Medications For Lowering Uric Acid Levels
Your doctor may prescribe medications to reduce the uric acid your body produces if you have frequent gout flares and severe symptoms. Some medications that can help lower uric acid levels include:
- Probenecid: This is taken in pill form and acts on the kidneys to promote uric acid excretion.
- Allopurinol: This medication increases the amount of uric acid that the kidneys can remove. Doctors often prescribe lower doses initially and gradually increase them if the uric acid level remains high.
- This medication increases the amount of uric acid that the kidneys remove. Doctors often prescribe this if is not an option.
- Pegloticase: Doctors administer this medication by intravenous infusion. This medication is only an option when other medications have not been effective.
- Indomethacin : This and other prescription-strength NSAIDs can treat pain and inflammation of severe gout.
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
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
Arthritis / Acute Gout Attack
Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.
The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.
An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack takes approximately 7-14 days.
An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of gout:
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Preventing Future Ankle Gout Symptoms
After surviving an arduous bout of gout ankle, keeping the body in a state of greater health by keeping the body chemistry on the more alkaline side is wise. Minimizing the causes of gout can be done in several ways:
- Strong breathing awareness and habits keep the blood healthy and oxygenated
- Maintaining consistent hydration is essential for proper pH balance
- A diet of alkalizing foods, and foods that support strong kidney and liver function is fundamental
- Managing stress is important for minimizing the effects of acid-forming hormones in the inner terrain
- Being aware of, and avoiding toxic environmental chemicals is a good way to retard the slow accumulation of low-level toxicity from seemingly mundane household products
- Consistent exercise and sleep are the basics to health, and obvious and easy measures to employ for guarding against the risk of gout
Remember! When symptoms of gout in the ankle start to become apparent, it is critical to take fast action.
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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What About Prp Injections For Gout
PRP injections for gout are only reserved for special cases. Just like cortisone injections, PRP injections are anti-inflammatory and will have a beneficial effect. This effect is probably better if the injected joint has underlying degenerative changes such as osteoarthritis. Nevertheless, the effect of PRP is less than cortisone. Overall, we would only consider PRP injection for gout if the risks of a cortisone injection are too great.
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Symptoms Of Ankle Gout
Doctors can sometimes misdiagnose gout in the ankles as a variety of other illnesses like a sprained ankle or cellulitis. But there are a few symptoms that Frisco patients can look for that could indicate its actually gout.
Pain While a sprained ankle may be tender, gout is usually extremely painful. Many patients find it difficult to even walk during a gout attack.
Stiffness Many patients report that their ankle joint will become stiff when a gout attack is setting in. It may start with a dull ache that turns into severe stiffness.
Color Joint affected by gout will almost always be very red, often a very bright red.
Swelling Of course, another symptom of gout is intense swelling at the joint.
Texture Another telltale sign of gout is that the skin will be shiny.
Temperature With gout, the ankle joint will be very warm to the touch.
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Natural Remedies Of Ankle Gout
- Drink more water As gout causes inflammation and swelling in joints, you need to drink much amount of water. By drinking water, you can reduce the swelling condition. Intake of more fluid will encourage your kidneys to discharge fluids. That is why you can alleviate swelling at your joints.
- Add ginger to your diet Ginger has anti-inflammatory properties, and thus, you may use it for gout treatment. To make this home treatment effective, you have to boil water and add one tablespoon of grated ginger. Then, apply ginger to the affected part. You must do it at least once every day for about 15 to 30 minutes. You may also drink the solution of water and ginger daily.
- Cherries Researchers have noticed that the consumption of cherries can minimize the gout risk. Cherries have anthocyanins that fight against inflammation. So drink cherry juice regularly to reduce your gout symptoms.
- Apply ice Cover an ice pack in a cloth and apply it to your affected part. This trick will help you in reducing inflammation. Leave the ice pack for 10 to 20 minutes.
- Apple cider vinegar It is another solution for your pain and swelling issues caused by gout. Add a spoon of vinegar to warm water. You will slowly get relief in this condition.
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Treating And Preventing Gout Pain
Gout pain is generally treated in two ways:
- Medications to relieve gout attacks in the short-term
- Preventive medications taken regularly to lower uric acid and stop gout attacks from occurring
While inflammation-fighting drugs are used to relieve pain during gout flares, different medicines are used to lower uric acid levels to prevent future attacks. These include:
- Allopurinol
- Probenecid
Another medication called pegloticase may be recommended for people with chronic gout who have not responded to other uric acid-lowering medication.
While many people with gout can be treated by their primary care physician, if gout is not responding to medication or is progressing with worsening or frequent flares or developing tophi gout deposits, then your primary care physician may refer you to see a rheumatologist who specializes in treating diseases that affect joints, muscles, bones and the immune system.
Taking medication to reduce uric acid levels and reduce the risk of gout progression is important, Dr. FitzGerald stresses. If you have risk factors for bad gout, such as kidney disease, or are experiencing frequent attacks, early treatment is better.
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How Long Gout Pain Lasts
Characteristically, gout pain comes on rapidly and the joint becomes red and swollen, with the swelling reaching a peak within the first 24 hours of the attack, Dr. FitzGerald explains.
At first, gout usually affects just one joint, but can affect more than one joint, sometimes adjacent joints. Flares typically resolve on their own over the next seven to 14 days. Treating a gout flare with medications can help it resolve faster. Medications for gout flares typically include:
- Non-steroidal anti-inflammatory drugs , such as ibuprofen or naproxen
- Colchicine
- Glucocorticoids
A gout attack may occur only one or two times a year or even only a few times ever. However, gout can become chronic, leading to frequent attacks and flares that occur at least a few times a year or never completely resolve. Chronic gout can damage and deform joints and can sometimes be mistaken for other inflammatory diseases like rheumatoid arthritis.
Signs Your Pain Is Likely Gout And Not Something Else
If you develop sharp sudden pain in a single joint or a couple of joints, if the pain is so debilitating that it is hard to walk or wear shoes, and if you have risk factors for gout , theres good reason to suspect gout as the culprit. However, its important to see a doctor for a thorough exam and proper diagnosis.
Dr. FitzGerald cautions that issues unrelated to gout can cause an angry, inflamed joint. Gout may be confused with several other conditions that can cause similar symptoms, including:
- Pseudogout
- An infected joint
- Bacterial skin infection
- Rheumatoid arthritis
- Psoriatic arthritis
Pseudogout is caused by a different kind of crystal, calcium pyrophosphate. A flare of pseudogout can resemble gout, but it more often affects your wrist and knee, and is unlikely to involve the big toe. Like gout, pseudogout is also considered a form of inflammatory arthritis. Its more likely to affect people over the age of 40 and those who have a thyroid condition, kidney failure, or disorder that affects calcium, phosphate, or iron metabolism, according to the Cleveland Clinic.
Its also possible to have gout without the classic presentation of red, hot, sharp, burning, sudden pain in the big toe, foot, ankle, or knee. Some patients may have joint pain that is less acute.
People can also have high levels of uric acid but not develop symptoms of gout.
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Pain Comes On Suddenly And Fiercely
Usually, when pain comes on suddenly, its something you can tracklike twisting your ankle or tripping. But theres no rhyme or reason with gout.
You may feel perfectly healthy, and out of nowhere, gout strikes. The symptoms usually come on fairly abruptly and worsen very quickly, says Dr. Siaton.
The worst pain usually occurs within the first 24 hours. As mentioned, NSAIDs can relieve pain, but they are usually more effective if taken as soon as the pain hits.
S Of The Gout For Better Understanding
Heres few pictures of the gout!
If you have pain, swelling and redness at the base of the great toe then most likely it is due to gout. It not only affects this joint but initially it may affect small joints of fingers of hand and leg, in the later stage, it may also affect large joints such as the ankle, knee wrist and elbow joint.
Gout happens due to increased blood uric acid level. Pharmacological management focuses on controlling the blood uric acid level but being a physiotherapist I will also suggest few home tips and exercises that will prevent the joint swelling, pain and most important is joint stiffness.
So, lets get started.
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What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.
What Causes Gout To Flare Up :
Gout is caused due to the excess of uric acid formation by the body which may be the result of lifestyle, weight or food.
High uric acid levels may be the result of over production of uric acid or the in-efficient process of kidneys, although not every human body develops gout. Uric acid is a substance that is made when our body breaks down purines.High uric acid levels leads to the accumulation of uric acid crystals in joints resulting the inflammation and swelling.
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Why Work With Dr Verville For Your Gout
Frisco patients suffering from gout can get some of the finest treatment with Dr. Verville. Shes been a practicing podiatrist for over 10 years and has performed over 1,500 surgical procedures. On top of that, patients love how gentle and compassionate she is with all of her patients. Dr. Verville works hard to develop strong and transparent relationships with all of her patients so that they feel comfortable and welcomed by her. We know that gout can be excruciatingly painful so make sure that you call Dr. Verville today for a consultation at . We would love to learn more about you and how we can help.
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Diagnosing And Treating Gout
At your evaluation, we examine your feet thoroughly and use imaging tests to determine the exact nature of your foot pain. If we determine you have gout, we start by treating it with medication, which for acute attacks can include:
- Nonsteroidal anti-inflammatory drugs to alleviate pain and inflammation
- Colchicine to reduce gout pain
- Corticosteroids, which have strong anti-inflammatory properties
In addition, we may prescribe medications to block uric acid production, and/or medications to increase uric acid removal.
If youre experiencing joint pain, especially if it starts in your big toe, its time to come into Chicagoland Foot and Ankle for an evaluation to determine if gout is the cause. Contact us today. We have locations in Chicago, Orland Park, and New Lenox, Illinois.
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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
How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
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