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
What Causes High Uric Acid Levels In The Body
When it comes to what causes gout, higher levels of uric acid in your body may be caused due to various reasons including obesity, diet pattern, genetic reasons etc. Higher levels of uric acid are also termed as Hyperuricaemia. If you are more than the normal weight, then the fatty tissues in your body also enhance the production of uric acid in your body.
We also get lots of purines through our diet and it has been proven that around 15% of purine is sourced from our diets. Foods that are rich in purines, main gout causing chemicals include red meat, sugary beverages, asparagus, spinach, turkey, beer, herring and scallops.
Our body also produces its own uric acid and normally most of the excess ones are eliminated from our body, but in certain conditions, it is not able to eliminate the uric acid content thus increasing the levels of uric acid in the body. The reason why your body couldnt remove the uric acid may vary including obesity, being diabetic, alcoholic and consuming certain kind of diuretics.
Major factors that cause higher levels of uric acid in your blood include:
- Drinking too much alcohol
- Hypothyroidism
Reduced Range Of Motion
Whether youre having an attack or have endured permanent damage, your joints will not fully function. Due to inflammation or damage, your range of motion may be hindered. This means that both the distance and direction that a joint can move, will essentially decrease. This is especially common within ones knee joints, however, some simple exercises can help prevent stiffness. If youre experiencing inflamed joints, its best to seek advice from your physician. Its important to remain active, reducing the possibility of overly stiff joints.
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How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
How Can Gout And Other Crystal Arthropathies Be Managed
The development of gout and other crystal arthropathies can be attributed to a number of factors including obesity, diet, alcohol intake, and certain medications. Gout and other crystal arthropathies can be managed with medication and lifestyle changes.Footnote 3Footnote 4 Anti-inflammatory drugs are often taken to reduce pain and decrease joint inflammation.Footnote 5 Self-management strategies include patient education on lifestyle and dietary recommendations, to help alleviate symptoms and decrease severity of attacks.Footnote 4Footnote 6
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Why Does Alcohol Cause Gout
Gout develops from a buildup of a chemical in the bloodstream called uric acid. The body makes uric acid as it breaks down chemicals called purines, which are in foods like seafood and meat. Usually, uric acid is dissolved into the blood and then removed from the body through urine. If there is too much uric acid in the body, it can turn into crystals in your joints and cause a painful gout flare.
Alcohol has been shown to cause gout flare-ups in several ways, including:
- By increasing the amount of uric acid that the body makes
The combination of all three of these factors makes a person more likely to have a gout flare if you drink alcohol. Dehydration, specifically, can cause gout flare-ups because, without enough water in the body, the kidneys cant get rid of the extra uric acid that causes gout. Alcohol only worsens this process. When a person drinks alcohol, it shuts off a chemical in their brain called the antidiuretic hormone, or ADH. Without enough ADH, someone can become extremely dehydrated very quickly because they will urinate a lot in a short time. Dehydration raises a persons chances of having a gout flare.
What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
References
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What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
What Are Gout Treatments And Home Remedies
When gout is mild, infrequent, and uncomplicated, it can be treated with diet and lifestyle changes. However, studies have shown that even the most rigorous diet does not lower the serum uric acid enough to control severe gout, and therefore medications are generally necessary. When attacks are frequent, uric acid kidney stones have occurred, tophi are present, or there is evidence of joint damage from gout attacks, medications are typically used to lower the uric acid blood level.
Medications for the treatment of gout generally fall into one of three categories: uric-acid-lowering medications, prophylactic medications , and rescue medications to provide immediate relief from gout pain.
Urate-lowering medications are the primary treatment for gout. These medications decrease the total amount of uric acid in the body and lower the serum uric acid level. For most patients, the goal of uric-acid-lowering medication is to achieve a serum uric acid level of less than 6 mg/dl. These medications also are effective treatments to decrease the size of tophi, with the ultimate goal of eradicating them. Uric-acid-lowering medications include allopurinol , , probenecid, and pegloticase .
Gout home remedies
Home remedies for an acute gout attack include drinking plenty of water. Over-the-counter NSAIDs , such as ibuprofen and naproxen sodium , can be used when there are no contra-indications, such as decreased kidney function or stomach ulcers.
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What Are The Mortality Rates Among Canadians With Or Without Gout And Other Crystal Arthropathies
Between 20072008 and 20162017, age-standardized all-cause mortality rates decreased among females with diagnosed gout and other crystal arthropathies , and among males with diagnosed gout and other crystal arthropathies .
Over the surveillance period, the age-standardized all-cause mortality rate ratios were relatively stable ranging from 1.9 to 2.2 for females and from 1.3 to 1.4 for males. While rate ratios were similar among females and males, they showed an increase in mortality risk among those with diagnosed gout and other crystal arthropathies.
Figure 4: Age-standardizedFootnote e all-cause mortality rates and rate ratios among Canadians aged 20 years and older with and without diagnosed gout and other crystal arthropathies, Canada,Footnote f from 20072008 to 20162017
- Footnote e
| 1.4 |
Points To Remember About Gout
- Gout is a type of arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then go away.
- With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
- The most common symptom of gout is pain in the affected joint, such as the big toe.
- Your doctor may recommend taking medications to manage the cause of your gout and treat active gout flares, and making changes to your diet and lifestyle.
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What Are Gout And Other Crystal Arthropathies
Gout and pseudogout are the two most common types of crystal arthropathies, caused by small crystals that accumulate in the joints.Footnote 2 Gout is characterized by the crystallization of uric acid within the joints and is often associated with the excess of uric acid in the blood , while pseudogout results from deposits of calcium pyrophosphate crystals in the joints. The bodys immune system is triggered by these crystals, and the immune system activity can lead to pain, swelling and redness in the joint and surrounding tissues. While gout can occur in any joint, it often occurs at the base of the big toe.Footnote 3 Other joints commonly involved include the knees, ankles, elbows, wrists and fingers. Both gout and pseudogout are episodic in nature with active and inactive periods. Active periods or attacks vary in length and severity, although it is common that pseudogout episodes are less intense than gout. Repeated attacks of these conditions may become more frequent, last longer and affect more joints, and can cause permanent joint damage.
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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How Common Is Gout In The Knee
As a general rule of thumb, if left untreated, gout tends to work its way up the body, Dr. Keenan explains.
For example, he cites research that shows 50 percent of patients experience their first gout attack in the big toe. If gout worsens, 35 percent of secondary flares occur in the knee, 40 percent in the midfoot and ankle, 30 percent in elbows and wrists, and 15 percent in fingers.
Its not uncommon for a person to experience their first gout flare in their knee and, after an X-ray or ultrasound, show signs of gout in the foot, he adds.
Gout can afflict both knees, but typically is felt more strongly in one knee where arthritis from general wear is worse.
Stage : Intercritical Gout
After a first gout flare, 75 percent of people will have a second within a year but some people can go years before another attack, says Dr. Fields. The in-between stage is where a person has already had a gout flare but is presently not having any joint pain or swelling, he says. Almost all gout patients will go through this phase, since it is the nature of gout to have flares and then quiet down for a period of time before the next flare.
Even though it may seem like nothing is happening, this is the point in which patients should begin long-term treatment. Lowering uric acid levels with medication can prevent future gout flares and long-term complications that go with them.
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What Are The Trends Over Time
Between 20072008 to 20162017, the age-standardized prevalence of diagnosed gout and other crystal arthropathies increased among females and males . During the same time period, the age-standardized incidence of diagnosed gout and other crystal arthropathies increased from 0.8 to 0.9 per 1,000 persons per year in females and from 2.7 to 2.9 per 1,000 persons per year in males.
Figure 3: Age-standardizedFootnote c prevalence and incidence of diagnosed gout and other crystal arthropathies among Canadians aged 20 years and older, by sex, Canada,Footnote d from 20072008 to 20162017
- Footnote c
| 0.9 | 2.9 |
What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
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Have An Emergency Companion
Anyone with a medical condition should have an emergency companion. This is someone that you can call and rely on in the event of an emergency. It can be a family member, a friend, or a close and trusted neighbor who can come to your aid during a gout attack.
This person will be important to you because a gout attack can leave a person incapacitated for a couple of hours. You might need help reaching for the medicine cabinet or doing a soak remedy. Maybe this person lives with you or near you, either way, whats important is that they are within close proximity so they can help you right away.
How Can I Self
The methods of managing an acute attack of gout differ from the ongoing methods for managing gout. If youve been diagnosed with gout, youll benefit in the long term from making healthy changes to your lifestyle, such as:
- maintaining a healthy body weight. If you do need to lose weight, make sure your weight loss is gradual as crash diets can increase uric acid levels
- drinking alcohol in moderation and avoiding binge drinking
- drinking plenty of water, and staying hydrated
- avoiding, or eating in moderation, foods that are high in purines. Talk with a dietitian for tips and advice
- exercising regularly aim to complete at least 30 minutes of physical activity most days of the week
- working closely with your GP to prevent further attacks and actively manage your condition.
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What Is The Difference Between Primary And Secondary Gout
Gout may be either primary or secondary . Primary gout is related to underexcretion or overproduction of uric acid, often associated with a mix of dietary excesses or alcohol overuse and metabolic syndrome. Secondary gout is related to medications or conditions that cause hyperuricemia, such as the following :
- Myeloproliferative diseases or their treatment
- Therapeutic regimens that produce hyperuricemia
- Renal failure
Symptoms That Indicate You Have Gout
When the body builds up too much uric acid, individuals often experience a number of gout-related symptoms. It is known to be one of the more painful forms of arthritis, often beginning in the big toe. Caused by a number of factors, including poor kidney function, its important to recognize the symptoms as early as possible. Although there is not currently a cure, painful symptoms can be alleviated and effectively managed. Anyone who has dealt with gout knows from experience that finding a treatment that works is of the utmost importance. A gout flare up can be extremely painful. However, there are treatments out there that can relieve the unwanted symptoms very quickly.
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Gout In Poultry Article Is All About Cause Treatment & Prevention Of Gout In Poultry Let Us Discuss About Gout In Poultry
Excretion of metabolic waste products is important in poultry and this function is performed by the kidneys. The function of kidneys is affected by a number of specific diseases and disorders. One of the important disorders associated with kidney damage is Gout in Poultry. In birds uric acid is the end product of nitrogen metabolism. Uric acid is a nitrogenous waste from protein breakdown. In mammals, it is converted to less harmful substance with the help of the enzyme uricase. But in birds this enzyme is absent. Hence, uric acid is the final excretory product. Uric acid is produced mainly in the liver and is excreted by the kidneys. High blood levels of uric acid favour its precipitation in tissues. Uric acid is not toxic but precipitated crystals can cause mechanical damage to tissues like kidneys, heart, lungs, intestines and also in the joints. These crystals severely damage body tissues. So Gout is a condition in which kidney function decreases to a point where uric acid accumulates in the blood and body fluids. Avian gout is a metabolic condition where abnormal accumulation of white chalky uric acid or urates occurs in soft tissues of various organs of body. Gout is commonly observed in chicken as they are uricotelic and lack the enzyme uricase. In gout, blood levels of uric acid can be as high as 44mg/100ml as compared to 5-7mg/100ml in a normal bird.
Cause of Gout in Poultry :
7.Hard water with higher salt content is also a load on the kidneys.