What To Do During An Attack
- 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.
Risk Factors For Gout
Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, diabetes, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels in patients with gout.
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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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.
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
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Stage : Intercritical Gout
After a first gout flare, 75 percent of people will have a second within a year but some people can go years before another attack, says Dr. Fields. The in-between stage is where a person has already had a gout flare but is presently not having any joint pain or swelling, he says. Almost all gout patients will go through this phase, since it is the nature of gout to have flares and then quiet down for a period of time before the next flare.
Even though it may seem like nothing is happening, this is the point in which patients should begin long-term treatment. Lowering uric acid levels with medication can prevent future gout flares and long-term complications that go with them.
How Gout Treatment Prevents Disease Progression
Fortunately, in part because of its long history, gout is one of the most well-understood and most medically treatable forms of arthritis. The progression of gout is preventable by starting appropriate treatment as soon as possible, Dr. Meysami says. Uric acid-lowering agents, such as allopurinol , can decrease uric acid levels and prevent gout attacks.
During flares, gout patients can take NSAIDs or corticosteroids to calm the attack. Local steroid injections may also be given. A medication called colchicine is also often used to stop acute attacks, but its given now at a much lower dose in order to avoid side effects, including stomach upset.
After a flare ends, long-term treatment can begin. Almost all people with gout will need medication to control their urate, Dr. Fields says. To get a good outcome, people with gout need to get their blood urate level below 6.0 mg/dl and keep it there. By doing that, the body will gradually pull the urate crystals out of their joints, and the flares can stop. Tophi will also gradually disappear.
Medications called xanthine oxidase inhibitors limit the amount of uric acid your body produces. These include allopurinol and febuxostat . Colchicine, which decreases the inflammatory response to gout, may also be given along with allopurinol at the start of long-term treatment after a flare subsides.
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When Should You Call Your Doctor
if you have:
- Severe pain in a single joint that comes on very quickly.
- Swollen, tender joints with warm, red skin over them.
It’s important to see your doctor even if the pain from gout has stopped. The uric acid buildup that caused your gout attack may still be irritating your joints and could eventually cause serious damage. Your doctor can prescribe medicines that can prevent and even reverse the uric acid buildup.
Myth: Gout Is Painful But It Won’t Kill You
Truth: Gout can’t kill you directly, but it can cause serious health problems that may eventually kill you, says Robert Keenan, M.D., assistant professor of medicine at Duke University. It can increase your risk of a heart attack or stroke, and it also may be linked to insulin resistance, the body’s shrinking ability to use insulin to lower blood sugar. If gout is untreated, you can develop clumps of uric acid crystals called tophi, which can become infected and life threatening.Join AARP Today Receive access to exclusive information, benefits and discounts.
There are prescription drugs that can treat gout.
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Now Its Your Turn To Understand What Age Do People Usually Get Gout
Presently theres nowadays a large number of us who no suffer gout because we tackled it at its reason longer. Rather than just tinkering with the symptoms.
Im one of them!
Remember, I acquired gout for exactly the same reasons you have it now.
An harmful gut microbiome meant that bacteria that should have been getting rid of a third of my bodys uric acid merely wasnt.
That bacteria had diminished to the point that my kidneys had been trying to cope with the acid on their own.
And they couldnt cope.
Nor can yours.
It wasnt i was suddenly producing too much uric acid. Its that my gut seemed to be no longer able to help my kidneys take it off from my body.
And the change from gout to no gout almost thought as promised.
You can possibly imagine it yourself.. what it would be like to simply never have any gout ever again.
Take my word for it, its wonderful!
No flare-ups, no pain, no being laid-up in bed for days waiting for the pain to subside.
An absense of wondering if some potential event shall be smudged because Im laid up in agony with another harm.
In the same way pleasing is the fact Ive substantially decreased my dangers of battling diabetes in addition, kidney failure, heart disease and some malignancies.
Shellys program lays it all out for us. No special knowledge is required. I found it easy.
Points To Remember About Gout
- Gout is a type of arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then go away.
- With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
- The most common symptom of gout is pain in the affected joint, such as the big toe.
- Your doctor may recommend taking medications to manage the cause of your gout and treat active gout flares, and making changes to your diet and lifestyle.
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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.
What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
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How Common Is Gout In The Knee
As a general rule of thumb, if left untreated, gout tends to work its way up the body, Dr. Keenan explains.
For example, he cites research that shows 50 percent of patients experience their first gout attack in the big toe. If gout worsens, 35 percent of secondary flares occur in the knee, 40 percent in the midfoot and ankle, 30 percent in elbows and wrists, and 15 percent in fingers.
Its not uncommon for a person to experience their first gout flare in their knee and, after an X-ray or ultrasound, show signs of gout in the foot, he adds.
Gout can afflict both knees, but typically is felt more strongly in one knee where arthritis from general wear is worse.
How Does The Prevalence Of Gout Differ Among Age Groups
The predominant age range of gout is 30-60 years. Usually, uric acid levels are elevated for 10-20 years before the onset of gout. In men, uric acid levels rise at puberty, and the peak age of onset of gout in men is in the fourth to sixth decade of life. However, onset may occur in men in their early 20s who have a genetic predisposition and lifestyle risk factors. In women, uric acid levels rise at menopause, and peak age of onset is in the sixth to eighth decade of life.
The rate of gout is almost 5 times higher in persons aged 70-79 years than in those younger than 50 years. The higher prevalence of gout in elderly persons may also reflect an increased prevalence of metabolic syndrome, high rates of diuretic treatment for hypertension and chronic heart failure, and the use of low-dose aspirin.
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Gout In Children And Teens
If a child or teenager has gout, it is important that blood and urine tests be done to determine why gout has occurred. It is usually a sign of an underlying problem that is often easily treated.
In children, the first test to do if gout is suspected is to measure the blood uric acid level. If this is elevated , this could be a sign that gout is present. Other important procedures are for a doctor to insert a needle into the affected joint, withdraw fluid, and examine this fluid for uric acid crystals.
Causes of gout in children and teenagers include:
- Inherited conditions that cause over-production of uric acid. These include HPRT deficiency and PRPP synthetase overactivity. These disorders are uncommon but are easily tested for. Patients produce extra uric acid and can have gout and kidney stones containing uric acid. These conditions usually occur in boys but can occasionally happen in girls as well.
- Kidney diseases resulting in decreased ability of the body to get rid of uric acid. These can include:
– The most common type is due to mutations in the gene that produces a protein called uromodulin. In this condition, patients develop gout in their teenage years and have slow worsening of kidney failure over time. There are usually many other family members who have had gout or kidney disease.
– Any type of kidney disease can also cause gout in childhood.
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.
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Contrast With Ra Mortality
Lead study author Hyon K. Choi, MD, director of the gout and crystal arthropathy center at Massachusetts General Hospital in Boston, says the lack of improvement in gouts mortality rate is in stark contrast to what has happened to mortality rates in rheumatoid arthritis. Dr. Chois group conducted a similar study of RA, also published recently in Annals of the Rheumatic Diseases, using the same database and the same time period.
They found that in the early group, people with RA were 56 percent more likely to die prematurely compared to those without RA. But in the late group, the mortality rate of people with RA was much lower: They were 29 percent more likely to die prematurely.
Dr. Choi says the improvement is most likely due to better treatment options available for people with RA and a trend for doctors to use medications earlier and more aggressively in order to reach certain treatment goals an approach called treat to target.
N. Lawrence Edwards, MD, vice chairman and professor in the department of medicine at the University of Florida in Gainesville agrees. He says, When you treat-to-target for rheumatoid arthritis, you really get to the basis of inflammation. Why that hasnt happened with gout is very important. It is because we do an absolutely crummy job as a profession of treating-to-target with gout. We do a very good job at treating to target with RA.
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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People With Gout At Risk Of Premature Death
A new study found that people with gout have a 25 percent greater likelihood of dying prematurely than people without gout. The findings also show that this increased mortality rate has not improved over the past 16 years, unlike the mortality rate for people with rheumatoid arthritis .
Gout, which affects more than 4 percent of adults in the United States, is the most common form of inflammatory arthritis. It develops in some people who have high levels of uric acid in the blood. The acid can form needle-like crystals in a joint and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling. Gout is also associated with other illnesses, such as cardiovascular disease and metabolic syndrome.
The study, published online recently in Annals of the Rheumatic Diseases, looked at data available in The Health Improvement Network an electronic medical record database in the United Kingdom that includes information on more than 10 million people.
The researchers identified more than 103,000 people with gout from the database. Each person with gout was matched based on age, sex and what calendar year they were entered into the database with up to five people without gout . The researchers then divided the participants into two groups based on the gout patients year of diagnosis, forming an early group and a late group . They then looked at how many people in each group died every year.
Why Do Individuals Develop High Uric Acid Levels
The major reason people develop gout is because their kidneys have difficulty excreting uric acid. This happens in 80% of cases of gout. Over-production of uric acid occurs in some patients due to inherited . In patients prone to gout, eating meat, liver, shellfish, and drinking beer can lead to gout attacks. However, kidney disease in the primary reason most people have gout.
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Processed Foods And Refined Carbs
The modern Western diet is often high in processed foods and refined carbohydrates. In addition, processed foods and refined carbohydrates have been linked to an increased risk of type 2 diabetes, heart disease, and weight gain.
A 2017 study looked at gout incidence in people who followed either a Western diet or the Dietary Approaches to Stop Hypertension diet. The researcher found the DASH diet was associated with a lower risk of gout, whereas the Western diet was associated with a higher risk of gout.
To help prevent gout symptoms, its best to limit highly processed foods and beverages and foods high in refined carbohydrates, such as sweets, baked goods and pastries, chips, crackers, cookies, candies, soda, ice cream, white breads, and some pre-made frozen meals.
Eating highly processed foods and refined carbohydrates in moderation will not only help with your gout, but your overall health as well.