usually, uric acid passes through your kidneys, which help to eliminate extra uric acid in your urine. But sometimes theres too much uric acid for your kidneys to handle. In other cases, the kidneys cant process a typical amount of uric acid due to an underlying condition.

As a result, more uric acid circulates throughout your body, ending up in your ankle as uric acid crystals.

4 percent of adults in the United States. It tends to be more common in men because women usually have lower levels of uric acid. But after menopause, women start to have higher uric acid levels. As a result, women tend to develop gout at an older age than men do.

Experts arent sure why some people produce more uric acid or have trouble processing it. But theres evidence that the condition is often genetic.

Other things that may increase your risk of developing gout include:

• consuming a lot of high-purine foods
• consuming foods and drinks, especially alcohol, that increase uric acid production
• being overweight

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Quick Answers For Clinicians

Hyperuricemia is a common condition and is classified by elevated serum urate concentrations. The most common complication of hyperuricemia is gout. However, many cases of hyperuricemia are asymptomatic. In patients with gout, serum urate concentrations are generally high, but can be normal at the time of an acute gout flare. The presence of hyperuricemia aids in the clinical diagnosis of gout, but it does not definitively confirm the diagnosis. Persistently low serum urate concentrations make the diagnosis of gout less likely. The Criteria for Diagnosis section has more detailed information about the definitive diagnosis of gout.

Imaging methods such as radiography and magnetic resonance imaging may be useful in monitoring the progression of joint erosion or tophus size in chronic gout. Ultrasound and dual-energy computed tomography are used to detect urate deposition in symptomatic joints. All of these imaging modalities are included in the American College of Rheumatology and the European League Against Rheumatism gout classification criteria. Imaging alone is insufficient to definitively diagnose gout and should be used in addition to laboratory testing methods.

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.

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Risk Factors For Gout

A number of references by Choi et al have identified, explained, and reviewed the risk factors for the development of gout.11-13 Nonmodifiable risk factors include being a male or a postmenopausal female, genetic influences, end-stage renal disease, and resulting major organ transplantation. Its prevalence increases with age, from 1.8/1,000 in people under the age of 45 years to 30.8/1,000 in those over age 65.8 Elevated serum urate levels are also associated with increased risk.8 Hypertension is a definite risk factor, as a significant percentage of patients with hyperuricemia will develop hypertension. Hyperuricemia and gout have been linked to other disease states including metabolic syndrome, cardiac disease, stroke, and renal disease.8 The risk of gout correlates with truncal obesity, as measured by body mass index and waist-to-hip ratios.8,11

Avoidable risk factors include diet and medications. Foods that have been implicated in causing gout are red-organ meats, seafood, and foods containing high-fructose corn syrup. Fructose has been recognized as a cause of hyperuricemia.8,14-16 Choi et al conducted a small prospective study that investigated the ability of diets high in fructose to induce higher serum urate levels relative to diets high in glucose or low in carbonates.16 High alcohol intake, especially beer, is also a risk factor. The presence of guanosine in beer has been identified as the cause of gouty attacks.

Pathophysiology And Risk Factors

• References

Genetic mutations may be associated with overproductionor more often underexcretionof uric acid because of defects in the renal urate transporter system.6 The prevalence of gout increases with age and peaks at more than 12% in persons older than 80 years.1 Because female sex hormones increase urinary excretion of uric acid, pre-menopausal women have a substantially lower prevalence of gout compared with men .6 Black persons have a higher risk.7 Consuming alcoholic drinks , meat , some seafood , fruit juice, and beverages sweetened with high-fructose corn syrup increases the risk of gout.8,9 Purine-rich foods such as nuts, oatmeal, asparagus, legumes, and mushrooms do not seem to increase the risk.10 Consumption of dairy products appears to confer slight protection from gout10 .

Diuretic use*

*Adjusted for age.

Adapted with permission from Roddy E, Doherty M. Epidemiology of gout. Arthritis Res Ther. 2010 12:223, with additional information from reference 12.

Diuretic use*

*Adjusted for age.

Adapted with permission from Roddy E, Doherty M. Epidemiology of gout. Arthritis Res Ther. 2010 12:223, with additional information from reference 12.

Hard nodules on distal digit.

• References

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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

Who Is Affected By Gout

Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.

People are more likely to get gout if they have:

• Obesity, or a lot of extra weight.

You are also more likely to develop gout if you:

• Consume a diet high in animal proteins
• Consume a significant amount of alcohol
• Are on water pills .

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