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.
Where Are The Most Common Sites Of Gout Arthritis
Other than the great toe, the most common sites of gouty arthritis are the instep, ankle, wrist, finger joints, and knee. In early gout, only 1 or 2 joints are usually involved. Consider the diagnosis in any patient with acute monoarticular arthritis of any peripheral joint except the glenohumeral joint of the shoulder.
Most Common Risks For Getting Gout
Remember the risk for getting gout:
- being a male
- moderate, regular, or heavy alcohol intake, especially beer
- diet rich in proteins like meat and seafood
- medications that remove salt and water from the body
- regular use of Aspirin
- sudden onset of an illness or infection
- lead exposure from work, diet, or hobbies
- low calorie diets
- injury to joints
Simple guidelines that may prevent gout attack Gout is treatable. If you can remember these simple guidelines it may help or prevent a gout attack:
- contact doctor as soon as possible to help with pain
- rest, to much activity can cause a flare again
- use ice on the affected joint
- reduce future attacks by, drinking lots of fluids to help dilute the uric acid, watching your weight and exercise. Watch what you eat, take extra sources of vitamin C and always listen to your doctor. Remember to always ask your doctor first before starting medication even vitamins.
Unfortunately there are some long term effects of gout, if left untreated, such as joint damage, kidney stones or damaged kidneys, and the potential for nerve damage to the affected area that may cause deformities. So if you do or think you have a gout problem talk to your doctor. There is no reason for you to live in pain.
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Diagnosis Of Chronic Gouty Arthritis
Chronic gouty arthritis should be suspected in patients with persistent joint disease or subcutaneous or bony tophi. Plain x-rays of the 1st metatarsophalangeal joint or other affected joint may be useful. These x-rays may show punched-out lesions of subchondral bone with overhanging bony margins, most commonly in the 1st metatarsophalangeal joint lesions must be â¥ 5 mm in diameter to be visible on x-ray. Joint space is typically preserved until very late in the course of disease. Synovial fluid findings from chronic effusions are usually diagnostic.
Diagnostic ultrasonography is increasingly used to detect a typical double-contour sign suggesting urate crystal deposition, but sensitivity is operator-dependent and differentiation from calcium pyrophosphate crystal deposits may be more difficult to do conclusively.
Whats The Outlook For People With Gout
Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.
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How Can An Attack Of Gout Be Treated
The management of an acute attack of gout is very different from the prevention of subsequent attacks.
Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.
There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.
If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.
Table 2: Medications to treat acute attacks of gout
Gout In Big Toe: Can You Get Gout In Any Toe
Most common place for gout is the big toe because uric acid is supposed to be sensitive of temperature changes.
At cooler temperatures, uric acid turns into crystals. Since the toe is the body part that is farthest from the heart, it is also the coolest part of the body and, thus, the most likely target for gout attack. However, gout can affect any joint in the body.
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Alternative And Complementary Therapies
Many complementary and alternative medicine approaches for managing gout focus on diet, weight loss, and exercise.
Your risk of gout goes up when your diet is high in naturally occurring compounds called purines. When purines break down in the body, they cause uric acid to form. In most cases, people who have gout will still need medication even when they follow a diet for gout. That said, tweaking your diet can be a powerful way to help manage gout and gout symptoms. Some research suggests that food changes alone can lower your uric acid levels by up to 15 percent, according to the Institute for Quality and Efficiency in Health Care.
The main principles of a gout diet are basically the same as those of any healthy diet: Reduce calorie consumption if you are overweight opt for unrefined carbohydrates like fruits, vegetables, and whole grains limit your intake of sugar, organ meats , and saturated fats.
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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Intense Big Toe Pain From Gout: A Classic Symptom Of An Attack
While the big toe is the most common place for a gout attack to happen, gout can also affect surrounding joints in the foot, ankle, and knee.
People with gout typically experience flare-ups, or attacks, of symptoms followed by periods with no symptoms. The attacks typically last 3 to 10 days. Some people go months or even years without a gout attack after having one. In other people, attacks may become more frequent over time.
Gout can be difficult to diagnose. Once its diagnosed, it can be treated with medication and lifestyle changes.
Gout And Heart Disease
Gout and cardiovascular disease commonly occur together. In a study published in the Journal of the American Heart Association, researchers from Duke University studied data from more than 17,000 patients, including 1,406 who had gout at the start of the study and were being treated for cardiovascular risk factors. After following patients for an average of 6.4 years, researchers found that the risk of dying of cardiovascular disease or having a heart attack or stroke was 15 percent higher among those with gout than in patients who never developed gout. Patients who had gout at any point during the study had a two-fold increased risk of heart failure death compared to people who never developed gout.
Gout causes inflammation in the joints and the rest of the body inflammation is also a risk factor for heart disease. Heart disease prevention strategies include maintaining a heart-healthy diet, regular exercise, and better cardiovascular risk assessment. Your doctor may recommend more frequent screening tests or more aggressive management of other heart disease risk factors that also occur with gout, such as high blood pressure.
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Gout And Mental Health
The chronic pain associated with repeated gout attacks can lead to stress, anxiety, and depression. Gout can cause severe pain that can make it tough for you to get around, go to work, and complete daily tasks. That impact on your daily life can impacts patients mental, social, and physical well-being.
Its not just about functionality and disability, but also how patients view themselves, says Dr. Khanna. I talk to patients about the fact that gout is treatable, and its possible to stay completely flare-free if they take their medications.
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 isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
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Foods And Medications That Ease The Gout
There are foods that are rich in vitamin C naturally like tomatoes, citrus fruits, cantaloupe, broccoli, spinach, green peppers, cabbage and potatoes, so eat up. Other natural products that are also believed to help with reducing the uric acid levels in the body are cherries or other dark color fruits like blackberries. Coffee, regular or decaffeinated was also note to help. Avoid alcohol because this inhibits the kidneys to disguard the uric acid from the body.
Some prevention methods are the vitamin C intake by foods like dark colored fruit, or vegetables like cabbage and potatoes. There are also medications that help block the uric acid production or improve the uric acid removal in the bloodstream through the kidneys. Cutting back on red meat, seafood, and avoiding alcohol helps. It is also said if you increase your intake of low-fat dairy products, eat more complex carbohydrates like whole grain breads and always drink plenty of fluids, which helps to dilute the uric acid in the body. You dont want to get dehydrated. Losing weight if needed also is thought to decrease the uric acid levels, so exercise.
Common Places For Gout
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Most Common Symptoms Of Gout You Should Never Ignore
15 Most Common Signs of Gout
Once upon a time, gout or gouty arthritis was known as the disease of kings. It was considered to be more prevalent among overweight, wealthy men who could afford to over-indulge in alcohol and fatty foods. While obesity and diet remain important risk factors for gout, your bank account or social class is no longer connected to the risk of developing this joint condition. The incidence of gout increases and become more than doubled between the 1970s and 2000s. Today, approximately four percent of U.S. adults are suffering from this.
Gout is a form of the joint condition that causes severe, sudden attacks of inflammation. It happens when there is too much accumulation of a chemical called uric acid in your blood. This causes urate crystals to build up in your joints and other body organs, leading to the telltale gout pain. Your body makes uric acid from the breakdown of purines, a natural substance found in your body as well as in some foods. While the diet itself is not associated with causing gout, certain drinks and foods may trigger its flares. People who develop gout usually have some genetic predisposition coupled with other risk factors such as obesity, diabetes, or kidney disease that cause uric acid to accumulate in the body.
Signs and Symptoms Of Gout
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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Diagnosis And Management Of Gout
JOEL R. PITTMAN, PHARM. D., and MICHAEL H. BROSS, M.D., University of Mississippi Medical Center, Jackson, Mississippi
Am Fam Physician. 1999 Apr 1 59:1799-1806.
Gout is a disease resulting from the deposition of urate crystals caused by the overproduction or underexcretion of uric acid. The disease is often, but not always, associated with elevated serum uric acid levels. Clinical manifestations include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joints, tissues or body fluids. Treatment goals include termination of the acute attack, prevention of recurrent attacks and prevention of complications associated with the deposition of urate crystals in tissues. Pharmacologic management remains the mainstay of treatment. Acute attacks may be terminated with the use of nonsteroidal anti-inflammatory agents, colchicine or intra-articular injections of corticosteroids. Probenecid, sulfinpyrazone and allopurinol can be used to prevent recurrent attacks. Obesity, alcohol intake and certain foods and medications can contribute to hyperuricemia. These potentially exacerbating factors should be identified and modified.
Gout In Shoulder: Can Gout Affect Your Shoulder
For many people, the first symptom of gout is unbearable pain and swelling in the big toe which often occurs after a trauma, such as an illness or injury. Later attacks may occur in other joints, typically the feet, ankles, knees, hands, wrists, and elbows.
Attack on shoulder is less common but can happen.
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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.