Tuesday, May 17, 2022

My Gout Is So Painful

Who Is At Risk For Gout

My gout, my painful gout. Aye!

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
  • Fever

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.

  • Talk to your doctor. You can play an active role in controlling your arthritis by attending regular appointments with your health care provider and following your recommended treatment plan. This is especially important if you also have other chronic conditions, like diabetes or heart disease.
  • Lose weight. For people who are overweight or obese, losing weight reduces pressure on joints, particularly weight bearing joints like the hips and knees. Reaching or maintaining a healthy weight can relieve pain, improve function, and slow the progression of arthritis.
  • Protect your joints. Joint injuries can cause or worsen arthritis. Choose activities that are easy on the joints like walking, bicycling, and swimming. These low-impact activities have a low risk of injury and do not twist or put too much stress on the joints. Learn more about how to exercise safely with arthritis.
  • Treating A Gout Attack

    What gout looks like. So very painful : mildlyinteresting

    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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    Preparing To Sleep While Having A Flare Up

  • 1Make yourself as comfortable as possible. Gout often flares up at night, at that point, the weight of a blanket on a gouty toe, for example, can be extremely painful. If you know this is the case for you, and you have been having flare ups, then avoid that discomfort by turning up the heat in your bedroom and keep the blankets off your affected area.
  • You may be more comfortable, at least the first night, sleeping in an armchair or a recliner where you can keep the joint elevated.
  • If the gouty pain is in your toe, ankle, or knee, it may be best not to use a blanket or to tent the area over the joint if you can.
  • 2Get sleep conditions treated. Gout is also associated with sleep conditions, such as sleep apnea. If you have been awakened at night by gout in the past, talk to your physician about possible treatments for a sleep condition.
  • Make sure you avoid any stimulants, such as caffeine or tobacco, in addition to avoiding any purine-rich food or beverage. Some purine-rich foods are red meats, anchovies, shellfish, fatty fish, asparagus, spinach, and most dry beans.XResearch source Avoiding these foods will help you sleep more soundly.
  • Keep drinking plenty of water. While this won√Ęt necessarily help you sleep in the immediate sense, but it will help flush out the uric acid that has built up.
  • Drinking a cup of chamomile tea before bed can help you relax and get ready for sleep.XExpert Source
  • 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

    Gout | Treating Severe Joint Pain | What Patients Should Know

    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

  • 1Ice the area. In general, the first 36-48 hours of a gout attack are the most painful but you can relieve the initial pain and make sure you are doing all you can to end the gout attack as soon as possible. You can relieve some of the pain of gout by icing the joint. Use an ice pack wrapped in a towel and apply to the affected area for 20-30 minutes every hour that you are awake.XTrustworthy SourceArthritis FoundationMain organization devoted to arthritis support and educationGo to source
  • Keep the affected joint elevated as much as possible while you ice it. This will help to avoid the blood settling in the area that is being iced.
  • 2Take over-the-counter pain relievers. Your can take common pain relievers, such as ibuprofen and naproxen . Use any OTC NSAIDs for as short a time as possible. Long-term NSAID use can increase the chances of a heart attack or stroke and can also increase the risk of ulcers and bleeding. Make certain you follow manufacturer√Ęs directions exactly.XTrustworthy SourceUS Food and Drug AdministrationU.S. government agency responsible for promoting public healthGo to source
  • However, avoid any aspirin or topical aspirin products . Aspirin products can cause more uric acid to deposit in the joints.
  • Tylenol is not an anti-inflammatory medicine and is not likely to help.
  • You could also take colchicine, but you may need a prescription from a doctor for that medication.
  • It’s Easy To Get The Care You Need

    Conceptual image of gout in the big toe. Gout is a form of ...

    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
    • dehydration
    • 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

      Whats Really Causing Your Gout?
    • Non-steroidal anti-inflammatory agents and COX-2 inhibitors are the mainstay of therapy of acute attacks of gout in patients who have no contra-indication to them. These medications include such agents as naproxen , ibuprofen , celecoxib , indomethacin and many others. These agents reliably decrease the inflammation and pain of gout. However, patients with ulcers, hypertension, coronary disease, and fluid retention must be careful with these agents, even for the short courses needed to resolve a gout attack. The doses of non-steroidal anti-inflammatory agents needed to resolve a gout attack are on the higher side, since full anti-inflammatory effect is needed. See examples of dosage in Table 2. Over-the-counter dosage levels, for example, ibuprofen at 200mg, two tabs three times a day, are often insufficient.
    • Corticosteroids, such as prednisone and methylprednisolone , are anti-inflammatory agents that are quite effective against gout attacks. Anti-inflammatory steroids are very different in action and side-effects as compared to male hormone steroids. Anti-inflammatory steroids have long-term risks, such as bone thinning and infection, but their risk for short-term therapy is relatively low. These agents can raise blood pressure and blood sugar, so can be a problem for those with uncontrolled hypertension or uncontrolled diabetes mellitus.
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      What To Do During An Attack

      You should:

      • 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.

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