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.
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
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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Check The Following Symptoms To Determine If You May Have Gout:
- Extreme pain. One of the most identifiable symptoms is the extreme pain that gout brings on. It has been likened to being stabbed with two little knives. With gout, you are not able to put your weight on the knee or foot that has gout.
- Swelling. When you have gout the crystals from the uric acid create a great deal of inflammation and irritation which results in swollen joints.
- Stiffness. The stiffness from having gout is a result of the combination of the pain and the swelling.
- Redness. The inflammation and irritation from having gout causes a redness around the infected area.
- Fever. With an inflammation of this magnitude, you may find yourself suffering from a fever as well because of your compromised immune system.
- Tophi. If you have had gout many times and it keeps recurring, you may find that the uric acid crystals have developed into tophi, which are tiny white chunks that you can see through your skin.
- Strikes at night. It was discovered that many cases of gout show up at night because the temperature of the body is lower. This causes the crystals from the uric acid to take over the feet and other joints.
- Only affects one joint. While around 90 percent of the cases of gout occur on only one joint, more than half of them affect the big toe.
Begin healing yourself from gout with:
- Plenty of rest
Here are some things you can do to reduce additional episodes in the future:
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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When To Get Help For A Gout Flare
It’s always a good idea to let your doctor know that you are having a flare. Sometimes, you may need to follow up to make sure your treatment plan is working or if your symptoms don’t improve. Call your doctor if:
This is your first flare-up. There are several other conditions, such as a joint infection, that have some of the same symptoms as gout attacks.
You have a highfever and chills. Gout attack symptoms may include a mild fever, but a higher temperature may be a sign of an infection.
Your symptoms don’t get any better after 48 hours or don’t end after about a week. If you don’t start to feel somewhat better after a few days, call your doctor. They may suggest a different treatment. Most gout attacks will go away by themselves in several weeks, even without treatment.
Rebecca Manno, MD, MHS, assistant professor of medicine, division of rheumatology, Johns Hopkins University School of Medicine.
Robert T. Keenan, MD, MPH, assistant professor of medicine, division of rheumatology and immunology, Duke University School of Medicine.
Scott Zashin, MD, clinical professor of medicine, University of Texas Southwestern Medical School attending physician, Presbyterian Hospital.
Lan Chen, MD, PhD, attending rheumatologist, Penn Presbyterian Medical Center.
Gout and Pseudogout Treatment & Management: “Treatment.”
Johns Hopkins Arthritis Center: “Gout — Treatments for Gout.”
Merck Manual: “Gout.”
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.
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Eat A Diet Low In Purines
If you have had more than one episode of gout, make sure you eat a healthy diet that is low in purines. The food groups that contain high levels of purine include: meat , seafood , lentils, specific vegetables, and dried beans. Foods you can enjoy that are lower in purines are eggs, complex carbohydrates, fruits, and low-fat dairy.
Medications For Acute Gout
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What Are Risk Factors For Gout
There are many risk factors for gout. Having high blood pressure is a risk factor for gout. Gout is more common after surgery, trauma, and dehydration. Certain medications such as diuretics , which treat high blood pressure, that raise the level of uric acid in the bloodstream are risks for gout. Surprisingly, medications that lower the level of uric acid in the bloodstream, such as allopurinol , can also initially cause a flare of gout. This is because anything that raises or lowers the uric acid level can cause a gout flare by causing uric acid crystals to deposit in a joint. Low-dose aspirin can precipitate gout attacks. The treatment of certain types of cancer can cause gout because of high levels of uric acid released when the cancer cells are destroyed. Degenerative arthritis also makes affected joints more likely to be the site of a gouty attack.
Are There Home Remedies For Gout
- Take medications as prescribed.
- While a joint is hot and swollen, use a cane or similar support to keep weight off that joint.
- It may be helpful to keep the swollen joint elevated above the chest as much as possible.
- Ice packs can be helpful in relieving pain and reducing inflammation.
- Maintain adequate hydration to minimize the frequency and intensity of attacks.
- Drink cherry juice to decrease the intensity and severity of attacks.
- Avoid eating red meats, internal organs, yeast, shellfish, and oily fish because these increase the risk for gout.
While some medications are used to treat the hot, swollen joint, other medications are used to prevent further attacks of gout. With any of these medications, call a doctor if you think they are not working or if you are having other problems with the medication.
Medicines used to treat acute gout and/or prevent further attacks are as follows:
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How To Identify Gout: 5 Common Symptoms
Do your joints feel like they have some prickly pains in them when you move? Are you struggling to get around during the day because youre just aching? Gout is a form of arthritis that occurs when crystals begin to form in the joints. This happens because your body cannot properly dispel the acids that build up from the foods we eat.
If youre thinking that you might have gout, here are some ways that you can be able to quickly identify the problem.
Did you wake up with a painful, swollen joint? Many acute gout attacks occur in the middle of the night because of the prone sleeping position. The most common way that gout attacks is through the primary joint of the big toe, but it can affect almost any joint in the body as well. Gout causes the joint to swell and this creates soft tissue inflammation that is very painful to the touch. Many people wake up because the sheets cause enormous amounts of pain.
Did you take an aspirin to relieve pain and it made your condition worse? Aspirin is an effective pain reliever, but not for gout. Aspirin increases the amount of uric acid that is in the body, the acid that is responsible for gout.
Has your joint turned purple? Although red joints are the most common side effect of gout, sometimes the joints can turn a purple hue as well, similar to a bruise.
How To Treat Gout In Ankle At Home : Gout In Ankle Symptoms & Treatment
Gout in the Ankle is an extremely painful and inflammatory condition caused due to the deposition of excess uric acid. The extra uric acid in the blood leads to the formation of urate crystals which get collected in the ankle joint and cause throbbing pain.
The area around the joint becomes red, hot, swollen, and extremely sensitive even to a normal touch. With time the ankle pain worsens and makes it difficult for the patient to wear shoes or even walk for long.
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Know More About Gout In The Finger Joint
Gout is a type of inflammatory arthritis that can cause intense pain. It mostly affects the joints in your body. For instance, the end of your limbs has a high risk of gout. Several patients have complained about the gout attack in the metatarsophalangeal joint. But, gout may hit several other sites, including the wrist, elbow, and finger joints.
Swelling and pain in the joint due to a gout attack can last 1 to 2 weeks. In due course, you will again notice the symptoms. Without effective treatment, the symptoms will become highly complicated.
The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
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What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
Gout In Women Treatment:
- In women whose body produces excessive uric acid due to genetic or other problems, allopurinol tablets are prescribed to lower overproduction. It works by retarding the enzyme called xanthine oxidase that metabolizes purines.
- In case the kidneys are not able to excrete the uric acid effectively, probenecid is prescribed to assist the body to flush out excess uric acid.
- Non-steroidal anti-inflammatory drug Ibuprofen or indomethacin is used to lower gout pain quickly.
- Colchicine tablets are prescribed to those women who cannot tolerate NSAIDs. It should be started as soon as the symptoms appear. Not more than 2 to 4 tablets a day should be taken as in overdose it causes nausea, diarrhea, and abdominal cramps.
- A cortisone injection is also administered in the affected joint to give instant relief to gout affected women.
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How Do Health Care Providers Diagnose Gout
The most reliable method to diagnose gout is by demonstrating uric acid crystals in joint fluid that has been removed from an inflamed joint . Specially trained physicians, such as a rheumatologist or orthopedist, can carefully remove fluid from the joint. The fluid is then examined under a microscope to determine if uric acid crystals are present. This is important because other medical conditions and diseases, such as pseudogout and infection, can have symptoms similar to gout.
Am I At Risk Of Having Gout
Youre more likely to have a gout attack if you:
- are male
- have a family history of gout
- have elevated levels of uric acid in the blood
- drink too much alcohol
- eat a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
- are overweight or obese
- use diuretics
- have type 2 diabetes, high blood pressure or high cholesterol these conditions can mean that your kidneys are less able to flush out the urates
- have kidney disease
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What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
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.