How Will Gout Affect Me
Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.
Without medication attacks tend to happen more often and other joints can become affected.
Having high urate levels and gout for a long time can lead to other health problems, including:
- narrowing of the arteries – which can lead to an increased risk of stroke or heart attacks or other heart problems
- osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
- an increased risk of developing kidney disease or worsening of the condition if you already have it
- kidney stones
- an increased risk of some cancers, especially prostate cancer
- mental health problems, including depression
- underactive thyroid
- erectile dysfunction in men.
If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.
Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:
- treating the acute attack
- treatments to prevent future attacks.
How Gout Differs From Bunions
When it comes to gout vs. bunion, one of the key differences is that gout is a type of inflammatory arthritis in which high uric acid levels in the blood cause the formation of extremely painful urate crystals in the joint. It is frequently misdiagnosed as a bunion because of the red, painful swelling around the big toe joint
The discomfort of gout is more severe, but generally, it can be difficult to distinguish between the two illnesses. Gout can affect any joint, although the big toe is most affected. Gout symptoms, including pain, inflammation and redness, might be mistaken for a painful bunion.
When comparing gout vs. bunion, bunions develop over time and cause discomfort gradually, gout frequently causes sudden and acute sensations. Gout is most typically linked with discomfort in the big toe joints, but it can affect other parts of the body as well.
Medications For Acute Gout
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What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
What Are The Symptoms Of Gout
An episode of gout is called a gout attack. Gout attacks are very painful and can happen quite suddenly, often overnight. During a gout attack, symptoms in the affected joint may include:
- Intense pain.
- Tenderness, even to light touch, such as from a bedsheet.
- Warmth, or a feeling like the joint is on fire.
- How long does a gout attack last?
A gout attack can last a week or two. Between gout attacks, you may have no symptoms at all.
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The Most Common Symptoms Of Gout
Health Check Certified By: Dr. Gerald Morris
Gout is a painful condition that is seeing a resurgence of sufferers. This uncomfortable affliction is a form of arthritis, often called gouty arthritis. Gout can affect anyone, but it is most common in people over the age of 30, and is more common in men than women. The causes of gout are mainly diet related, but overall the condition is caused by high levels of uric acids in the body, which collects in the joints and can cause pain. While most gout sufferers have a condition called hyperuricemia, which is abnormally high uric acid blood levels, not all do. Conversely, not all people with high uric acid levels suffer from gout.
The triggers of a gout attack are mainly diet related, but dehydration is also a leading cause of gout pain. Certain beverages, such as coffee, tea, and alcohol can trigger dehydration. Medications can also play a role in gout attacks. The symptoms of gout are very similar to other forms of arthritis, so it can be hard to diagnose. Here are 20 of the most common symptoms of gout
What Procedure Is Used To Diagnose Gouty Arthritis
Gout is usually diagnosed by a doctor based on the location of the inflamed joint and a history of having similar non-traumatic attacks of pain and swelling. The most reliable test for confirming gout is an arthrocentesis. Arthrocentesis is a procedure where fluid is withdrawn from an inflamed joint with a needle and syringe, using a sterile technique and a local anesthetic such as lidocaine. The fluid is sent to a lab where it is analyzed for the presence of uric acid crystals.
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Pain In Your Knees Ankles Wrists And/or Elbows
While uric acid crystals tend to deposit themselves near the big toe, they can form in any joint in the body. That means severe, unexplained pain in any joint could be a sign of gout.
Some people develop pain in just one joint , but about 25 percent of gout patients have polyarticular symptoms meaning they strike more than one joint at a time, says Dr. Huffstutter.
Treatments For Big Toe Gout
Remedies for gout has proven to be successful after a wide range of research. There are two major parts to treating gout. They include :- 1) treating the acute gout attack and 2) treatment for prevention of future attacks.
Treating acute gout attack: This treatment only helps to manage your symptoms in the event of an attack. The common drugs used for treating gout attacks are:
Non-steroidal anti-inflammatory drugs : These drugs help to reduce pain and inflammation. Examples are ibuprofen, diclofenac, and naproxen. However, NSAIDs may not be suitable for everyone. There re other alternative options that work like NSAIDs.
Colchicine: This is another drug you can take in place of NSAIDs. It is also effective in reducing the inflammation caused by uric acid crystals. If you have chronic kidney disease, avoid taking colchicine as it causes diarrhea or stomach pain.
Steroids: These are drugs you can take if you are at risk of side effects of NSAIDs and colchicine.
For managing a gout attack at home, you can adopt the PRICE therapy. Rest Rest the affected joint, that is, the big toe joint
Ice-Make sure to ice the joint area immediately after sustaining the attack to reduce the swelling. Apply cold packs for about 20 minutes at a time, and do this several times a day.
Compression Wrap the area of the joint with a compression bandage to prevent further swelling.
Elevation Raise the joint area and support with a soft object like a pillow.
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What Does Gout Look Like
Now that youre up to speed on what gout feels like, you might be wondering if there are any visible symptoms to look out for. In some cases, you might notice one or more lumps around the joint.
Sometimes called tophi, these hard protrusions are caused by a buildup of uric acid around the soft tissue lining a joint. They may become infected, which could ultimately result in further damage to the joint or, in severe cases, a physical disability. And as mentioned above, the inflammation can cause swelling or redness.
What Can Increase Your Risk
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it’s still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don’t.
Other factors that may increase your risk of developing gout are outlined below.
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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
- 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.
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
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Gout Symptomsfoot Pain Especiallyshould Not Be Left Untreated Because It Can Cause Damage To Your Joints
A recent study discovered that men with gout were 31 percent more likely to report erectile dysfunction than men without the condition.
Since gout is often thought of as a mans disease, many women lack awareness of gout symptomsfoot pain, in particularwhich means that many women have gout but arent aware they have it.
Although women are less likely than men to suffer from gout, a womans chance of developing gout increases significantly in her postmenopausal years, says Linda Russell, MD, a rheumatologist and the director of perioperative medicine at Weill Cornell. It appears that estrogen helps regulate uric acid content, and when estrogen levels drop, a womans body retains more uric acid.
The most common symptom of gout is pain, sometimes accompanied by redness, swelling, and/or heat, at the base of the big toe, says Dr. Russell.
WHAT YOU SHOULD KNOW
Risk factors for gout include:
- Being overweight or obese
- Being postmenopausal
- Consuming alcohol
- Eating foods high in purines , including red meat, organ meats, and some types of seafood
- Consuming foods and beverages high in fructose
- Having heart failure, high blood pressure, diabetes, or impaired kidney function
What Causes Pain In The Big Toe Joints
1 Injury. One of the most common reasons for big toe joint pain is injury. 2 Gout. Gout is a medical condition that causes uric acid to build up and form crystals. 3 Arthritis. Arthritis is a disorder affecting the joints that can cause pain, swelling, and restricted movement. 4 Bunions. 5 Sesamoiditis. 6 Turf Toe.
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Is There A Connection Between Gout And Turf Toe
If you are predisposed to gout or have multiple risk factors, joint injury may trigger a gout attack. Even stubbing your toe can cause a gout attack if there are enough uric acid crystals in your cartilage already.
If you have gout, its important to take precautions for your feet and joints when you exercise. Continuing to manage your condition over time is important.
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.
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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
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
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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 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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