Effective Medical Treatment For Gout
The American College of Rheumatology released gout management guidelines in 2012 and updated them in 2020. They recommend drugs classified as urate-lowering therapy for those who have experienced two or more gout attacks in a year as well as for those with joint damage from gout.
Specifically, the organization recommends allopurinol as a first-line treatment for all gout patients, even those with chronic kidney disease. Next in line is febuxostat both are a class of drugs called xanthine oxidase inhibitors.
In addition, the guidelines recommend use of anti-inflammatory medications including NSAIDs, prednisone, or colchicine along with the other medication.
Dads Diuretic Could Be Linked To Gout
Dear Doctor: Can you please explain what gout is and how it’s treated? Our father is 81 years old and was just told that he has gout. His doctor says it could be because he takes water pills for swelling due to congestive heart failure. Does that make sense?
Dear Reader: Gout is a type of arthritis that can occur due to the presence of high levels of uric acid, a metabolic waste product, within the body. The kidneys eliminate uric acid via the urine, and some is excreted via the gut. But sometimes the accumulation of uric acid in the blood can exceed the amount that is excreted. This can lead to the buildup of tiny needle-shaped deposits, known as urate crystals, in and around the joints.
The condition causes periodic episodes of swelling and pain, which can be intense. Symptoms of someone’s first gout attack typically begin at the base of the big toe. However, in subsequent flare-ups, gout can also affect the other joints of the lower leg, including in the foot, ankle and knee. Although gout can affect either sex, it’s three times more common in men than in women. For men, the onset typically begins in middle age, often around age 40 and onward. Women become more susceptible to developing gout during and after menopause.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
This Common Type Of Arthritis Can Show Up Suddenly And Cause Debilitating Pain
The great artists Ludwig van Beethoven, Luciano Pavarotti, and Leonardo da Vinci had more than extraordinary talent in common they were also sufferers of a type of inflammatory arthritis called gout. You may be at risk of joining their ranks if you have any potential triggers for the condition. “Most people are surprised by their initial gout diagnosis, unless they have a strong family history,” says Dr. Mark Fisher, a rheumatologist at Harvard-affiliated Massachusetts General Hospital.
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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.
Studies On Genetics And Gout
According to a study published in Annals of Rheumatic Diseases states that individuals who have either parents, children, or siblings with gout, those same individuals have a 1.91 increased risk of developing gout for men and a 1.97 for women, meaning the risk is twice as high!
For individuals who have grandparents, uncles, aunts, nieces and nephews , those individuals had a 1.27 increased risk while women had 1.40 according to the researchers which conducted this population-based study in Taiwan, where gout is on the rise. The study population included some 11 million men and 11 million women who enrolled in a database in 2004 and which 802,765 men and 242,294 women had later been diagnosed with gout.
The study also found that as more relatives in the family had gout, the more increased risk you faced of developing the disease in your lifetime. The study also concluded that biological relatives tended to share similar environmental influences like obesity, hypertension, diets high in purines, alcohol and lifestyle risk factors in addition to genes.
Just like my father and grandfather shared a similar lifestyle of drinking excess alcohol. The sum of these factors probably may have caused my bout with gout since in my late teens and early twenties I partied pretty hard, drinking very often thinking I was immortal and that nothing could hurt me.
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Lay Off The Sheep Heart And Smelt Or Else
If you suffer from gout you should be careful to avoid foods that contain purines. Purines are organic compounds that increase the body’s production of uric acid and when you read the list below you’ll be surprised to see how many foods contain purines which, in the non-gout sufferer, are not necessarily so bad when taken in moderation. The good thing for the gout sufferer is that most of the foods that contain the highest concentration of purines are also the most disgusting. If only you had known about this stuff as a kid then you could have said “Sorry, mom, I can’t eat your sheep heart stew. It’s loaded with purines.”
In addition to the foods listed below, remember that all alcoholic beverages can lead to gout.
Foods that contain very large amounts of purine bodies in 100 grams:
|Heart, sheep 174|
Foods that contain a large amount of purine bodies in 100 grams: anchovies, bacon, codfish, goose, grouse, haddock, liver, kidneys, mackerel, mutton leg, partridge, pheasant, pigeon, salmon, scallops, trout, turkey, veal, venison.
Foods that contain a moderate amount of purine bodies in 100 grams: asparagus, bass, beef, bouillon, brains, chicken, crab, duck, eel, halibut, ham, kidney beans, lentils, lima beans, liverwurst, lobster, mushrooms, mutton chop, navy beans, oysters, peas, plaice, pork, rabbit, roe, shrimp, spinach, tongue, tripe.
Foods that contain an insignificant amount of purine or no purine:
My Father Has A Gout On His Hand Knee And Both Of His Feet He Cannot Sleep Because Of The Pain Please Tell Me What Can I Do To Atleast Relieve The Pain Thank You So Much
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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.
Where Does A Gout Attack Occur
Gout often attacks the largest joint in your big toe. However, it can also attack the foot, ankle knees, hands, or wrists. Intense pain, redness, and swelling can start with no warning, although you may have warning signs of an impending attack. If you start to feel tingling, burning, or itching in a joint, your body is giving you a warning signal that a flare-up is imminent.
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Myth: Gout Pain Always Attacks The Big Toe
Truth: Gout occurs when uric acid builds up in the blood, forming crystals that lodge in and inflame joints. It’s true that gout often first attacks the joints of the big toe, but it can also occur in the knees, ankles, feet and hands. In women with osteoarthritis, for example, gout pain commonly starts in the small joints of the hands. Although the first attacks often involve only one or two joints, over time multiple joints become affected. If the disease isn’t treated, it can cause permanent damage.
Avoiding alcohol may reduce your chance of getting gout attacks.
How Is Gout Diagnosed
Your doctor will do a physical exam and review your symptoms and health history. Tell them if gout runs in your family. Your doctor may detect gout by looking at your joints. To confirm a diagnosis, they will do a blood test or take a sample of fluid from your joint. These can check your uric acid level and look for uric acid crystals.
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My Mom Got Diagnosed With High Uric Acid Heres Everything I Learnt About The Condition
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As a child, I remember my nani complaining about severe joint pain. At that time, because of the lack of awareness, we assumed it would be arthritis and didnt give it much notice thinking its related to old age. Recently, when my mother started experiencing the pain as well, we realized we should investigate the root cause of it.
The doctor we visited asked us to get my mothers uric acid blood test done which basically is used to measure the level of uric acid in the blood. When we got the reports, it was quite high. Although my mother didnt have any gout, which is a complex form of arthritis that causes pain and inflammation, it was not something to be taken lightly.
After my mothers diagnosis, I had many questions. I talked with Dr. Salil Jain, Director and Head of the Department of nephrology and kidney transplant at the Fortis Memorial Research Institute, Gurgaon for some concrete answers and to understand the condition better.
Dr. Salil clarified what uric acid is As the name suggests, our urine is made up of uric acid. Most of our bodys uric acid is released when we urinate or from the stool. Uric acid is nothing but a waste byproduct that our body has created by the breakdown of purine, which is also a form of protein mostly found in the meat, mushroom or protein supplements, explained Dr. Salil.
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.
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Do Genetics Play A Role In Gout
Some breaking news hit the newswires this past week about gout and genetics. This coincided with the passing of my father, Angelo Koulouris, who died of a heart attack on November the 7th, 2013 at the age of 58, inside his 1 bedroom apartment. His body was found 3 days later from the landlord and he was transported to the morgue since they didnt have any contact information from any family members.
I was contacted by his ex-girlfriend who had passed by the apartment to see him and was told the devastating news by the landlord. She contacted me on November 27! So for about 3 weeks I didnt even know that my own father was dead! I quickly contacted his brothers from New York and they arrived the next day so we can arrange a viewing for him and burial on the following day.
You see my father was an alcoholic from his early twenties which caused the divorce between my mother and him while I was just 3 years old. He made contact with me while I was 10 years old and we would see each other from time to time, he bought me my first bass guitar and paid for my lessons back when I dreamed of becoming a musician, we went to hockey games together and we would go over to see his sister which is my aunt and hang out with my cousins. Unfortunately, as the years went by, he steadily drank more since he lived alone and was one depressed man, always thinking about days past and never really focused on the present nor the future.
So Why Do You Keep Getting Recurring Attacks
The condition we call gout is caused by the appearance of microscopic crystals in your joints. These are needle-like in character and usually form in your big toe most of the time, although you can get gout in any part of your body, e.g. your ankle, side of your foot, knee, finger, hand, elbow, etc.
The crystals appear when the conditions are right for their formation. This is usually when you have high uric acid levels in your bloodstream. Now, uric acid is just a natural byproduct of your bodys metabolization and is produced when chemical compounds called purines breakdown as part of that process.
But as well as existing in our bodies, purines also exist naturally in our foods. And some foods have higher concentrations of purines than others. Unfortunately, the foods with the high and very high levels are exactly the foods that we all love, e.g. red meat, game, kidneys, liver, seafood, poultry, yeast products, legumes, etc.
However, not everyone who eats a typical western diet keeps getting gout, or indeed, ever gets it. So why is this?
The thing is that the kidneys usually process the uric acid formed in the body and excrete the excess out of your system through urine with a little via the stools. When the kidneys are operating efficiently, there are no high uric acid levels in the blood.
So what are the factors that increase your risk of having high uric acid and thus of your getting gout?
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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.
What Are Causes Of Gout
Uric acid is generated as we metabolize the food we eat and as the body’s tissues are broken down during normal cell turnover. Some people with gout generate too much uric acid and are medically referred to as “over-producers.” Other people with gout do not effectively eliminate their uric acid into the urine and are medically referred to as “under-excreters.”
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