How Are Gout Attacks Prevented
Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
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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.
Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine
Colchicine isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
Steroids
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What To Do During An Attack
You should:
- take any medication youve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
- rest and raise the limb
- avoid knocking or damaging the affected joint
- keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
- ensure youre well hydrated
Apply the ice pack to your joint for around 20 minutes. Dont apply ice directly to your skin and dont apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.
Dr Verville Is Here For You
With over 10 years of experiencing providing Frisco men and women with foot and ankle relief, Dr. Verville knows just what to do to help you with your specific pain or problem area. She and her staff at RNV Podiatry stand ready to welcome you into their practice and provide you with high-quality, friendly care.
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Be Aware Of The Common Signs And Symptoms Of Gout
Gout, a form of inflammatory arthritis, is a particularly painful condition that affects millions of Americans. The pain is caused by inflammation in the joint induced by the deposition of sharp uric acid crystals. Uric acid is created when purines are metabolized or broken down by the body. Uric acid in and of itself is not harmful it only becomes worrisome when the body is unable to properly process the acid or if the body is experiencing unusually high levels of the acid.
One of the most distinguishing signs of gout is its sudden onset in the middle of the night in the large joint of the big toe. Although, much less commonly, gout can occur at any time during the day and in a variety of other joints such as the ankles, knees, and wrists. Gouty arthritis is unique in that it primarily only affects a single joint at a time. However, if left untreated for long periods of time, multiple joints will likely begin to be implicated.
Gout symptoms include intense joint pain, redness, swelling, warmth, and a limited range of motion at the affected site. Gout often causes the joint to become so sensitive that it is difficult to walk, wear shoes, or even have a sheet resting against it. Read on to learn more about gout signs and symptoms.
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Signs Of An Impending Gout Attack
Many individuals learn to recognize when a gout flare up is imminent. The intense pain that is experienced in the midst of an attack is often preceded by burning, itching, or tingling in the affected joint. These signs can begin one to two hours before an attack. Once you have experienced these symptoms once, you can begin to predict recurrent attacks and start treatment as soon as the signs appear. However, it is not uncommon to have no precursor signs and some individuals are struck with an attack seemingly out of the blue, especially when attacks are infrequent.
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Gout Is No Joke This I Know From Painful Experience
When I mention to someone that I suffer from gout – and I try hard not to bring it into the conversation too often – I can predict that they will respond in one of three ways. In response number one they say: “I thought gout was an 18th-century thing I didn’t know people got it nowadays.” Response number two is to say: “Been drinking too much port, have you, old chap?” The third response is to laugh.
To which my own reactions go like this. First, you can bet your life that people still suffer from gout today, and in growing numbers. Second, I think I last had a glass of port at Christmas 1995 or thereabouts, and drink normally has very little to do with it. Third, when someone laughs about gout, I have to try hard not to hit them.
Until I had my first attack 18 months ago, I was one of the ignorant majority too. When the word gout cropped up, I thought of Dr Johnson and Pitt the Elder, not Tony Soprano or Harry Kewell . But then the gout crept silently into my foot in the night – a common initial assault – and my world changed. Ever since, I have become aware that ignorance about gout is normal. Like many mainly guy things, gout is rarely discussed. But it is one of the most excruciatingly painful things that it can ever be your misfortune to encounter. I’m also told it makes you irritable. Damn right it does.
Spotlight On Gout: A Serious Yet Understated Form Of Arthritis
Meredith Hemler
Gout is not a disease that gets a lot of attention. Consequently, gout is widely misunderstood and often understated by the general public and even by those who suffer from the disease. In fact, just 10 percent of people with gout receive needed, ongoing treatment. This needs to be changed, considering the devastating consequences of untreated gout and elevated serum uric acid levels.
Caused by an accumulation of uric acid crystals in the joints and other tissues, gout is an extremely painful and chronic form of arthritis. Affecting more than 8.3 million Americans and growing, gout is the most common type of inflammatory arthritis even three to four times more common than Rheumatoid Arthritis, yet it gets just a fraction of the attention. Despite its growing prevalence, 70 percent of Americans dont know that gout is a form of arthritis three-quarters dont know what parts of the body it affects and half are unaware of gouts potentially crippling consequences.
Many people may recognize the classic signs of a gout attack sudden pain, warmth and swelling in one or more joints. Gout often begins in the big toe, but can also affect other areas including the feet, ankle, wrists, hands and elbows. The pain during a gout flare is so excruciating that many visit the emergency room for care. On a typical pain scale, most people with gout will rank their pain as a nine or a 10 with even the slightest touch causing agony.
About N. Lawrence Edwards, MD
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What Does Gout Look Like
Gout pain is the most common and noticeable symptom of gout.
Many, but not all, people experience their first gout attack or flare-up in their big toe. The pain often starts during the night and comes on suddenly.
The type of pain you feel with gout may vary depending on whether youre experiencing an acute gout episode or a flare-up of chronic gout.
Severe Cases Of Gout In Hands
Chronic cases of gout can lead to the development of bumps under the skin and near the affected joint area. These visible bumps are known as tophi and are uric acid deposits that resemble small, chalky nodules.
Over time, the continued growth of tophi can lead to grotesque deformities of the joints. Needless to say, these deformities create additional complications like limited movement, ulcerations, necrosis and nerve compression, to name a few.
For chronic cases of gout tophi, getting them surgically removed by a doctor is usually recommended.
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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 .
How Long Does Gout In The Ankle Last
Gout flare-ups can last for several hours at a time, but you may feel pain in your ankle for days or weeks. Some people only have one flare-up in their life, while others have them several times a year.
Keep in mind that gout is a chronic condition, meaning it lasts for a long time and requires ongoing management. Dietary changes and medications can make a big difference, but youll also be at risk of having a flare-up.
Keep in mind that it can also take some time to find the right combination of diet changes and medication that works for you. Dont be discouraged if things dont seem to be improving right away.
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Symptoms Of Foot Gout
A gout flare in the foot can be sudden and extremely painful. It feels like your big toe is on fire as it feels hot, swollen, and tender. The first 36 hours are the worst but after that, the pain lessens and lingers, but it doesnt entirely go away until after a week or two.
Once you experience a gout attack, call your doctor right away. They will provide you with medication to help lower uric acid levels and prevent it from worsening.
You may have difficulty walking or wearing shoes when you have foot gout. Its pretty common for gout sufferers to walk slower, have reduced stride length, and less pressure on the midfoot. This is because gout in the foot can be very painful and walking in such a manner can help lessen the pain.
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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Differences Between Men And Women
Sex differences play a role in which joints are affected:
- In men, about 85% of gout flare-ups affect joints in the lower extremities. About 50% of first-time gout attacks involve a big toe joint.8
- In women, a gout attack is most likely to occur in a knee.10 In addition, women may be more likely to get gout in the upper extremities.9
While women are less likely to get gout, they are more likely to have multiple joints affected by gout.13
Risk Factors For Gout
Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, diabetes, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels in patients with gout.
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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.
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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