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:
What Are The Symptoms Of Gout
Gout flare-ups are extremely unpleasant. The main symptoms are intense and even excruciating joint pain that eventually subsides to discomfort, inflammation and redness. Here are some common symptoms of gout to look out for.
1. Pain in Your Big ToePain in the big toe is the most common symptom of gout. Excess uric acid accumulates in the joint of the big toe, resulting in a very sore toe and the inability to walk. The pain can be so bad that it causes you to limp until it fades after a few hours or days.
2. Tenderness, Swelling and RednessThese three things are all signs and symptoms of gout. After the initial pain of a gout attack has subsided, you will likely experience all these things at one point or another. You may notice them directly on the joint, or in the surrounding areas and even across the body. If you have gout in your big toe, you may notice your entire foot and leg affected by these symptoms.
3. Pain Attacks People with gout experience sudden pain attacks, most often in the toes, feet, legs and lower extremities. These attacks can reverberate throughout your body and make it hard for you to walk or stand. These pain attacks often happen in the middle of the night, making it difficult for you to get back to sleep.
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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The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
Elevating The Affected Joints
Gout can cause pain and swelling, especially in the feet, hands, knees, and ankles.
One way to reduce swelling is by elevating the affected joints. This encourages blood and fluid to move away from the joint and back toward the heart.
A person can also use an ice-pack in combination with elevation to reduce their gout symptoms.
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Home Remedies For Long
The American College of Rheumatology recommends a couple of lifestyle modifications for preventing future attacks of gout:
1) Lose weight if you need to. Being overweight can increase uric acid levels as well as put pressure on the joints.
2) Follow a low-purine diet. Another effective way to reduce uric acid levels is to follow a low-purine diet. Purines are organic compounds that break down into uric acid. Following a low-purine diet means avoiding the big four alcohol, shellfish, red meat, and high fructose corn syrup.
Limiting these foods is also beneficial for heart health and people with gout are at higher risk for heart disease.
But dont go overboard with dietary changes to relieve gout pain though, advises Dr. Fields. You can find lists of thousands of different foods youre not supposed to have if you have gout. Those recommendations are impossible to follow and can make you crazy.
How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
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Drink Plenty Of Water
This wont likely provide immediate relief, but inadequate hydration is known to contribute towards the creation of urate crystals.
Drinking water may flush uric acid crystals out of your system.
Preliminary research suggests that adequate water consumption during the 24-hour period before a gout flare can decrease recurrent gout attacks.
What Are The Risk Factors For Gout
Risk factors for gout include:
- being male
- taking medications that increase water excretion by the kidneys
- being overweight
- eating a diet with a lot of meat, offal and shellfish
- having kidney disease, high blood pressure, diabetes or abnormal levels of fat and cholesterol in the blood
- drinking a lot of alcohol, especially beer, port or spirits
- going on a crash diet or fasting
- being of Maori or Pacific Islander origin, which can predispose a person to high uric acid levels
Gout is more common in men than in women, and among women it’s more common after menopause. It’s more likely to occur in older people, but can affect anyone.
It can also affect people with certain types of blood disorder and people in treatment for cancer.
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Consider Chronic Generalized Pain In Gout Management
Generalized pain is an important finding in patients and can impact their daily lives, and the management differs from that of localized inflammatory pain, Theodore Fields, MD, attending rheumatologist at the Hospital for Special Surgery and Professor of Clinical Medicine, Weill Cornell College of Medicine, NY, told PPM.
We have seen generalized pain reported in patients with many of our chronic rheumatic diseases, such as rheumatoid arthritis and psoriatic arthritis, Dr. Fields said. Data from the current study and other research suggest that chronic pain of an inflammatory type can, over time, lead to a concurrent central and more generalized pain, he noted.
Dr. Fields was not surprised by Dr. Kloosters team findings. People with gout whose flares are not controlled can experience not only more frequent flares but also joint damage and chronic pain, he said. However, in the Netherlands study, it was interesting that the authors found more generalized pain in patients who used less urate-lowering therapy, explained Dr. Fields. This suggests that the group of gout patients with a higher incidence of generalized pain may have more flares of gout.
Indeed, Klooster et al did highlight the need to ask patients about chronic pain.
Disclosure: Dr. Fields disclosed serving as a physician advisor for Horizon, Novartis, and Avion Pharmaceuticals.
Treatment To Reduce Pain And Swelling
Gout is usually treated with anti-inflammatory medicine like ibuprofen.
If the gout does not improve after 3 to 4 days, you might be given steroids as tablets or an injection.
You should:
- take any medicine you’ve been prescribed as soon as possible, it should start to work within 3 days
- rest and raise the affected limb
- keep the joint cool apply an ice pack, or a bag of frozen peas wrapped in a towel, for up to 20 minutes at a time
- drink lots of water, unless advised not to by your GP
- try to keep bedclothes off the affected joint at night
Do not knock the joint or put pressure on it.
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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
Managing Gout And Diabetes
Lifestyle changes can lower uric acid and help control blood sugar.
Watch what you eat. Diet is a key to managing both conditions well. In addition to your diabetes-friendly diet, avoid certain foods and add others.
- Cut out or limit high-purine foods like red meat and seafood, including shrimp, lobster, mussels, anchovies, and sardines.
- Limit or eliminate alcohol to prevent another attack.
- Add dairy products like skim milk and low-fat yogurt, which may protect against gout.
Consider seeing a registered dietitian. They can put together an eating plan that suits your tastes and your needs.
Get moving. Regular exercise helps control blood sugar and can help you lose weight, which can help your body remove excess uric acid. Talk to your doctor about what kinds of activities can benefit both conditions.
Stay hydrated. Itâs thought that drinking plenty of water can help flush out uric acid and keep your kidneys working well. A good goal is to down 64 ounces a day, roughly eight glasses. Drink more when youâre exercising.
Control other health problems. High blood pressure, kidney disease, and obesity raise uric acid levels and can bring on a gout flare. Make sure youâre seeing your doctor regularly and following your treatment plan if you have any of these conditions.
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Arthritis Foundation: âManaging a Gout Attack,â âGout Symptoms,â âWhat is Gout?â âHow Fat Affects Gout,â âGout Causes,â âGout Treatment,â “Gout and Diabetes.â
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What To Do During An Attack
You should:
- take any medication you’ve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
- rest and raise the limb
- avoid knocking or damaging the affected joint
- keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
- ensure you’re well hydrated
Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.
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 Is Gout Treated
If you dont have treatment, the gout will usually last for about a week. You may not have another attack for months or years.
The treatment of gout usually involves painkillers such as paracetamol and non-steroidal anti-inflammatory medications . In some cases, doctors may prescribe other medication to quickly relieve the pain and reduce the swelling and redness.
It is also important to rest the joint. Putting ice on it and elevating the joint can help ease the pain.
Getting treatment promptly will help relieve the discomfort and inflammation caused by acute gout, and help prevent irreversible damage to the joint and the nearby bone. Recurrent attacks can, over time, also cause kidney stones, kidney damage and tophi solid lumps of urate crystals often found in the ears, fingers, hands, forearms, knees and elbows.
Why Does Gout Hurt More At Night
The body loses moisture when sleeping as a result of breathing and sweating. As a result, a portion of the water content of the blood is depleted. The quantity of uric acid in the blood increases as the amount of water in the body decreases. Hyperuricemia, which is a precursor to gout, is caused or exacerbated by this rise.
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How To Get Fast Relief From Gout Attacks
Gout pain can be debilitating, and can prevent you from performing routine activitieseven walking or standing can hurt.
Thats because many attacks start at the base of the big toe.
Pain and inflammation in this region can make walking or standing for long periods of time excruciating.
There are a few home remedies that may provide quick relief for a gout flare-up.
But if your pain is severe, sudden, or worsening, contact a healthcare professional before attempting any remedies at home.
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 .
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Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
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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Homeopathic Remedies For Gout
Homeopathic remedies are trusted by 81% of people worldwide. It can provide instant relief in gout pain, without any harm to the body. Take a look at some of the homeopathic remedies for gout pain.
1. Aconite : Aconite can be taken in order to get instant relief, when gout attack approaches. It works well for gout of the feet joints.
2. Colchicum : Colchicum is a very common homeopathic remedy for treating gout. If the gout is causing too much pain in the joints and is accompanied with redness, this remedy can be taken for relief.
3. Ledum : Ledum is a very useful remedy for treating gout. This is the best homeopathic remedy for gout in the foot. If the patient feels coldness in the affected area, this medicine can be given.
4. Belladonna : Belladonna can provide relief from all the symptoms of gout, like swelling, pain, inflammation, red or purplish skin.
Other homeopathic remedies can also be taken to get instant relief, such as Bryonia, Rhododendron, Calcarea fluorica, Berberis vulgaris, Urtica urens, Sulphur, Lycopodium, and Rhus toxicodendron.