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
Tips For Avoiding A Gout Flare
Gout is a form of arthritis that usually affects the joint between your foot and your big toe. Its caused when theres a buildup of uric acid in your bloodstream, and the acid crystallizes. The crystals tend to form around that particular joint because its far from your heart, so your circulation may not be as strong there as in other parts of your body.
The uric acid crystals cause inflammation that can ultimately lead to joint damage and pain. Gout can be debilitating, but there are some things you can do to avoid the pain of a gout attack.
Dr. Michael Tran and the staff at AllCare Foot & Ankle Center present these five tips for avoiding gout flare-ups. Youll likely still need medication, but these lifestyle changes can also be an important part of your treatment plan.
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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Lifestyle And Diet Changes
Lifestyle and diet modification can play a huge role in reducing the frequency and intensity of gout attacks. The American Dietetic Association has several recommendations to help prevent the painful flare-ups. The first is to drink 8-16 glasses of fluid per day with at least half being water. Avoiding alcohol is also recommended as alcohol can increase the concentration of uric acid in the blood, which is likely to trigger an attack. Food choices also have an impact on gout flare-ups. The ADA recommends eating a moderate amount of healthy proteins including low fat dairy, eggs, tofu, and nut butters, while limiting your daily intake of meat, fish, and poultry to 4-6 ounces or 113-170 grams.
Alternative therapies for the prevention of gout attacks are also being looked at, and though more research needs to be done, there are a few potential options available if youre not finding the relief you are looking for. Coffee drinking has been shown to have an association with lower uric acid levels, which may be good news for gout sufferers. Vitamin C and Cherries have also been associated with lower levels of uric acid, though in some cases megadoses of vitamin C have actually been shown to increase these levels in the body. Consider adding fruits and vegetables high in vitamin C to your daily diet before adding supplementation. As with all therapies, it is important to discuss these alternative remedies with your doctor before making any changes to your treatment regimen.
Causes Of Gout Flares
Gout, a type of inflammatory arthritis, happens when levels of uric acid a normal byproduct of metabolic reactions in your body become too high, says Kenneth Saag, MD, professor of medicine in the division of clinical immunology and rheumatology at the University of Alabama at Birmingham. When this substance cant be sufficiently dissolved and excreted in the urine, it starts to crystallize, and those crystals deposit themselves in joints where they cause severe inflammation.
Certain risk factors, such as having a family history/genetic predisposition or having chronic kidney disease, can affect the development of gout over time. Taking certain medications , a high alcohol or sugar intake, or eating high-purine foods can trigger a gout flare. Read more about what causes gout here.
If youre new to gout, your doctor will need to confirm the diagnosis, as it can sometimes masquerade as other ailments that impact the joints . Your doctor will likely use a needle to remove some fluid from the swollen joint, then examine it under a microscope to confirm that it contains uric acid crystals.
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Avoid Alcohol And Sugary Drinks
The heavy consumption both of alcohol and of sugary drinks â such as sodas and sweetened juices â correlates with an increased risk of developing gout.
Alcohol and sweetened drinks also add unnecessary calories to the diet, potentially causing weight gain and metabolic issues.
2010 analysis of data from female participants in the Nursesâ Health Study found that gout risk decreased as coffee consumption increased.
Women who consumed 1 to 3 cups of coffee per day had a 22% reduction in their risk of gout compared with those who drank no coffee. Women who consumed more than 4 cups of coffee per day had a 57% decrease in their risk of getting this condition.
A handful of studies have also linked coffee consumption to a lower risk of cardiovascular disease. A 2014 systematic review and meta-analysis of long-term coffee consumption found that people who consumed 3â5 cups of coffee per day had the lowest risk of cardiovascular disease.
As people with gout have a higher risk of cardiovascular disease, drinking coffee may help improve their overall health.
2011 meta-analysis of 13 randomized controlled trials found that vitamin C significantly reduced levels of uric acid in the blood.
Reduced uric acid levels could lower the risk of gout attacks. Research has not conclusively proven that vitamin C treats or prevents gout, however â only that it lowers uric acid levels.
When To Get Help For A Gout Flare
It’s always a good idea to let your doctor know that you are having a flare. Sometimes, you may need to follow up to make sure your treatment plan is working or if your symptoms don’t improve. Call your doctor if:
This is your first flare-up. There are several other conditions, such as a joint infection, that have some of the same symptoms as gout attacks.
You have a highfever and chills. Gout attack symptoms may include a mild fever, but a higher temperature may be a sign of an infection.
Your symptoms don’t get any better after 48 hours or don’t end after about a week. If you don’t start to feel somewhat better after a few days, call your doctor. They may suggest a different treatment. Most gout attacks will go away by themselves in several weeks, even without treatment.
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How To Prevent Gout Attacks
Theres nothing you can do about your genetics, but you can make healthy lifestyle changes that may help reduce the likelihood of developing gout. They include:
Munch On Bananas Cherries And Celery
Instead of opting for meats and yeasty carbs when youre hungry, consider eating bananas, cherries, and celery. Bananas are rich in vitamin K, which liquifies uric acid crystals and flushes them from your body. As part of their antioxidant makeup, cherries contain a pigment called anthocyanin that reduces gout pain and inflammation. Celery works to lower uric acid levels, as well as alleviate pain and swelling.
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Additional Tips For Treating Gout Naturally
Studies show that many of the dietary items we consume lead to gout as well as other health problems. Changing your diet and lifestyle may be the easy solution to beating gout. One of the first things to do is eliminate certain foods and beverages from your diet to beat gout.
1. Eliminate or reduce sugar intake
As many studies are now illustrating, gout is common in people with excessive sugar intake, especially high fructose corn syrup Its wise to read the labels of all your food and drinks. If you find HFCS then eliminate that from your diet. In addition, look for sugar added under the guise of other common names for sugar look for cose at the end of words and these are probably types of sugar you dont want to be consuming.
2. Eliminate grains
Grains in the body are converted to sugars so again you want to limit or avoid grains altogether. They are also very inflammatory to your body.
3. Limit alcohol consumption
Again, alcohol becomes sugar once ingested so eliminate this completely unless you have a healthy body already. Any substance that will be converted to one or another type of sugar by the body should be avoided at all costs. In order to get your uric acid levels down you must consistently avoid sugar in your diet.
4. Eliminate soda and diet soda
5. Consume cherries and strawberries daily
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S To Stop A Gout Attack Or Gout Flare Up
If you have or know anyone who has gout attacks, you know how incredibly debilitating and painful they can be. When you have a gout attack, it can become extremely painful as joints begin to swell, become warm to the touch and turn red. When a flare up is happening, even the slightest touch or bit of pressure can be extremely painful.
When an attack happens, there are several steps you can take immediately to manage the attack, reducing pain and discomfort:
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Make Your World More Colorful
One way to trade in those feelings of deprivation for feelings of abundance is to take advantage of recipes from around the world that rely on vegetables and fruits that you may have never heard of.
Most local grocery stores now carry a wide variety of fresh produce that can expand your palate, including:
Yeast is also present in both wine and beer, which you should limit, too.
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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When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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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Can You Recommend Some Natural Home Remedies For On
Gout is a treatable disease that has amassed a library of options for home therapy. Four popular home remedies for gout include:
- Apple Cider Vinegar
- Baking Soda
- Ginger Root
Consuming an apple cider vinegar tonic has been a popular remedy for many. Apple cider vinegar helps to neutralize your urine, making it easier for uric acid to be eliminated from the body.
Tart Cherries are a long standing remedy for gout and arthritis patients. Studies have been conducted to support its efficacy against gout and the final verdict is that at least a cup and a half a day can help to reduce inflammation and lower uric acid levels.
Baking soda is another remedy that is consumed through an ‘anti-gout’ drink mixture. It helps by neutralizing the pH of your urine, helping to eliminate uric acid more quickly from your body.
Ginger is an easily available and easy to do home remedy. Its anti-inflammatory properties are excellent for reducing swelling and providing pain relief. You can consume ginger in its powder form or boil the sliced root and drink it as tea.
Home remedies are not meant to treat gout, but are excellent complementary therapy to gout prevention and management.
Pain Relief Without Medicine
Use cold. If your pain isn’t too bad, try cold packs or compresses on the joint to lower inflammation and soothe the ache. Wrap ice in a thin towel and apply it to the joint for up to 20 minutes several times a day. Do not apply ice to your hands or feet if you have nerve problems from diabetes or other causes.
Rest the joint. It’s a good idea to rest it until the pain eases up. You probably won’t want to move it much anyway. If you can, raise the joint on a pillow or other soft object.
Drink water. When your body doesnât have enough water, your uric acid levels rise even higher. Stay hydrated to help keep those levels normal.
Watch what you eat and drink. Foods that are high in substances called purines, such as some seafood, organ meats like liver, and fatty foods, can raise the uric acid in your blood even more. So can fructose-sweetened drinks and alcohol — especially beer.
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Overcoming A Gout Flare
If you were to ask anyone who suffers from gout, they would tell you the worst pain to experience is a gout flare-up.
My dad suffers from gout. I can remember when I was in high school and he was initially diagnosed. He went to bed one morning feeling fine. He woke up the next morning and couldnt even put pressure on his foot. It was baffling.
Now that Ive been a nurse for ten years, Ive seen some pretty intense things and seen grown men cry because theyre in excruciating pain. Still, some people have told me that gout pain rates high on their list.
So, here are four tips that Ive compiled from my professional experience and from my personal experience that can help you get through a flare-up.
The Excruciating Pain And Swelling During A Gout Flare Is Pretty Hard To Ignore
Whether youve been plagued by gout in the past or have never experienced it before, chances are that when a gout flare strikes youll quickly know something is very, very wrong: The excruciating pain and swelling, which often occurs in a single joint , is pretty hard to ignore.
If youve never had a gout attack and are thinking that people with gout must be exaggerating, consider this: 37 percent of people with gout said that theyd willingly give up a winning lottery ticket if they never had to experience a gout flare again, according to a patient survey.
Of course, making that sort of trade-off isnt an option. So what real-life choices do you have? Your best bet is to call your doctor stat. As soon as you feel a twinge, you need to get medical attention, says Joseph Huffstutter, MD, a rheumatologist with Arthritis Associates in Hixson, Tennessee. The sooner you treat a gout attack, the easier it will be to treat.
Heres a look at why gout flares happen and how to rein in the pain as quickly as possible.
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