Treating And Preventing Gout Pain
Gout pain is generally treated in two ways:
- Medications to relieve gout attacks in the short-term
- Preventive medications taken regularly to lower uric acid and stop gout attacks from occurring
While inflammation-fighting drugs are used to relieve pain during gout flares, different medicines are used to lower uric acid levels to prevent future attacks. These include:
Another medication called pegloticase may be recommended for people with chronic gout who have not responded to other uric acid-lowering medication.
While many people with gout can be treated by their primary care physician, if gout is not responding to medication or is progressing with worsening or frequent flares or developing tophi gout deposits, then your primary care physician may refer you to see a rheumatologist who specializes in treating diseases that affect joints, muscles, bones and the immune system.
Taking medication to reduce uric acid levels and reduce the risk of gout progression is important, Dr. FitzGerald stresses. If you have risk factors for bad gout, such as kidney disease, or are experiencing frequent attacks, early treatment is better.
Who Is At Risk Of Gout
Gout is sometimes called the disease of kings because of a false link to overindulgence in food and alcohol. Anyone can get the condition, but certain factors can increase your risk:
- Gender: Males are more likely to get gout than females.
- Age: Middle-aged and older men and women after menopause are more at risk for gout.
- Family history
- Diet: A diet high in purines, which are broken down into uric acid, can lead to gout. High purine foods include meats like bacon, turkey, veal, venison, and liver, and seafood like anchovies, sardines, mussels, codfish, scallops, trout, and haddock. High fructose foods and drinks such as soda pop also can increase your risk.
- Alcohol use
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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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
Gout And Pain In The Heel
Gout isnot always easy to understand, though its common. It is a complex type ofarthritis. It can attack anyone, but some factors may make this painfularthritis more likely. These include :
Theamounts of uric acid, derived from purines, increases for several reasons. Butin general, it occurs when the body makes too much uric acid or if there is something wrong with themechanism of the body to get rid of excess uric acid .
Overtime, excess uric acid can accumulate and build up somewhere in the body,resulting in sharp & needlelike crystals. The urate crystals thataccumulate in the joint and its surrounding structures can cause inflammation,swelling, and pain.
Theneedlelike crystals are likely to accumulate in the large joint of the big toe,probably due to gravity. Therefore, gout is often found in the big toe. Jointsof knees, ankles, wrists, elbow, and fingers are other commonly affected sites. How about the heel?
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Treatment For Gout In The Foot Prevention
This is one point that I think most bland advice sites written by authors who pay a clinician to approve it get horribly wrong. Exercise is always listed as a cure-all without any recognition that certain exercises are better than others for different areas.
In the case of gout, you need to avoid trauma. Now trauma doesnt mean injury just constant impact causes tiny trauma that can attract gout. If you often suffer gout in your feet, then the last thing you want to do is go out running during your recovery.
Running is great for certain diseases/ activites, but not gout. Cycling is better if you enjoy cardio-based workouts, but swimming is best of all.
The lack of pressure/ weight on your feet, makes swimming a perfect treatment for gout in the foot.
Rowing also is not advisable due to the pressure on your feet. Likewise, push-ups cause real pressure on your toes unless you touch the floor with your knees rather than your toes .
Sit-ups however, are really good again, especially with your feet in the air. Just dont use a sit up bar or have someone holding your feet down. A standard abdominal crunch with your feet in the air however is a great exercise for feet that might suffer with gout.
Weight training is a bit of a mixed bag dead lifting may cause gout in your feet because your feet are taking the pressure, while a lot of new shoulder/ arm lifting machines involve sitting and so taking the pressure off your feet are fine.
What Is Gout Know The Signs And Risk Factors
4 Minute Read
Medically Reviewed by UPMC Orthopaedic Care
Gout is a potentially debilitating form of inflammatory arthritis that causes pain, redness, stiffness, and swelling in your joints. More than 8 million people in the United States have gout.
The condition usually affects one joint at a time. About half of all gout attacks begin in the big toe, but it also can occur in the ankles, heels, knees, wrists, fingers, and elbows.
Although gout can cause pain, it can be managed with proper treatment.
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The End Of Gout Your Ultimate Beginners Approach
Shelly Mannings The End of Gout is not only a fascinating read its also refreshingly practical.
Shelly gives you two simple quick-starts:
Eat more of these
Eat fewer of these
This simple modification can correct years of gout-causing errors inside your eating. And you may start on this straight away within minutes of acquiring the program.That really helped my problem of What Part Of The Foot Does Gout Affect.
The next step is to follow Shellys 7-day plan.
It tightens up the quick start advice and turns it into a solid, follow-along program.
The 7-day plan was the real clincher for me.
I am a pretty average cook Im competent but not at all skilled or adventurous. Turns out I didnt need to be.
The plan takes away all the thinking and gives me, for the first week, something I can simply copy.
After the first 7 days I used Shellys advice to adapt the plan according to my own tastes.
Which was pretty easy the plan is full of options so you can try different foods and see what you like best.
Its all food you can buy in your supermarket. And it includes lots of nice stuff the chocolate and strawberries desserts were real winners in my house!
Gout Symptoms To Be Aware Of
Gout can also occur in the whole body in the form of a mild fever. This is when you have chills and shivers which get more intense as the pain in the affected joint gets stronger. You may also feel muscle ache and fatigue.
This combination of symptoms almost resembles the flu which is caused by the inflammation during a gout flare. However, it doesnt last as long and will gradually subside after reaching maximum intensity.
After the initial pain of a gout attack has subsided , you may notice that the affected joint feels tender. Usually this tenderness climbs up slowly past the ankle and the leg. You may have difficulties walking in the next few days or weeks as your joints recover from the attack.
When the affected joint is tender, your doctor may prescribe you to use a crutch otherwise, you will be limping –not the best way to go about your daily activities. It can be hard to function so be sure to get treatment right away.
5. Reddish, Purple Shiny Skin
As the swollen area becomes larger, you may notice that the skin around the affected joint will turn reddish purple, and shiny. It almost looks as if youre having an infection under the skin.
6. Skin Peeling
In certain cases, a gout flare can cause skin to peel and shed, almost as if you have a bad sunburn. When the skin swells from the inflammation, it stretches, turns red, and becomes flaky and itchy, sometimes even cracked.
7. Elbow Gout
8. Kidney Stones
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Factors Influencing Crystal Deposition
Gout is one of the best understood inflammatory arthropathies. Clinical features can be easily understood and interpreted in the context of a clearly elucidated pathogenetic process. Specific risk factors such as genetics, dietary factors, co-morbidity and its treatment lead to hyperuricaemia and subsequently MSU crystal formation occurs . Crystals are then shed into the joint and activate the inflammatory cascade via the NALP3 inflammasome . Hence, any explanation of why gout targets the foot must link these pathological processes to the specific anatomical, functional, and disease characteristics of the foot .
Processes enhancing MSU crystal formation and deposition at the first MTPJ.
How Is Foot Gout Diagnosed
If you are experiencing sudden bouts of intense pain in your joints, or if you feel you are experiencing the symptoms of foot gout, you should see your doctor immediately. Early detection can improve your chances of catching the gout during its early stages and successfully treating the condition.
Your doctor will perform a number of tests on you and ask questions about your family history, medical history, personal habits, and diet. He or she may also perform a joint fluid test. During this test, a needle is used to draw fluid from your affected joint for analysis. Your doctor may also order a blood test to measure your uric acid levels.
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Acute Attack Pain Management
Home remedies. Reducing inflammation during an acute gout attack will provide pain relief.
- Ice. Apply ice to the affected area to reduce swelling. Do not apply ice directly to the skin. Use an ice pack or wrap a towel around the ice. Apply ice for about 20 minutes at a time.
- Elevate. Frequently raise and keep the affected area above the level of the heart.
- Rest. Move the affected area as little as possible while symptoms are present.
- Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs even the over-the-counter strength be sure to check with your doctor before taking them.
Prescription medications. Your doctor may recommend a prescription-strength non-steroidal anti-inflammatory medicine such as indomethacin.
Colchicine is also given to reduce inflammation during an acute gout attack. This drug has recently been approved by the Federal Drug Administration for treatment of gout. Like all medications, colchicine has side effects that you will need to discuss with your doctor.
Your doctor may also prescribe corticosteroids for acute gout attacks. These are strong anti-inflammatory medications that can be taken either in pill form, intravenously, or injected into the painful joint. Cortisone may improve the severe inflammation very quickly.
Top 10 Symptoms Of Gout
Gout forms into sharp, needle-like crystals which can cause serious pain in the joints, with the big toe joint being the most affected. However, that is not the only sign of gout. Here are the top 10 gout symptoms and signs to watch out for. If you experience any combination of these symptoms, you may have gout.
1. Toe Pain
Lets start with the most obvious, toe pain or podagra as doctors call it. This is probably one of the most known symptoms of gout. Its furthest from the heart making it the most prone for gout attacks. Flares usually happen in the middle of the night when the temperature is at its coldest.
If you are lucky, your toe will be the only joint that gets affected when you have gout. What happens is that uric acid builds up in this particular area causing the sufferer to feel immense pain during a gout flare. At this point, its best to rest and elevate the affected joint to promote circulation. Recovering from a gout attack will take anywhere between one to two weeks.
Aside from pain, you will also experience swelling and sensitivity. You will notice that the area around the joint or even the whole lower limb becomes very swollen. It becomes so sensitive that even the lightest touch or vibration caused by a person walking in a room can cause immense pain. You would have to take NSAIDs to make the pain subside.
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How Can I Treat My Foot Gout
Gout is easily treated. The main goal of treatment is to lower the uric acid levels in your body, decrease pain and other symptoms, and prevent further attacks or flare-ups.
If you only experience one episode of foot gout, your doctor may recommend a non-steroidal anti-inflammatory drug other than aspirin, such as ibuprofen or naproxen.
Aspirin is not used to treat gout because if can interfere with the excretion of uric acid crystals in your urine. Doctors have several ways to treat your gout, including:
- Anti-inflammatory medications or injections to reduce pain, swelling, and inflammation
- Corticosteroid injection into affected joint to reduce inflammation
- Suggesting a change in diet to eliminate or reduce intake of foods and beverages that are high in purines and protein because protein can increase your uric acid level
- Encouraging the patient to drink plenty of fluids each day, especially water
- Explaining the importance of avoiding alcoholic beverages
- Requiring you to stay off your feet
- Cold compresses
It is very important that you talk to a doctor if you are experiencing foot gout symptoms or a flare-up.
Symptoms will generally subside within three to ten days with treatment. If the problem is left untreated, or if gout continues to occur with treatment, the uric acid buildup can eventually cause arthritic damage to your joint.
In severe cases, your doctor may recommend surgically removing the uric acid crystals from your joint.
Can Uric Acid Cause Heel Pain Signs Of Gout In The Heel
Gout is a type of arthritis caused by a buildup of uric acid and characterized by foot pain, swelling, redness, and difficulty walking is typically localized in the big toe. However, some types of gout may be localized in the heel, making it difficult to distinguish from plantar fasciitis.
Lets explore the connection between gout and heel pain, as well as symptoms that can help you tell the difference between plantar fasciitis and gout
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During A Foot Gout Flare
If you are experiencing a gout flare-up and are unable to reach your doctor, there are a few things you can do to help reduce the symptoms:
- At the first sign of symptoms, take ibuprofen or naproxen
- Drink plenty of water
- Rest and elevate your foot immediately
- Place cold compresses on the affected area
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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