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
Medication That Contribute To Gout
- Diuretics that are prescribed for conditions like hypertension and heart disease contain hydrochlorothiazide, furosemide and metolazone which can trigger gout attacks.
- The immunosuppressive drugs like ciclosporin and tacrolimus can cause gout.
- Cyclosporine when used with hydrochlorothiazide can lead to gout pain. This drug suppresses bodys immune system.
- Levodopa or Laradopa, the drug used to treat Parkinsons disease and some other degenerative diseases can result in gout attack.
- Antiuricosurics, like ethambutol or pyrazinamide, which are used to treat tuberculosis, can affect the process of removal of uric acid from blood by the kidneys.
- Excessive intake of over-the-counter medicines like niacin or ascorbic acid is one of the main causes of gout attacks.
- Prescription medication like theophylline , methyldopa and cisplatin are also considered as instigators of gout.
- Experts believe that excessive consumption of certain drugs like Pyrazinamide, Lotrel, Maxzide, Nadide, Ethacrynic Acid, Dyazide, etc. can result in gout attacks but more research is needed to confirm this belief.
You should always consult your physician and discuss the side effects of medication. It is essential to follow the instructions of the physician religiously. This helps avoid serious health complications.
What Are The Signs And Symptoms Of Gout
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remissionweeks, months, or yearswithout symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Symptoms in the affected joint may include:
- Pain, usually intense
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Medicines For Gout Prevention And Complications
Your doctor can prescribe medicines that can help keep a healthy level of uric acid in your body, which can prevent future gout attacks and the complications from gout. When you have gout, your body either makes too much uric acid, or cannot get rid of enough of it, which causes it to build up. Some medicines are safe to take when you have kidney disease, but some are not. Talk to your doctor about which medicines are safe for you.
Allopurinol
Allopurinol is a medicine for people who make too much uric acid. It is the most common medicine used to treat chronic gout. Your doctor can tell you if allopurinol is safe for you to take if you have kidney disease.
Probenecid
Probenecid is a medicine that works for people who cannot get rid of enough uric acid. It works to remove extra uric acid through your urine. Probenecid can increase your risk of kidney stones. Probenecid is not safe to take for many people with kidney disease, so talk to your doctor for more information about probenecid.
Pegloticase
Pegloticase is an infusion medicine given by injection into your vein at your doctors office, usually every two weeks. It is used for severe chronic gout when other medicines do not work. Pegloticase can quickly bring your uric acid level down to a lower level than most medicines can. Talk to your doctor about whether pegloticase is safe for you.
What Are The Potential Side Effects
Unless youre allergic to cherries, its unlikely that youll have an adverse reaction. However, its important to eat everything in moderation and cherries are no exception. Its possible to have diarrhea if you drink too much cherry juice or eat too many cherries.
How much is too much cherry juice? Thats hard to say, as it depends on your own digestive system. As mentioned, one glass a day should be enough to treat gout without producing any side effects. If you have any adverse reactions, make a note of them and speak to a healthcare provider about it.
If you want to add more cherries into your diet, you can do so in a number of different ways. You can:
- drink tart cherry juice
- add cherries to yogurt or fruit salad
- blend cherries or cherry juice up in a smoothie
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Gout Myths And Misconceptions And The Facts
Gout was once called the disease of kings, because of its propensity to affect overweight, rich men throughout history. Famous gout sufferers have included Alexander the Great, Charlemagne, Henry VIII of England, and Benjamin Franklin.
While gout is no longer thought to be a disease of the wealthy, it is more common in men and people with weight-related health problems including high blood pressure and type 2 diabetes.
The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
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The End Of Gout Your Ultimate Beginners Approach
Shelly Mannings The End of Gout is not only a fascinating read its also refreshingly practical.
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What Blood Pressure Medications Can Cause Gout: What You Should Know
Gout is becoming more and more common and its one of the worst issues to have
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Get Answers Advice And Medicine
The pain from a gout attack usually gets better in 3 to 10 days. But youâll feel better faster if the gout is treated. If you think you might have it, contact your doctor. An exam and tests will show if itâs gout or something else, like an infection.
Talk with your doctor about the best medicines for you. The type will depend on how well your kidneys work, the possible side effects, and other health issues.
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
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How Should I Use Allopurinol
Take allopurinol exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.
Take allopurinol oral with a full glass of water. To reduce your risk of kidney stones forming, drink 8 to 10 full glasses of fluid every day, unless your doctor tells you otherwise.
If this medicine upsets your stomach, take allopurinol oral after a meal.
Allopurinol injection is given as an infusion into a vein if you are unable to take the medicine by mouth. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.
You may need to mix the injection with a liquid in an IV bag. When using injections by yourself, be sure you understand how to properly mix and store the medicine. Ask your doctor or pharmacist if you don’t understand all instructions.
Prepare an injection only when you are ready to give it. Do not use if the medicine has changed colors or has particles in it. Call your pharmacist for new medicine.
You may need frequent medical tests. Even if you have no symptoms, tests can help your doctor determine if allopurinol is effective.
You may have gout attacks more often when you first start taking this medicine oral. Your doctor may recommend other gout medication to take with allopurinol. Keep taking the medicine as directed.
Store at room temperature away from moisture and heat.
Chronic Gout Signs And Symptoms
- Compared with the dramatic nature of acute gout pain, chronic gout pain is more of a soreness or persistent ache.
- Pain that tends to be a more continuous feeling of dull aching or soreness in the joints
- Hard white deposits or lumps under the skin, called tophi, found on the elbows, ears, or fingers.
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Can You Get Rid Of Gout
It ought to be fairly obvious why youd want to get rid of gout, but is it possible actually?
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Who Can And Cannot Take Allopurinol
Allopurinol can be taken by adults and sometimes children.
Allopurinol is not suitable for certain people.
Talk to a doctor or pharmacist if you:
- have ever had an allergic reaction to allopurinol or any other medicine
- are of Han Chinese, Thai or Korean origin
- have problems with your liver or kidneys
- currently have an attack of gout
- have thyroid problems
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How Much Should You Take
Despite the fact that research strongly suggests that cherry juice can treat gout, there isnt yet a standard dosage. The amount of cherry juice that you consume should depend on the intensity of your symptoms.
The Arthritis Foundation suggests eating a handful of cherries or drinking a glass of tart cherry juice per day, since the available research noted improvements in people who drank a glass every day.
However, its always best to talk to your doctor before pursuing any treatment, as they might be able to give you more specific directions on dosage.
Related Conditions And Causes Of Gout
Other conditions that are sometimes confused with gout include:
- Reactive arthritis
- Infectious arthritis
- Psoriatic arthritis
- Rheumatoid arthritis , which occurs when the body releases too many inflammatory chemicals . Gout is caused by too much uric acid.
- Osteoarthritis , known as wear-and-tear arthritis.
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Causes And Symptoms Of Gout
Uric acid in the body is generated during the metabolism of purine that is obtained from the food. It is flushed out of the body regularly through urine. This means, dysfunction of kidneys , impaired metabolic functions and high purine intake can result in high uric acid levels.
Mushrooms, wheat bran, meat products, fish, legumes like black-eyed peas, white beans, split peas, lentils, red beans, garbanzo beans, vegetables like spinach, cauliflower, asparagus, are some examples of purine rich foods. Those who are diagnosed with gout should avoid foods that cause gout. Excessive consumption of alcohol and caffeine can raise uric acid levels. So, alcoholic or caffeine rich beverages should be avoided by gout sufferers.
Gout mainly affects legs or feet. It generally affects a single joint at a time. Sudden occurrence of pain and swelling in joints at the ankles, knees, wrists, fingers and elbows is the main symptom of gout. Reddened skin at the affected joint, warmth, increased tenderness, restricted movement of the joint and severe pain is experienced during the attack. The person experiences pain for several hours or days. Now, let us take a look at what medication causes 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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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.
Medications For Acute Gout
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