Who Is At Risk For Gout
Anyone can be affected by gout.
Gout is most common in middle-aged men, especially those with a family history of the disease. Women can get gout, too, most often after menopause.
Your chances of developing gout are higher if you:
- Are overweight
- Drink too much alcohol, especially beer
- Eat a diet rich in meat and fish, which can be high in chemicals called purines
- Take certain medicines, like water pills , that can trigger an attack
Recent research also indicates that genetics may play a big role in determining who gets gout. Ask your doctor if you have questions about your risk for developing this condition.
Struggling With Gout Pain Dr Stuart Weisman’s Tips
- Boulder Community Health
Gout can strike suddenly causing excruciating pain and swelling in joints. It usually strikes a big toe, but can also affect the ankle, knee, foot, elbow or finger. The affected joint becomes so tender that even the slightest touch can be unbearable.
“Fortunately, an attack will clear in time, and there’s a lot we can do to prevent further attacks,” rheumatologist Stuart Weisman, MD, of Boulder Medical Center told a crowd of more than 120 people during a free health lecture held at the Boulder Jewish Community Center.
Gout Causes and Symptoms“Gout is a type of arthritis that occurs when you have high levels of uric acid in your blood,” explained Dr. Weismain. “Over time, the uric acid forms needle-sharp crystals that collect around your joints and soft tissues. Eventually, these crystals trigger a gout attack.” He said symptoms include:
- Sudden excruciating joint pain
Gout Flare-Ups: How to Get ReliefGout attacks can be quite severe, so it’s good to know how to quell the pain as soon as possible. Dr. Weisman offered a few options:
- Over-the-counter drugs – Take nonsteroidal anti-inflammatory drugs early in an attack and at a maximum dose. For example, he said you could take a naproxen dosage of 500MG two times/day.
- Corticosteroids – Your doctor can prescribe a 5-to-14-day course of corticosteroids to reduce the inflammation.
- Colchicine – Best taken at the onset of an attack, prescription colchicine can help decrease the pain and swelling.
Common Myths About Gout
Drinking too much alcohol and eating too much rich food were once considered the prime suspects in causing gout. Although eating certain foods and drinking alcohol may cause uric acid levels to spike, these habits alone may not cause gout.
A recent study indicates that our DNA is a key factor in gout flare-ups. Researchers found that diet was less important than genetics in determining whether or not patients would develop high levels of uric acid.
If you suspect you have gout, make an appointment with your doctor to be tested and learn how to prevent or reduce future gout attacks.
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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.
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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Preparing To Sleep While Having A Flare Up
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.
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Trying To Sleep Through Gout Pain
Gout can wake you from a sound sleep, and getting back to sleep without medication can be impossible. Here’s how to be well prepared.
If you have ever been jolted out of a sound sleep with throbbing pain in your big toe, you know that a gout flare can make it impossible to get the rest you need. About 50 percent of gout flares begin in the toe, a condition called “podagra.” This gout pain usually starts at night and may be accompanied by fever and muscle aches. Even the weight of a sheet or blanket on your foot can be excruciating.
“Gout occurs when monosodium urate crystals precipitate in bones, joints, or soft tissues. These crystals are more likely to crystallize in lower temperatures. As it generally is colder at night, this may be why many gout attacks begin at night,” says Jennifer Sloane, MD, a rheumatologist at Temple University Hospital in Philadelphia.
The sudden onset of pain in a single joint, with accompanying swelling, redness, and warmth around the joint, is such a classic symptom for a gout flare that most doctors can make the diagnosis over the phone. And, if you have had previous attacks of gouty arthritis, you know right away what’s happening.
What to Do for a Gout Pain Flare
Because gout pain can be quite severe, it is important to know how to quell it as fast as possible, usually by taking medication as soon as possible.
Here are the basics for treating a gout flare:
Can Poor Sleep Trigger a Gout Flare?
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.
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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
What Are Symptoms Of Gout
Chances are you wont even know you have gout until youve experienced your first painful attack, often at night. Symptoms may not develop for years, but these often include:
- Arthritis that develops quickly, resulting in a swollen, red, and warm joint with limited movement
- An arthritis attack in only one joint often the big toe, as well as a foot, ankle, or knee
- Bright red or purplish skin around the affected joint
- More than one attack of acute arthritis
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Treating Acute Pain To Help You Sleep
It’s Easy To Get The Care You Need
See a Premier Physician Network provider near you.
If you havegout, youre all too familiar with the sudden, burning joint pain that a gout attack can bring on most commonly in the big toe.
Gout a type ofarthritis is caused by too much uric acid in the blood. Usually, having an excess of uric acid isnt harmful. In fact, many people with high levels in their blood never get gout. But when uricacid levels in your blood are too high, the uric acid may form hard crystals in your joints.
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What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
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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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.
Medications For Acute Gout
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What To Do During An Attack
- take any medication you’ve 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 you’re well hydrated
Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t 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.