How To Handle Your First Gout Attack
After a first attack of gout, its OK to try to stave off another one with dietary changes alone. But if you have another attack, its important to start taking preventive gout medications on a regular basis. Long-term medications for gout include allopurinol and febuxostat, both of which limit uric acid production.
Some patients, says Dr. Fields, treat each attack as a separate event and dont talk to their doctors about doing a preventive approach. He uses the analogy of lighting a book of matches. If you have one match lit, its easy to put out, but if you have the whole book lit, its a lot harder.
The Right Treatment Plan
Over-the-counter medications such as ibuprofen , prescription anti-inflammatory drugs like colchicine , and prescription steroids like prednisone can help reduce joint pain and swelling during an acute attack or flare.
Long-term, your doctor may recommend urate-lowering therapy , which means taking medications such as allopurinol and febuxostat daily. There is the possibility of future damage to your joints if you dont control it, says Stanford Shoor, MD, a clinical professor of medicine and rheumatology at Stanford University.
ACR recommends ULT if you have tophi or evidence of joint damage, or if youve had two or more attacks in a year. But whether or not you start ULT after one attack depends a bit on how much we think youre going to have future attacks, FitzGerald says. If you dont have kidney disease or very high uric acid levels, it may be years before you have another attack, and you might not want to go on daily therapy.
The standard of care generally calls for whats called treat to target, starting with a low dose of ULT and adjusting it until your uric acid levels drop to a specific level. Newer ACR guidelines strongly recommend treatment that keeps uric acid concentrations below 6 mg/dL, which is low enough to keep the acid from crystallizing.
Signs & Gout Symptoms
As mentioned above, the first sign of gout symptoms may be the sudden onset of severe pain in one of your big toes or other joints. In fact, this first attack often occurs at night and causes enough pain and discomfort to awaken you. Many individuals experience pain so severe that even lying under a sheet may become unbearable.
For some, the pain may go away on its own in a week or 10 days, only to recur in the weeks or months following. For others, the pain may last for extended periods of time, or slightly ebb and flow over weeks or months.
Typically, the pain is at its greatest in the first 12 to 24 hours of the attack however, this can vary depending on your diet and other factors. In addition to severe pain in the big toe, other common gout symptoms include:
- Severe pain in joints including feet, ankles, knees, hips, wrists, hands, fingers and back where even the weight of a sheet or clothing is intolerable.
- Noticeable discoloration in the joints they may become deep red or even purple at onset, and change color through the attack.
- Joints that are swollen and stiff and hot to the touch.
- A fever of up to 102.2F, with or without chills.
- Joints that are inflamed and tender accompanied by decreased mobility.
- Lingering discomfort as the joint pain and inflammation can last for days or weeks.
- Hard lumps or bumps at the joints.
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Diagnosis And Treatment For Gout In Wrist
Wrist pain may be misdiagnosed with other conditions. Therefore, a correct diagnosis of wrist gout is essential to give proper treatment. The diagnosis of gout in the wrist is done on the basis of physical examination of the wrist joint, knowing family and medical history, laboratory investigations such as determination of serum uric acid levels, and synovial fluid analysis.
The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
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Pseudogout Vs Gout: How Can We Tell
Generally, it can be challenging to differentiate between the two. However, there are clues as to whether symptoms are pseudogout or gout.
First, gout usually occurs in younger men in theirs 50s and initially affects one joint at a time usually the toe or ankle. Pseudogout usually affects older people and can affect more than one joint of the knees, wrists, and ankle.
Second, diets high in purines can trigger gout whereas pseudogout is unaffected by diet.
Thirdly, attacks of gout usually last for only days and rarely weeks whereas pseudogout can last up to 3 months.
Finally, tests can give further clues. On ultrasound, uric acid crystals form on top of the cartilage and are often referred to as a double contour sign. In pseudogout, we see calcium in the middle of the articular cartilage. When analysing fluid from joints, uric acid crystals look needle-shaped while calcium crystals are rod-shaped.
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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Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
End Discomfort & Pain From Gout Symptoms
May 18, 2017
If you awaken from a sound sleep to excruciating joint pain in your big toe, you may be experiencing one of several gout symptoms. Gout is on the rise in America, affecting millions of people each year. In fact, the latest research, from 10 years ago, found that the rates of gout doubled in 20 years prior. More than eight million Americans have gout. ” rel=”nofollow”> 2)
Many believe this dramatic increase is due to poor diets, obesity and a lack of exercise, although genetics is also thought to play a role.
Too much uric acid in the body can also cause kidney stones and in more severe cases lead to kidney failure due to the blockage caused by uric acid crystals. In addition, if the root cause of gout is not addressed, you may be at a greater risk of developing certain types of cancer and heart disease.
Statistically, men are far more likely to get gout than women. However, it is becoming more common in women, particularly after menopause.
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Other Symptoms Of Acute Gout Or A Gout Attack
- Sudden crushing or throbbing pain in one or a few joints that may last for a few days
- Sometimes an acute gouty arthritis attack has a sudden onset at nighttime. The big toe joint pain may be so severe that even the weight of bedsheets causes discomfort.
- Joints that appear swollen and inflamed, with reddish-purple skin that may feel warm
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 Achilles’ 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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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.
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
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The End Of Gout Your Quick Start Plan
Shelly Mannings The End of Gout is not only a fascinating read its also refreshingly practical.
Shelly gives you two simple quick-starts:
Eat more of these
Eat fewer of these
This simple adjustment can correct years of gout-causing errors within your eating. And you can start on this straight within minutes of receiving the program away.That really helped my problem of How To Treat Gout In The Big Toe.
The next step is to follow Shellys 7-day plan.
It tightens up the quick start advice and turns it into a solid, follow-along program.
The 7-day plan was the real clincher for me.
I am a pretty average cook Im competent but not at all skilled or adventurous. Turns out I didnt need to be.
The plan takes away all the thinking and gives me, for the first week, something I can simply copy.
After the first 7 days I used Shellys advice to adapt the plan according to my own tastes.
Which was pretty easy the plan is full of options so you can try different foods and see what you like best.
Its all food you can buy in your supermarket. And it includes lots of nice stuff the chocolate and strawberries desserts were real winners in my house!
Managing Symptoms And The Underlying Triggers
Gout is a form of arthritis caused by the buildup and crystallization of uric acid in a joint. Depending on the severity of an attack, treatment may involve over-the-counter anti-inflammatory drugs to alleviate pain, as well as behavioral modifications to reduce the frequency of attacks. Chronic attacks may require prescription medications to help reduce uric acid levels in the blood.
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When To Get Help For A Gout Flare
It’s always a good idea to let your doctor know that you are having a flare. Sometimes, you may need to follow up to make sure your treatment plan is working or if your symptoms don’t improve. Call your doctor if:
This is your first flare-up. There are several other conditions, such as a joint infection, that have some of the same symptoms as gout attacks.
You have a highfever and chills. Gout attack symptoms may include a mild fever, but a higher temperature may be a sign of an infection.
Your symptoms don’t get any better after 48 hours or don’t end after about a week. If you don’t start to feel somewhat better after a few days, call your doctor. They may suggest a different treatment. Most gout attacks will go away by themselves in several weeks, even without treatment.
Show Sources
Rebecca Manno, MD, MHS, assistant professor of medicine, division of rheumatology, Johns Hopkins University School of Medicine.
Robert T. Keenan, MD, MPH, assistant professor of medicine, division of rheumatology and immunology, Duke University School of Medicine.
Scott Zashin, MD, clinical professor of medicine, University of Texas Southwestern Medical School attending physician, Presbyterian Hospital.
Lan Chen, MD, PhD, attending rheumatologist, Penn Presbyterian Medical Center.
Gout and Pseudogout Treatment & Management: “Treatment.”
Johns Hopkins Arthritis Center: “Gout — Treatments for Gout.”
Merck Manual: “Gout.”
Take Your Prescription Drugs
If you’ve had a gout attack before, your physician may have prescribed drugs to treat attacks. This may be your first line of defense or you may decide to use them only when NSAIDs fail to relieve your pain.
Prescription medications to treat gout include:
- Prednisolone oral tablets, which has been shown to work as well as NSAIDs and often doesnt cause the same stomach upset. Prednisolone is a type of corticosteroid and does carry other potential side effects, particularly if it is taken for longer than the recommended 5 days.4
- Colchicine, which has been shown effective in reducing pain and inflammation if taken in the first 24 hours of an attack. Always follow your physicians instructions regarding dosing to decrease your risk for potential complications and side effects.
Opioid painkillers, such as codeine, hydrocodone, and oxycodone, are not recommended to treat the pain caused by gout.
See Pain Medications for Arthritis Pain Relief
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Chronic Gout Signs And Symptoms
- Compared with the dramatic nature of acute gout pain, chronic gout pain is more of a soreness or persistent ache.
- Pain that tends to be a more continuous feeling of dull aching or soreness in the joints
- Hard white deposits or lumps under the skin, called tophi, found on the elbows, ears, or fingers.