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.
Joints Affected By Gout
Gout can affect any joint, but some joints are more likely to be affected than others. Joints commonly affected include the big toe, the foots instep, heel, ankle, and knee.2 Less often, gout affects the elbow, wrist, fingertips, or spine.2–7
Gout is acute, painful swelling in the joints from uric acid buildup. Common areas include the foot and big toe.
Gout In Foot: Causes And Risk Factors
In about 90 percent of hyperuricaemia cases, there is impaired renal excretion in about 10 percent, there is a problem with overproduction.
- Urate overproduction can be linked to lifestyle factors and certain diseases such as bone marrow cancers, psoriasis, and hemolytic anemia. Lifestyle factors include being overweight and ingesting excess amount of fructose or alcohol.
- Renal impairment has multiple causes, including gene mutations, hypertension, diuretic drugs, lead exposure, and cyclosporine immunosuppressive therapy.
- Gender and age. Men are twice as likely to develop gout as women. In men, the risk rises with age. Gout is uncommon in younger women but the incidence increases dramatically after menopause, due to falling estrogen.
- Western diet. There is solid evidence from the Health Professional Follow-up Study of a link between gout and purine-rich foods. See gout diet.
- Medications. Diuretics, antihypertensives, niacin, aspirin, chemotherapy and immunosuppressive drugs increase the risk of gout.
- Other conditions. Certain conditions carry an increased risk of gout including: Recent joint injury or surgery, cardiovascular disease, chronic pulmonary disease, anemia, psoriasis, renal disease, blood cancers, and metabolic syndrome.
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Differences Between Ra And Gout
Both diseases cause redness, swelling, and pain in the joints. Both can cause serious disability and disrupt your quality of life.
However, a close look at initial signs and which joints are involved will clearly differentiate these two diseases. The best way to know whether you have RA or gout is to make an appointment with your doctor for a diagnosis.
Specific signs that distinguish the diseases:
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Acute Classic Gout Attack
Why classic? Because these symptoms are characteristic of manifestations of gout. They occur in 70-80% of cases. Most often, seizures overtake a person in the middle of the night. A person begins to feel weakness in the legs, hands, it shivers, he can not walk around the kitchen to drink a glass of water. In addition, severe headaches, arthralgia, subfebrile condition are possible.
The indicator that a person has gout in its classical manifestation will be a sharp pain in the joint of the metatarsal phalanx, which concentrates in the big toe. This joint swells very quickly, it can also be distinguished by red skin, then the skin changes its shade to bluish-red, with the skin glistening and firm touching.
The finger is hot at this time, it hurts to touch it. Of course, in this state the finger is very difficult to move – it freezes in one position, it is not possible to wear shoes at all.
The human body temperature rises to 39 degrees, it fever. These are the manifestations of classical gout.
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Genes And Family History
Research over the past decade has increasingly identified a link between a genetic predisposition and high uric acid levels. For example, in a 2012 study, researchers looking at a large number of peoples unique genomes found that patients with gout often shared a similar variation on a gene that affects kidney function. A 2018 study further identified several genes that influence how the body gets rid of uric acid.
What Are The Causes And Triggers Of Gout In The Knee
The buildup of uric acid in the body is known as hyperuricemia. Your body produces uric acid when it breaks down purines. These are compounds found in all your cells. You can also find purines in several types of food, especially red meat and some seafood, as well as alcohol and some sugar-sweetened drinks.
Usually, uric acid passes through your kidneys, which help to eliminate extra uric acid in your urine. But sometimes, theres too much uric acid for your kidneys to handle. In other cases, the kidneys cant process typical amounts of uric acid due to an underlying condition.
As a result, more uric acid circulates throughout your body, ending up in your knee as uric acid crystals.
4 percent of adults in the United States. It tends to be more common in men because women usually have lower levels of uric acid. But after menopause, women start to have higher uric acid levels. As a result, women tend to develop gout at an older age than men do.
Experts arent sure why some people produce more uric acid or have trouble processing it. But theres evidence that the condition is often genetic.
Other things that may increase your risk of developing gout include:
- consuming a lot of high-purine foods
- consuming foods and drinks, especially alcohol, that increase uric acid production
- being overweight
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How Can You Treat Your Gout
Your path to freedom from gout begins with an evaluation. Dr. Blackwell meets with you and conducts a thorough investigation into your symptoms and your medical history. From there, he customizes a treatment plan that could include:
- Physical therapy
- Medications
- Cortisone or viscosupplementation injections
Dont let gout pain sideline you. Instead, let us help keep you moving with our expert and comprehensive care.
If youd like more information or would like to get started with a consultation, or book an appointment online. You can also send a message to Dr. Blackwell and the team here on our website.
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The Pathology Of Gout
Gout is primarily a metabolic disorder in which uric acid accumulates in blood and tissues. When tissue levels reach saturation, needle-like crystals form, causing inflammation. This occurs most commonly in the cooler joints, notably the metatarsophalangeal joint of the big toe.
Many people with hyperuricemia never develop gout, but those with the highest levels are most likely to suffer episodes. Hyperuricemia may also lead to kidney stones.
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Gout Associated With Kidney Disease
Gout attacks can be combined with kidney stones, causing pain in the joints and kidneys to increase. Such pains are very frequent, they occur in 40% of patients. Kidney stones and manifestations of gout may be aggravated by pyelonephritis.
Gout may be aggravated by another rather terrible disease – gouty nephropathy. This is the state of the kidneys, when the kidneys can not perform their functions. To this condition, kidney failure may be associated. An indicative symptom may also be increased blood pressure, causing patients to experience severe headaches, such patients about a third.
Managing Symptoms Of Gout
Medications are available to help you manage symptoms of gout. These include nonsteroidal anti-inflammatory drugs, such as indomethacin , ibuprofen , and naproxen . Side effects of these medications can include bleeding, stomach ulcers, and stomach pain. If your symptoms dont respond to these medications, your doctors may recommend other drugs to stop an attack and prevent future attacks.
Colchicine can reduce gout pain, but side effects may include nausea, diarrhea, and vomiting.
Corticosteroids such as prednisone also reduce inflammation and pain. These prescription medications can be taken orally or injected into your joint. Side effects include mood changes, elevated blood pressure, and water retention.
There are medications that block the production of uric acid and others that help your body remove uric acid, such as allopurinol and probenecid, respectively.
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What Happens In The Body During An Attack
First of all, the inflammatory process in the body is underway, which means that blood is necessarily reacting to it – our vital fluid. So, when analyzing blood, doctors detect an elevated level of ESR, acids of sialin, seromucoid, fibrin, and also identify C-reactive protein, which should not be in a healthy state. C-reactive protein is a protein that appears in the blood, as soon as inflammatory processes are detected in the body.
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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Who Should Diagnose And Treat Gout
The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.
Am I At Risk Of Having Gout
Youre more likely to have a gout attack if you:
- are male
- have a family history of gout
- have elevated levels of uric acid in the blood
- drink too much alcohol
- eat a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
- are overweight or obese
- use diuretics
- have type 2 diabetes, high blood pressure or high cholesterol these conditions can mean that your kidneys are less able to flush out the urates
- have kidney disease
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Symptoms Of Rheumatoid Arthritis And Gout
Because they are both forms of inflammatory arthritis, RA and gout share some of the same symptoms. Both can cause pain, inflammation and redness, swollen joints, and visible nodules . RA and gout can also cause stiffness in the affected joints, limiting the joints range of motion over time. These similarities may appear to make the two conditions indiscernible, but the location and onset of pain can help set them apart.
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The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
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What Examinations Are Done With Gout
The general analysis of a blood – on it can define, whether there are inflammatory processes in an organism In addition, with gout in the blood will be increased ESR.
Blood analysis for biochemistry – when gout is determined by increasing levels of sialic acids, haptoglobin, Y-globulins, alpha-2, as well as fibrin, uric acid. Elevated blood levels of uric acid will be more than 0.12-0.24 mmol / l.
Radiography of all joints – this method helps to determine if a person has a chronic form of gout. If so, white spots with a value of 0.5 mm to 3 cm in diameter will be visible on the screen. All these changes in the joints are due to tofus, of which you are already well aware.
Tofuses can be large, and then, destroying, they destroy the cortical substance of the joints. This phenomenon is called a symptom of bloating of the bone edge. When gout worries a person for a very long time, the gland of internal secretion, which is called the pineal body, can collapse almost completely. Instead of it salts of uric acid in a solid form – urates are formed. They can be seen on fluoroscopy, but not in the initial stage, and not less than five years after the person became ill with 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
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Gout Symptoms And Complications
Gout is not gout until symptoms occur. When they do, they usually come on suddenly and, at least initially, affect a single joint. Within hours, that joint becomes red, swollen, hot, and painful they’re called gout attacks for a reason. It’s easy to mistake a gout attack for a localized infection of a joint. The metatarsophalangeal joint at the base of the big toe is often the site of the first attack, but the knees, ankles, and joints between the many small bones that form the foot are also common sites. People who already have osteoarthritis the most common form of arthritis often experience their gout attacks in the joints of the finger
Decreased Excretion Of Uric Acid
Two thirds of urate excretion occurs in the kidneys while the rest is excreted through the gastrointestinal tract . Reduced secretory function of the transporter ABCG2 leads to decreased excretion of uric acid through the GIT resulting in rise of serum levels of uric acid and enhanced renal excretion .
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What Does The Future Hold For Gout
Active research is ongoing in a variety of fields related to gout and hyperuricemia. Scientists have found that high animal protein slightly increased the risk for gout. New drugs are being developed that may be more versatile and safe in treating the elevated uric acid levels in patients with chronic gout.
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Attack Of Gout In Men And Women
If the attack of gout passes for the first time, then men may have additional symptoms, characteristic of arthritis. The joint of the big toe hurts, it swells, the metatarsophalangeal joints, and tarsus suffer the same way.
Inflammation and ulnar joints can also be inflamed, but this is not a frequent manifestation of gout. It is very rare that the joints of the pelvis, hips, shoulders, chest, and also the collarbone can become inflamed and hurt.
But all these manifestations in men – manifestations of monoarthritis, that is, it inflames and hurts any one part of the body of the above.
As for women, their doctor can establish polyarthritis – that is, multiple joint diseases of different parts of the body. Basically, these are hands , As well as diseases and swelling of the ankle joint, metatarsus, knees, wrist joint.
For these symptoms, men and women can determine that they have gout, not injury to the joints or something else.
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