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:
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
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So There You Have It: 42 Well
*Postscript*
You can change things up by substituting other nutritious options, such as:
- Mashed avocado, chopped red onion & tomato, on toasted sourdough, topped with a poached egg.
- Peanut butter and sliced banana on one wholemeal toast slice.
- Turkey breast instead of chicken breast.
- Baked potato with 1 cup max. of sauteed mushrooms .
- Smoked haddock, grilled tomatoes and poached egg / scrambled eggs.
- Roasted red pepper risotto with brown risotto rice, vegetable stock, no wine.
- Baked or grilled hake with salsa verde and steamed vegetables.
- Wholegrain penne pasta with onion, garlic, red and yellow bell peppers, zucchini, dried Italian herbs, and fresh basil.
Remember the meat, poultry and fish in these listings have to be restricted to a 4 oz serving since they generally have a moderately-high purine content.
But what about pork?
Except in certain religious communities, pork is the most widely consumed meat, so is it safe to eat in a gout diet?
It is, but only in moderation. However, there are several important health and moral issues being hotly debated which I cover in another article: Pork and Gout: Safe For Gout Sufferers?
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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.
How Is Gout Treated
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.
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Dont Be Scared Of Beans Legumes Vegetables
The most inconsistent recommendations are for beans, legumes and certain vegetables. No source indicated to avoid these food groups. However, many state they are high risk like some seafood.
From this particular purine table, beans, lentils and peanuts have far less purines than the other food groups mentioned previously. Therefore, they are not as high-risk for gout. Keep in mind, cured or dried food, such as beans, will have a higher purine concentration per weight because of shrinkage.
Some sources caution eating asparagus, cauliflower, peas, chickpeas, spinach and broccoli because it contains more purines than most vegetables. However, the purine amounts for asparagus, spinach and broccoli are less than half of pork or beef. Lastly, a recent study concluded purine-rich vegetables are less of a risk than animal based purines.
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Practice Mindfulness And Meditation
The good news: A gout attack is self-limited and will clear in time. In the meantime, according to the Arthritis Foundation, meditation, yoga breathing, mindfulness, and guided imagery can help you deal with the pain.
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How Does Food Affect Gout
If you have gout, certain foods may trigger an attack by raising your uric acid levels.
Trigger foods are commonly high in purines, a substance found naturally in foods. When you digest purines, your body makes uric acid as a waste product .
This is not a concern for healthy people, as they efficiently remove excess uric acid from the body.
However, people with gout cant efficiently remove excess uric acid. Thus, a high-purine diet may let uric acid accumulate and cause a gout attack (
10 ).
Foods that commonly trigger gout attacks include organ meats, red meats, seafood,alcohol and beer. They contain a moderate-to-high amount of purines .
However, there is one exception to this rule. Research shows that high-purine vegetables do not trigger gout attacks .
And interestingly, fructose and sugar-sweetened beverages can increase the risk of gout and gout attacks, even though theyre not purine-rich (
16 ).
For instance, a study including over 125,000 participants found that people who consumed the most fructose had a 62% higher risk of developing gout .
On the other hand, research shows that low-fat dairy products, soy products and vitamin C supplements may help prevent gout attacks by reducing blood uric acid levels (
Summary: Foods can either raise or lower your uric acid levels, depending on their purine content. However, fructose can raise your uric acid levels even though it is not purine-rich.
Five Ways To Ease A Gout Attack
If you have gout, you know what its like to suffer from a flare-up. Also known as gouty arthritis, a gout attack begins with a burning or itching feeling in your joints. The next sign is redness, swelling, or severe pain in the joint. This is caused by a buildup of uric acid around the joints, which forms uncomfortable uric crystals. This condition can be so painful that anything touching the jointeven a bedsheetcan cause severe pain.
If you are suffering from a gout attack or flare-up, you dont need to agonize alone or in silence. There are a few things you can do to ease the pain and prevent future flare-ups.
Over-the-counter treatments.
Several over-the-counter treatments can help relieve the pain caused by a gout attack. These nonsteroidal anti-inflammatory drugs can lower uric acid levels and treat episodes of inflammation. Some good choices include Aleve, Motrin, and Advil, and, when taken in prescription doses, can be very effective.
Contact Carolina Arthritis for guidance and to learn more about this strategy for your gout attacks.
Change your diet.
Many dietary and lifestyle changes can assist in recovery. Foods high in purines can increase the uric acid in your blood and trigger a gout flare-up. Some of these foods include:
- Some seafood
- Organ meats like liver
- Fatty foods
Ice, elevate, and relax.
Steroids treatments.
Make an appointment with Carolina Arthritis.
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Risk Factors For Gout And Diabetes
Many of the same things can make your chances of having gout or diabetes go up. You may be more likely to get them if you:
- Are overweight or obese. If you carry extra fat on your body, youâre more likely to have both gout and type 2 diabetes.
- Drink too much alcohol. Moderate amounts of alcohol one drink a day for women and men over 65 and two for men 65 and younger may actually lower your chances of getting diabetes. But too much can affect how your pancreas releases insulin, which can lead to type 2 diabetes. More than two drinks a day can also up your odds of gout.
- Have a family history of them. If one of your family members has had gout or diabetes, youâre more likely to get these diseases, too.
- Have other health problems. High cholesterol and high blood pressure are linked to both conditions.
Organ Meats Are Extremely High In Purines And Should Also Be Avoided
Organ meats, known as Offal, contain by far the most purines of any food in the human diet.
The most common forms of offal in the Western diet include liver , brain, heart, kidneys, and a mixture called Pâté.
Below is the purine content of a handful of foods. Note this is just an example Ive selected, and you can find much more extensive lists on Goutpal or here.
Purine Content of Food :
Consider that values listed are per 100 grams, so portion sizes must be taken into account Meat portions we eat tend to be heaviest.
Previous studies have not differentiated between intake of conventional meat and offal, so recommendations have to be the same. Given the strong link between meat intake and gout which is based on purine content alone offal should definitely be avoided too.
Somewhat contradictory to the purine-gout theory, consumption of purine-rich vegetables is not associated with an increased risk of gout .
Researchers speculate this could be due to a lower bioavailability of purines in vegetabes, as well as other nutrients which may offset the harmful effects of their purines.
Summary: Organ meats are some of the highest purine foods and should be completely avoided if you suffer gout attacks.
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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
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High Purine Vegetables Are Ok
Some vegetables and plant foods, such as peas, beans, lentils, spinach, mushrooms, oats, and cauliflower, are high in purines. However, several studies have shown that they do not increase the risk of gout.
In fact, the opposite seems to be true, with a vegetable-rich diet being associated with a lower risk of gout compared with the lower consumption of vegetables. Therefore, you do not need to limit or avoid any vegetables on a gout-friendly diet.
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Topical Cold Or Hot Application
Applying cold or hot water to inflamed joints may also be effective.
Studies and opinions on this are mixed. Soaking in cold water is most often recommended and considered most effective. Ice packs may also work.
Soaking in hot water is typically only recommended when inflammation isnt as intense.
Alternating hot and cold applications may also be helpful.
How To Handle Your First Gout Attack
After a first attack of gout, its OK to try to stave off another one with dietary changes alone. But if you have another attack, its important to start taking preventive gout medications on a regular basis. Long-term medications for gout include allopurinol and febuxostat, both of which limit uric acid production.
Some patients, says Dr. Fields, treat each attack as a separate event and dont talk to their doctors about doing a preventive approach. He uses the analogy of lighting a book of matches. If you have one match lit, its easy to put out, but if you have the whole book lit, its a lot harder.
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Medications Used For Treating Gout Flares
Gout Symptoms
Gout attacks, or gout flares, usually occur when there is an excess build-up of uric acid in your blood. When the human body breaks down purines, it leads to the formation of uric acid. The level of uric acid in your body becomes harmful when your kidney is not able to remove it from your body through urine. When the uric acid level increases, it may lead to gout. This inflammatory disease mainly affects your joints, causing severe pain, inflammation, and swelling.
Doctors prescribe several medications to prevent gout flare-ups. You should note that these medications cannot cure gout but can alleviate gout symptoms. In this article, we will take a look at some of the short-term and long-term gout medications.
Celery Or Celery Seeds
Celery is a food traditionally used to treat urinary issues. For gout, extract and seeds of the vegetable have become popular home remedies.
Experimental use is well-documented, though scientific research is scant. Its thought that celery may reduce inflammation.
Adequate celery amounts for treating gout arent documented. Try eating celery many times per day, especially raw celery sticks, juice, extract, or seeds.
If purchasing an extract or supplement, follow label directions closely.
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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
Gout Flare Ups Caused Due To Certain Vegetables
Not just meat and alcohol, but some vegetables also contain high to moderate amount of purines and may increase your uric acid levels and cause gout flare ups. These would include ladies finger, tomatoes, green chillies, and red lentils. Most of the lentils for that matter contain a high to moderate amount of purines and hence, must be removed from diet, if you are prone to gout flare ups.
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Using Tart Cherry Juice For Gout
Tart cherry juice may help decrease uric acid levels and inflammation in gout. Research is limited, with often small numbers of study participants and short-term follow-up.
Nevertheless, a 2019 review of six studies that looked at the effect of cherry juice or cherry extract intake on gout concluded that cherry intake was associated with a reduced risk of gout attacks. Researchers did note that larger, more long-term studies are needed to clarify this association.
When choosing tart cherry juice, be sure to look for unsweetened varieties to help reduce the amount of added sugar in your diet.
Who Can Benefit From A Low Purine Diet
Anyone with high uric acid levels in their blood can benefit from reducing high-purine foods. This may help to prevent gout in people with hyperuricemia who havent yet developed the disease. It may also help prevent existing gout from progressing and prevent other complications of hyperuricemia, such as kidney stones.
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