Hot And Cold Compresses
Switching between a hot compress for three minutes and a cold compress for 30 seconds on the affected area can help reduce pain and swelling that occurs during a gout attack.
In most people, a first acute gout attack comes without warning, and there arent any other symptoms of high uric acid. Prevention efforts for gout are focused on preventing future attacks or lessening their severity.
Medicines For Gout Attacks
The main goal of treatment during a gout attack is to decrease pain and swelling. Some medicines are safe for people with kidney disease, and some are not. Talk to your doctor about which medicines make the most sense for you to try.
Nonsteroidal anti-inflammatory drugs
NSAIDs are medicines that decrease pain and swelling. Some NSAIDs are available over-the-counter, like ibuprofen and naproxen sodium. Stronger NSAIDs like indomethacin and celecoxib must be prescribed by a doctor. Taking NSAIDs can lead to kidney disease over time or make kidney disease worse. NSAIDs may not be recommended when you have kidney disease even for the treatment of gout attacks.
Colchine is a medicine that can relieve pain. Your doctor may recommend taking colchine during a gout attack, or low doses of colchine every day if you have chronic gout. Colchine may not be recommended for people with kidney disease. Talk to your doctor about whether colchine is right for you.
Corticosteroids, also known as steroids
Steroids are strong medicines used to decrease swelling and pain. Steroids are usually only given for gout if you cannot take NSAIDS or colchine. Steroids can be in the form of a pill or given as an injection. Talk to your doctor about whether steroids are safe for you.
Pain Relief Without Medicine
Use cold. If your pain isn’t too bad, try cold packs or compresses on the joint to lower inflammation and soothe the ache. Wrap ice in a thin towel and apply it to the joint for up to 20 minutes several times a day. Do not apply ice to your hands or feet if you have nerve problems from diabetes or other causes.
Rest the joint. It’s a good idea to rest it until the pain eases up. You probably won’t want to move it much anyway. If you can, raise the joint on a pillow or other soft object.
Drink water. When your body doesnât have enough water, your uric acid levels rise even higher. Stay hydrated to help keep those levels normal.
Watch what you eat and drink. Foods that are high in substances called purines, such as some seafood, organ meats like liver, and fatty foods, can raise the uric acid in your blood even more. So can fructose-sweetened drinks and alcohol — especially beer.
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Corticotropin Or Adrenocorticotrophic Hormone
Another possible first-line therapy for an acute gout attack is adrenocorticotropic hormone, or corticotropin or ACTH . Its not a common first-line treatment for a gout attack, but its a possible option for some people, particularly those who cannot take oral NSAIDs, colchicine or corticosteroids for some reason, or who are hospitalized.
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How To Treat Gout
It can be excruciating, and many sufferers go undertreated. But you can prevent the pain.
The word gout may make you think of overweight Victorian-era royalty with overly rich diets. But this common form of inflammatory arthritis, which leads to pain and swelling in one or more jointsespecially in the lower bodyaffects people even in the modern era. In fact, more than 9 million adults in the U.S. have been diagnosed with the disease, which occurs when the body produces too much uric acid or the kidneys dont excrete enough.
That surplus forms crystals in and around joints, eventually causing flares or attacks. People with high levels of uric acid can be accumulating crystals and damage to the joints for years before they have their first gout attack, says Larry Edwards, MD, a professor of medicine at the University of Florida.
Gout is on the rise, says John FitzGerald, MD, a professor of medicine at the David Geffen School of Medicine at UCLA and an author of guidelines from the American College of Rheumatology about gout management.
A genetic predisposition, diabetes, kidney disease, and other health problems may increase the chance of developing it. The growing number of people with metabolic syndrome and obesity is increasing the risk of gout, says FitzGerald, adding that some of the treatments for the conditions mentioned above may also raise the risk.
Other Ways To Treat Gout
Medicine is considered the most effective treatment method for gout, but there are lifestyle changes you can make to manage your symptoms during a gout attack, or help prevent gout attacks from happening. Learn more about other ways to manage symptoms of gout during an attack here. Learn more about preventing future gout attacks here.
Educational content made possible by Horizon Therapeutics.
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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.
Urinary Uric Acid Excretion
Urinary uric acid excretion is rarely performed in clinical practice as xanthine oxidase inhibitors are extremely effective in treating gout, and need only be checked in those with premature onset gout, that is disease onset prior to 25 years of age, or if there is a family history of early-onset gout. If required, a 24-hour urine collection is preferred over a spot uric acid creatinine ratio.
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Crystal Formation And The Inflammatory Response
The formation of urate crystals only occurs in about 20% of people with uric acid concentrations above the saturation level, however the likelihood increases as the concentration increases. Crystals form initially within joints and subsequently in other connective tissue sites such as bones, skin and tendons. An aggregation of crystals is called a tophus. Although hyperuricaemia is required for crystal formation, it is not the full explanation. Urate crystals form in only certain locations, and not at all in most people with hyperuricaemia. Various biological substances, such as IgG, influence the nucleation and growth of urate crystals. The balance between inhibitors and promoters of crystal formation probably plays a major role in determining if and where urate crystals form.
Urate crystal formation occurs slowly and does not produce symptoms. The inflammatory system largely ignores the crystals most of the time, but eventually an inflammatory response occurs resulting in an attack of gout. Many components of the inflammatory system are involved in acute gouty inflammation and neutrophils play a key role.
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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Home Remedies For Gout Flares
While you taking medication to fight the pain and inflammation during a gout flare, there are a few other simple gout home remedies you can use to ease the discomfort. Rest is important try to keep the impacted joint higher than your heart. Ice may also be helpful, because it brings down swelling. Research shows that ice is particularly soothing for gout if youre dealing with a different type of arthritis, a heating pad may be a better choice.
Some people also say that eating cherries or drinking tart cherry juice helps during a gout flare. While studies have shown that cherry lovers may be less likely to have frequent gout flares, its not clear whether loading up on this fruit during an attack will make an immediate difference. Cherries may be helpful because theyre rich in antioxidants, and tart cherries may help lower uric acid levels .
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The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
Medicines To Prevent Recurrent Gout Attacks
If you have repeated attacks of gout, your doctor may recommend preventive medication. This helps to prevent further attacks of gout and damage to your joints and organs such as your kidneys.
Because gout is caused by raised uric acid levels in the blood, preventive medications work by reducing uric acid levels. This is also called urate lowering therapy.
The goal of these medicines is to reduce the uric acid levels below 0.36mmol/L. If the uric acid level is kept at this level long-term, the gout crystals will dissolve, and the risk of gout attacks and joint damage from gout will gradually reduce. The options include:
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Why Do I Suffer From Gout
One word: hyperuricemia. Or, in other words, increased uric acid in your blood. This is the reason why your joints are painful and inflamed. Uric acid is a normal product in your body it is a substance that breaks down purines in your body which are found in certain foods that we eat, in addition to being found in human cells. When your body overproduces uric acid, youre at risk for developing gout. But, why would your body overproduce uric acid?
The triggers of hyperuricemia include:
- Excessive alcohol consumption
- Eating large amounts of red meat and shellfish
- Drinking sugary sodas
It is these types of triggers that can create the hyperuricemia, which can result in gout. When you overproduce uric acid, your kidneys have to work harder to flush out the extra uric acid out of your bloodstream, as they would normally do.
Take Caution With Supplements For Gout
As for the many supplements and other purported home remedies available for gout, including turmeric and bromelain, there is no significant evidence backing them up as of now, and theres no adequate evidence showing that supplements have any effect even comparable to that of medicines.
From my point of view, says Dr. Fields, the home remedy concept to gout is often harmful because it keeps patients from taking medications that we know are effective.
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Who Is Affected By Gout
Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
- Obesity, or a lot of extra weight.
You are also more likely to develop gout if you:
- Consume a diet high in animal proteins
- Consume a significant amount of alcohol
- Are on water pills .
Can Diet Make A Difference
Your doctor may recommend that you limit foods that may hike uric acid levels. That includes organ and red meats, shellfish , alcohol , and sugar and high-fructose corn syrup.
According to the ACR, purine-rich vegetables like mushrooms and spinach should be fine, and low-fat dairy foods may help lower uric acid levels. But even with a gout-preventing diet, most people see, at best, a modest decline in uric acid levels, Shoor says. So if youre on ULT, sticking to your regimen is key.
Editors Note: A version of this article also appeared in the January 2021 issue of Consumer Reports On Health.
Sally Wadyka is a freelance writer who contributes to Consumer Reports, Real Simple, Martha Stewart Living, Yoga Journal, and the Food Network on topics such as health, nutrition, and wellness.
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Elevating The Affected Joints
Gout can cause pain and swelling, especially in the feet, hands, knees, and ankles.
One way to reduce swelling is by elevating the affected joints. This encourages blood and fluid to move away from the joint and back toward the heart.
A person can also use an ice-pack in combination with elevation to reduce their gout symptoms.
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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