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:
What Are Symptoms Of Gout
The large joint at the base of the big toe is the most common site for a gout attack, however, any other joint can be affected. Most commonly, other joints affected are the ankles, knees, wrists, fingers, and elbows.
Patients with gout attacks suffer a rapid onset of pain in the affected joint followed by swelling, redness, and severe tenderness. Some experience pain so intense that even the light touch of a bed sheet on the joint is excruciating. These painful attacks can last from hours to several days. In cases of chronic inflammation, the attack may last for weeks. Unfortunately, patients with gout are at risk for repeated attacks of gouty arthritis.
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
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What Are The Causes And Triggers Of Gout In The Elbow
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 elbow 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
How Common Is Elbow Gout
In terms of gout flare-ups, the elbows are not the most commonly affected joints the big toe, knees, hands, and even ankles are more likely to suffer from the condition. It is speculated that this may be due to the fact that the elbow joints are somewhat warmer than the joints found in the distal extremities. This makes sense as the parts of the body closest to the heart tend to be warmer due to increased blood circulation from the heart. Also, remember that uric acid crystal formation is promoted by colder temperatures.
Another explanation for the relative rarity of elbow gout is that the synovial fluid of the elbow joint is more alkaline, which means it has a higher pH level. Observations of previously documented cases of gout found that the higher pH levels of the synovial fluid of the elbow were associated with less virulent attacks.
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The Difference Between Bursitis And Gout
One condition that may also affect the elbow, which may also be confused with gout, is bursitis. As a matter of fact, these two conditions share the same symptoms. This is the reason why it is important to visit your doctor if you have an inflamed elbow to diagnose and treat it properly. Bursitis is a condition, which affects the small sacs filled with fluid that cushion the bones, muscles, and tendons nearing the joints. When these small sacs get swollen, bursitis may occur close to the joints. These joints perform recurrent motion like the hip, heel, elbow, and knee. Moreover, the bursitis is a condition that typically needs a rest to treat.
It is important to take not that those who are suffering from gout, diabetes, and rheumatoid arthritis have a much higher risk of developing bursitis. Also, remember that one complication of bursitis, which affects the big toes sometimes is the development of a bunion. This is a tender swelling on the joint of the bog toes. This too may be confused with gout, thats why checking it out is very important.
As a conclusion, one thing is for a certain. If you acquire gout in the elbow, it just means that your own gout treatment is not working for you or you may have just ignored the treatment at all. This should be a warning for you to taking the important lifestyle, medical changes in life, as well as dietary changes.
Treatments Your Physician May Prescribe
The goals of treatment of gout are to reduce the pain associated with acute attacks, to prevent future attacks from occurring, and to avoid the formation of tophi and kidney stones.Your physician may recommend one or more of the following treatments for acute attacks:
- Rest and elevation of the affected joint
- Anti-inflammatory medications, including ibuprofen, naproxen, or indomethacin
- Colchicine
- Corticosteroids such as triamcinolone injections or prednisone pills
- Low-purine diet
- Allopurinol
- Probenecid
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How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
Elbows Appearance And Other Symptoms
Another sign of gout is how your elbow looks during the attack. Gout will cause your elbow to become inflamed or swollen. This inflammation can start at your elbow and move to other areas of your body, such as your forearm or fingers. In addition, you may notice that the skin on your elbow appears shiny, constricted and red. After a few days, the skin on and around your elbow may start peeling.
References
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Bursitis Isnt The Same As Gout
It is important to explain that a similar condition may appear on your elbows, but it isnt gout. The condition in question is known as bursitis. Bursitis affects small sacs filled with fluids between the bones. It also affects mostly joints that are responsible for frequent movements, like hips, knees and obviously elbows.
Despite the fact the symptoms of gout and bursitis are almost the same, this isnt the same condition and the treatment is completely different. Bursitis will require a long period of rest in order to disappear and it is harmless, although can cause discomfort and a lot of pain. In addition, you will have to consult your doctor and ask for tests in order to determine the cause of the pain in your elbow and try to discover is that gout or bursitis. As I have explained, you wont be able to tell the difference due to almost identical symptoms. A doctor will probably check the elbows for the uric acid levels and the crystals. This is a simple test and it can be completed in no time. Also, it is painless.
There are a lot of different conditions that may affect your elbows and cause the same symptoms as gout, but they are not it. For example, nerve compression will cause pain and reduce the movement of the elbow. Rheumatoid arthritis will also cause the same issues. None of these conditions is actual gout and each one has a separate treatment.
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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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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
What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
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Gout Vs Bursitis Differences In Symptoms Causes And Treatments
Written byMohan GarikiparithiPublished onJuly 5, 2016
Bursitis and gout both affect the joints and can lead to inflammation and severe pain in the affected joints. Gout impacts the joint more directly than bursitis, which impacts the fluid-filled sacs that surround the joints and eliminate friction. Gout is caused by the formation of uric acid crystals, while bursitis can actually have a variety of causes, which we will go over in greater detail further on.
Another main difference between gout and bursitis is that bursitis can occur due to overuse of a certain joint, whereas this is not the case in gout. Performing repetitive motions is a key risk factor for bursitis again, this doesnt apply to gout.
Here, we will further explore the similarities and differences between bursitis and gout to help you better understand both of these joint conditions.
When To Seek Treatment
Dr. Glen Seidman
If you experience any elbow bursitis symptoms, you should visit the doctor right away. They will conduct an exam of the arm and several imaging tests to rule out other conditions. In addition, a blood sample and/or a bursa fluid analysis may be performed to pinpoint the exact cause of the fluid.
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Elbow Bursitis: Signs And Treatments
Elbow bursitis, also called olecranon bursitis, causes fluid to collect in a sac that lies behind the elbow, called the olecranon bursa. People may notice elbow bursitis as a squishy lump on the back of their elbow. Often this seemingly appears out of nowhere, or they may remember something that led to the onset of their symptoms.
Elbow bursitis is more common as people get older, seen more frequently in men, and more often on their dominant arm.
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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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
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.
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