Medications For Acute Gout
How Is Gout In The Ankle Diagnosed
If you think you might have gout but havent been diagnosed, try to see a doctor while youre having symptoms. Gout is easier to diagnose when youre in the middle of a flare-up thats causing swelling, redness, and other visible symptoms.
During your appointment, your doctor will likely ask you several questions about your diet, any medications you take, and whether you have a family history of gout. This can help to rule out other potential causes of your symptoms, including an infection or rheumatoid arthritis.
Your doctor may also order a blood test to check your uric acid levels. But some people have high levels of uric acid and dont develop gout. Others have typical uric acid levels but still develop gout. As a result, theyll want to do some other tests as well.
An X-ray, MRI, or CT scan of your ankle can also help to eliminate other possible causes of joint inflammation. Depending on your exam, they may also order an ultrasound to check for the presence of crystals in your ankle.
Finally, they might do a joint fluid test. This involves taking a small sample of joint fluid from your ankle with a small needle and looking at it under a microscope for any uric acid crystals.
Based on the results of your exam and tests, they may refer you to an inflammatory arthritis specialist called a rheumatologist for treatment.
Theres no cure for gout, but a combination of medications and home treatments can help to manage ankle pain and reduce the number of flare-ups you have.
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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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.
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.
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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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What Are The Symptoms Of Gout
An episode of gout is called a gout attack. Gout attacks are very painful and can happen quite suddenly, often overnight. During a gout attack, symptoms in the affected joint may include:
- Intense pain.
- Tenderness, even to light touch, such as from a bedsheet.
- Warmth, or a feeling like the joint is on fire.
- How long does a gout attack last?
A gout attack can last a week or two. Between gout attacks, you may have no symptoms at all.
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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.
How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
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Diagnosis Treatment And Prevention Of Gout
BARRY L. HAINER, MD ERIC MATHESON, MD and R. TRAVIS WILKES, MD, Medical University of South Carolina, Charleston, South Carolina
Am Fam Physician. 2014 Dec 15 90:831-836.
Gout is the most common inflammatory arthropathy, affecting more than 8 million Americans.1 Gout accounts for approximately 7 million ambulatory visits in the United States annually at a cost of nearly $1 billion.2 Risk factors include genetics, age, sex, and diet.2,3 These factors may contribute to a high serum uric acid level, which is currently defined as a value of at least 6.8 mg per dL .4,5
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Oral corticosteroids and nonsteroidal anti-inflammatory drugs are equally effective in the treatment of acute gout.
| Clinical recommendation | ||
|---|---|---|
|
To prevent recurrent gout, patients should reduce their consumption of high-fructose corn syrupsweetened soft drinks, fruit juices, and fructose-rich vegetables and fruits . Reducing consumption of meat and seafood, and increasing consumption of dairy products help reduce the frequency of gouty symptoms. Consumption of low-fat or nonfat dairy products may help reduce the frequency of flares. |
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
How Do You Get Gout
So, how do you get gout after all? Having lots of beer and purine rich foods might be the most popular issue. But then, there are people who never bother about what they eat or drink and they never experience gout. This is because there are a few risk factors to take in consideration and each of them could increase the risk of developing the affection.
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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
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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Blood Test To Check Uric Acid
A blood test is another way to diagnose gout, as it helps in checking the uric acid level in your blood. A high uric acid level can cause arthritis like gout. The normal level of uric acid in the blood ranges from 3.5 to 7.2 mg per deciliter. While you have some gout symptoms, doctors will ask you to check the uric acid level in your bloodstream. It must be lower than 6.0 mg/dl.
However, the blood test alone cannot ensure that you have gout. Some patients with a higher uric acid level do not have gout. On the contrary, those with a lower uric acid level have gout symptoms. Physicians will ask you to do other tests with the blood test to confirm the gout problems.
Is There A Test For Gout
There is no one test for gout, and its symptoms are similar to several different conditions. To see if you have gout, your health care provider may:
- Ask you to provide your medical history, including:
- Your symptoms.
- Any other medical problems you have.
- Any medications you are taking.
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What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
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.
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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.
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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