Thursday, June 16, 2022

How To Diagnose Gout In Toe

How Are Gout Attacks Prevented

How to Recognize Gout Symptoms | Foot Care

Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.

Related Conditions And Causes Of Gout

Other conditions that are sometimes confused with gout include:

What Are The Symptoms Of Gout In The Ankle

The main symptom of gout in the ankle is pain and discomfort in the surrounding area. Keep in mind that gout is often unpredictable, regardless of the joint its affecting. You might go weeks or even months without any symptoms, only to wake up with a burning pain in your ankle.

In some cases, gout starts out in one of your big toes before moving on to other areas, such as your ankle. Over time, these flare-ups may last longer than they previously did.

Other symptoms you might feel from gout in your ankle include:

  • tenderness

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When To See A Doctor

Gout occurs without warning. Anyone experiencing intense pain on the big toe, followed by warmth, tenderness, redness or discoloration, should immediately seek medical attention.

If a person does not receive treatment for gout, it can lead to joint damage over time, including bone erosions and arthritis.

Avoid Foods That May Trigger Gout

Gout in big toe: How to identify, causes, and treatment

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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The Role Of Medication In Prevention Of Gout

Table 3: Medications to pevent attacks of gout

  • Colchicine: to decrease the ability of uric acid crystals to cause inflammation.
  • Allopurinol and febuxostat: to decrease production of uric acid
  • Probenecid and lesinurad: to increase the excretion of uric acid
  • Pegloticase: to increase the breakdown of uric acid
  • 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

    Diagnosis And Management Of Gout

    Gout is a common cause of acute arthritis. An ageing population, increasing obesity, and lifestyle changes will render it more common.1 Here I outline the epidemiology of gout, appraise the evidence base for its management, and suggest ways of managing idiopathic gout. Management of hyperuricaemia due to inborn errors of metabolism and its prevention during cancer chemotherapy are not discussed here.

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    Risk Factors And Potential Causes Of Gout

    Gout strikes men more often than women until women undergo menopause, and then women experience increased risk. Being overweight or obese, having recent surgery, and experiencing a trauma also increase your risk, as well as your family history.

    Your body produces uric acid when it breaks down purines a substance found naturally in your body, and also in high-protein red meat, organ meat, and certain types of seafood. In addition, alcoholic drinks, beer, and beverages sweetened with fructose can raise your natural uric acid levels. When your body either creates too much uric acid or excretes too little, it can lead to gout. Hundreds of years ago, gout was called the disease of kings because the average peasant couldnt afford such rich food and drink.

    Medical conditions like untreated high blood pressure, diabetes, heart disease, and kidney disease can also increase your chances of developing gout, as does taking certain medications, such as thiazide diuretics and low-dose aspirin.

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    Differences Between Men And Women

    What is the Best Way to Diagnose Gout in the Foot?.m4v

    Sex differences play a role in which joints are affected:

    • In men, about 85% of gout flare-ups affect joints in the lower extremities. About 50% of first-time gout attacks involve a big toe joint.8
    • In women, a gout attack is most likely to occur in a knee.10 In addition, women may be more likely to get gout in the upper extremities.9

    While women are less likely to get gout, they are more likely to have multiple joints affected by gout.13

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    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

  • Nonsteroidal anti-inflammatory drugs or COX-2 inhibitorsExamples of : Naproxen 500mg twice daily, indomethacin 25mg three times daily. Example of COX-2 inhibitor: celecoxib 200mg twice a day. Possible side-effects: Elevation of blood pressure, ankle swelling, upset stomach, ulcer . Use with caution if kidney or liver problems.
  • Anti-Inflammatory corticosteroidsExamples of : Prednisone 40mg first day, 30mg 2nd day, 20mg third day, 10mg fourth day. Possible side-effects: Elevation of blood pressure, elevation of blood sugar, mood changes. Short-term use, as in gout, generally much better tolerated than long-term use. Use with caution if diabetic.
  • Treatments For Big Toe Gout

    Remedies for gout has proven to be successful after a wide range of research. There are two major parts to treating gout. They include :- 1) treating the acute gout attack and 2) treatment for prevention of future attacks.

    Treating acute gout attack: This treatment only helps to manage your symptoms in the event of an attack. The common drugs used for treating gout attacks are:

    Non-steroidal anti-inflammatory drugs : These drugs help to reduce pain and inflammation. Examples are ibuprofen, diclofenac, and naproxen. However, NSAIDs may not be suitable for everyone. There re other alternative options that work like NSAIDs.

    Colchicine: This is another drug you can take in place of NSAIDs. It is also effective in reducing the inflammation caused by uric acid crystals. If you have chronic kidney disease, avoid taking colchicine as it causes diarrhea or stomach pain.

    Steroids: These are drugs you can take if you are at risk of side effects of NSAIDs and colchicine.

    For managing a gout attack at home, you can adopt the PRICE therapy. Rest Rest the affected joint, that is, the big toe joint

    Ice-Make sure to ice the joint area immediately after sustaining the attack to reduce the swelling. Apply cold packs for about 20 minutes at a time, and do this several times a day.

    Compression Wrap the area of the joint with a compression bandage to prevent further swelling.

    Elevation Raise the joint area and support with a soft object like a pillow.

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    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.

    How To Prevent Gout

    Gout

    You can manage gout symptoms and help to prevent them occurring by taking gout medication and making dietary and lifestyle choices. Medication can help to stop your level of uric acid getting too high, whilst avoiding certain foods which cause your body to create more uric acid can also be effective in preventing gout. Lifestyle choices, such as exercise, can also help to prevent gout.

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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.

    Risk Factors For Gout

    Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, diabetes, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels in patients with gout.

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    Get An Accurate Diagnosis And Treatment

    While gout attack symptoms do resolve on their own, people are advised to seek medical treatment. If left untreated, gout can become chronic and cause lasting joint damage.

    Diagnosis begins with a clinical exam and interview. Patients are encouraged to be honest with their health care providers about their eating, drinking, and other lifestyle habits. This honesty can be helpful both for diagnosing gout and creating a treatment plan. Diagnosis may also involve blood tests, urine tests, and medical imaging, such as x-rays and ultrasound.

    See Gout Diagnosis

    Treatment typically involves advice to avoid alcohol and certain foods known to trigger gout, such as foods and drink high in sugar, seafood, red meat, and organ meats.19 Medications to lower urate levels in the bloodâwhich can lead to gout attacksâare often recommended. Losing excess weight is another effective way to reduce the risk of a gout attack and chronic gout.20

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    Who Gets Gout And Hyperuricaemia

    Gout in the big toe joint or the foot: *Complete Home Guide*

    In most studies the prevalence of gout is at least 1%. In some countries it is substantially higherfor example, 3.6% in New Zealand Europeans and 6.4% in Maoris.57 Gout is much more common in men than in women it is rare before menopause and more common in old age .

    Prevalence of gout. Adapted from Mikuls et al5

    Box 1 Factors affecting serum urate concentration

    Factors that decrease serum urate concentration

    • Diet: low fat dairy products

    • Drugs: xanthine oxidase inhibitors , uricosuric drugs , uricase drugs , coumarin anticoagulants, and oestrogens

    Factors that increase serum urate concentration

    • Diet: meat, fish, alcohol , obesity, and weight gain

    • Drugs: including diuretics, low dose salicylates, pyrazinamide, ethambutol, cytotoxics, and lead poisoning

    • Disease: increased purine turnovermyeloproliferative and lymphoproliferative disorders, chronic haemolytic anaemia, haemoglobinopathies, secondary polycythaemia, thalassaemia increased purine synthesisglucose-6-phosphate dehydrogenase deficiency, Lesch-Nyhan syndrome reduced renal excretionhypertension, hypothyroidism, sickle cell anaemia, hyperparathyroidism, chronic renal disease

    Box 2 American College of Rheumatology preliminary criteria for the clinical diagnosis of gout14

    Six or more of these criteria are needed to make a diagnosis:

    Relation between serum urate concentration and annual incidence of gout. Adapted from Campion et al8

    Data from health professionals follow-up study.9,10

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    What To Do During An Attack

    You should:

    • take any medication you’ve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
    • rest and raise the limb
    • avoid knocking or damaging the affected joint
    • keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
    • ensure you’re well hydrated

    Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.

    If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.

    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

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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

    Gout In Foot: Causes And Risk Factors

    Gout in big toe: How to identify, causes, and treatment

    In about 90 percent of hyperuricaemia cases, there is impaired renal excretion in about 10 percent, there is a problem with overproduction.

    • Urate overproduction can be linked to lifestyle factors and certain diseases such as bone marrow cancers, psoriasis, and hemolytic anemia. Lifestyle factors include being overweight and ingesting excess amount of fructose or alcohol.
    • Renal impairment has multiple causes, including gene mutations, hypertension, diuretic drugs, lead exposure, and cyclosporine immunosuppressive therapy.
    • Gender and age. Men are twice as likely to develop gout as women. In men, the risk rises with age. Gout is uncommon in younger women but the incidence increases dramatically after menopause, due to falling estrogen.
    • Western diet. There is solid evidence from the Health Professional Follow-up Study of a link between gout and purine-rich foods. See gout diet.
    • Medications. Diuretics, antihypertensives, niacin, aspirin, chemotherapy and immunosuppressive drugs increase the risk of gout.
    • Other conditions. Certain conditions carry an increased risk of gout including: Recent joint injury or surgery, cardiovascular disease, chronic pulmonary disease, anemia, psoriasis, renal disease, blood cancers, and metabolic syndrome.

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    Gout Big Toe Facts List

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