Tuesday, October 4, 2022

How Long Does Pain From Gout Last

What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like

HOW LONG DOES A GOUT ATTACK LAST?

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.

Signs And Symptoms Of Gout

Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.

Signs and symptoms of gout include:

  • severe pain in one or more joints
  • the joint feeling hot and very tender
  • swelling in and around the affected joint
  • red, shiny skin over the affected joint

Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.

Almost everyone with gout will experience further attacks at some point, usually within a year.

Read more about the complications of gout.

What Increases Your Chances For Gout

The following make it more likely that you will develop hyperuricemia, which causes gout:

  • Being male
  • Using certain medications, such as diuretics .
  • Drinking alcohol. The risk of gout is greater as alcohol intake goes up.
  • Eating or drinking food and drinks high in fructose .
  • Having a diet high in purines, which the body breaks down into uric acid. Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna.
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    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:

    Who Is At Risk For Gout

    How Long Does Gout Last? These 3 Factors Determine the Answer ...

    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.

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    How Will Gout Affect Me

    Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.

    Without medication attacks tend to happen more often and other joints can become affected.

    Having high urate levels and gout for a long time can lead to other health problems, including:

    • narrowing of the arteries – which can lead to an increased risk of stroke or heart attacks or other heart problems
    • osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
    • an increased risk of developing kidney disease or worsening of the condition if you already have it
    • kidney stones
    • an increased risk of some cancers, especially prostate cancer
    • mental health problems, including depression
    • underactive thyroid
    • erectile dysfunction in men.

    If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.

    Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:

    • treating the acute attack
    • treatments to prevent future attacks.

    S To Care For Yourself During A Gout Attack

    There are some steps you can take at home to help ease the pain of gout, encourage kidney function, and lower the levels of uric acid thats triggering and worsening your flare-up:

    • Increase your fluids, especially water
    • Dont resist the urge to urinate
    • Rest, elevate, and ice your painful joints
    • Take an anti-inflammatory pain medication like ibuprofen or naproxen
    • Use epsom salt soaks
    • Take any prescribed medicines that decrease your uric acid levels
    • Eat foods and supplements that lower uric acid, such as magnesium, sour cherries, ginger, and celery
    • Stay away from alcohol, shellfish, and red meat, which cause your body to make uric acid

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    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.

    Different Pain Intensity Is Noticed

    How long does gout usually last?

    The first thing I will reveal is that the pain you feel wont always be the same. It is the strongest during the first 12-24 hours, but after that, it will start declining, until you are finally free of it. Most people experience a gout attack which lasts between 3 days and 1 week, but as I have mentioned, this matter cannot be generalized. It is possible that your gout attack lasts for a few weeks, even 2 months! During that time, you will be trapped in a bed at home and you wont be able to go to work or to continue with your daily routine.

    I also must add the fact that gout and its attacks must be treated as soon as possible. Ideally, you would use some method for prevention, but if still, an attack occurs make sure you start a treatment at the same moment. Take ibuprofen or colchicine. Stay calm and continue using some of the preventives I have revealed so far.

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    If you have frequent gout attacks, make sure to find the main cause of it. As we all know, gout is a progressive disease which can be triggered by numerous factors, so always try to find the solution and use it straight away.

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    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.

    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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    What To Do For A Gout Attack

    Medication may shorten a gout attack. Your doctor may prescribe medication that blocks inflammation called a nonsteroidal anti-inflammatory drug , you may also take a drug called colchicine or a strong anti-inflammatory steroid drug. Over-the-counter NSAIDs include ibuprofen and naproxen.

    These drugs will reduce the pain and inflammation, but there are also home treatments that will help. Home treatment includes resting your joint, elevating your joint above the level of your heart, and using ice packs to reduce pain and swelling.

    What Can Trigger A Gout Attack

    Gout: Symptoms, Causes and Natural Support Strategies

    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.

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    To Treat An Acute Attack

    To stop a gout attack, your doctor will give you medicines. These are usually pills like colchicine, NSAIDs , or a steroid medicine. Sometimes it’s treated with a steroid shot. The sooner you get started on medicines, the sooner your symptoms will start to get better.

    To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. Using ice on the sore joint may also help.

    How Long Does Gout Last If Untreated Introduction

    You might be aware that I usually explain facts about resources for gout sufferers. Then, I conclude with suggestions how you might apply those facts to adapt resources to your personal situation. But, for gout duration questions, there are too many variables to consider. Because most of the factors that set how long gout takes are up to you.

    Especially in this case, where we are looking at allowing gout to end naturally. Because it is extremely rare for any gout sufferer to make no effort to limit gout pain. However, if you are in a situation where you cannot get treatment, the following information might help.

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    What Else Should I Ask My Healthcare Provider About Gout

    Consider asking your healthcare provider:

    • What is causing the gout?
    • Do I have any joint damage?
    • What can I do to prevent future attacks?
    • Can any gout medications help me?
    • How long will I need to take gout medications?

    A note from Cleveland Clinic

    Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.

    Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.

    References

    What Happens At Your Appointment

    HOW LONG DOES A GOUT ATTACK LAST

    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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    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.

    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.

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    Why Do Gout Attacks Occur

    The simplest explanation is due to high levels of uric acid. If the level is 5 mg/dl or higher, you can expect a gout attack. Some people can even record extremely high levels of the aforementioned acid and it may reach up to 18 mg/dl. If this occurs, you can expect a permanent joint inflammation so wheelchairs are mandatory!

    The main point here is that you must keep your uric acid level at 5 mg/dl or lower. Thats why it is important to have regular tests in order to determine if the therapy actually working. If it is, then there is no need for you to feel scared. There wont be a gout attack. On the other hand, if the uric acid level is too high, you will have to start a new therapy. I dont have to tell you that the test is performed by a doctor who will measure the uric acid level and the elimination of its crystals in the joints. If they are not eliminated on time or in proper amounts. The therapy will have to be increased, all in order to protect you from pain and gout.

    Keep in mind that gout is a progressive disease, meaning that it will advance all the time. If you dont get used to it, you will expose yourself to more frequent gout attacks, which are definitely something worth avoiding!

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    Can It Lead To Any Complications

    Why Does My Big Toe Pain?

    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.

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    How Long Can Untreated Gout Last

    In the colchicine trial, one-third of patients taking placebo experienced a 50% improvement in pain after 2 days. So, though this was half the success rate of the colchicine group, it shows untreated gout can resolve naturally in 2 days. But, as this was a fixed 2-day trial, we dont know the upper limit.

    However, the untreated gout attack study lasted 7 days. So this gives us a range of days, despite different criteria being used. Because this study reports 18% improved gout pain in 2 days, with 100% in 5 days. Therefore we can see that gout pain resolves naturally in 2 to 5 days. But, that is not the full story.

    In addition to gout pain, we suffer tenderness, redness, swelling, and heat. All of which cause discomfort. So, we cannot truly say that a gout attack has ended after 5 days. Because patients in the second study continued to experience some discomfort after 7 days.

    In conclusion, these reports prove that acute gout will resolve naturally if untreated. So, it is recognized as a self-limiting disease. But putting an exact time on the duration of untreated gout is impossible. So a range of 2 to 5 days for most gout sufferers is the nearest we can get. Hence, we should consider a recent review of managing acute gout. Where Scheslinger concludes:

    The initial attacks are usually self-limiting, but recurrent acute attacks tend to become more frequent and prolonged.

    Furthermore, recent research confirms:

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