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.
Allopurinol And Renal Impairment
One of the only ways allopurinol will be forbidden from therapy in gout is related to renal impairment. Patients with kidney damage can have life-threatening complications when they start using allopurinol, either in the acute or the chronic phase. Renal injury is a risk factor to develop a condition called allopurinol hypersensitivity syndrome.
Allopurinol hypersensitivity syndrome is a severe systemic reaction to allopurinol. It includes symptoms such as fever, skin manifestations, eosinophilia , and multiorgan dysfunction. There is a 25% mortality in patients who develop this syndrome, which is quite high and alarming. Thus, even though there are guidelines to prevent this from happening, doctors might prefer to use other urate-lowering alternatives in this group of patients.
In a nutshell, the main goal of allopurinol is to lower uric acid levels in chronic gout patients. There is current debate on the matter, but the majority of doctors agree that initiating allopurinol in patients recently diagnosed with acute gout is not recommended and does not have any benefit. It is only maintained in patients with chronic gout under treatment with allopurinol, and the only side effect doctors will try to avoid is allopurinol hypersensitivity syndrome, which is more common in patients with renal impairment.
Drug and Therapeutics Bulletin Editorial Office. . Latest guidance on the management of gout. BMJ, 362, k2893.
What Causes Pseudo Gout To Flare Up
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Exercising To Help Prevent Future Gout Attacks
Although its not recommended to exercise in the middle of a gout attack, its definitely recommended that you exercise once the attack is over and the symptoms have abated.
There are several important things you should do to prevent future gout attacks. Things such as:
- keep properly hydrated
- get plenty of rest and sleep
Regular exercise can definitely help with at least 4 of those: losing weight, reducing stress, controlling blood pressure, and getting good rest and sleep.
All are very important in gout prevention, but losing weight is of particular importance because we know that being overweight or obese is a key determinant for gout.
So if you can get back down to a healthy weight, reduce the stress in your life, maintain healthy blood sugar levels, and get a good nights sleep, you can help to reduce the risk of another painful gout attack.
Now, we already know that regular exercise helps to reduce weight and this is key if youre overweight and have gout.
But exercise also produces endorphins in the brain that help to reduce stress and pain. They also improve the ability to sleep, which also reduces stress.
Regular exercise strengthens your heart muscles, making it pump more efficiently, so reducing the pressure on the walls of your arteries and lowering your blood pressure.
Home Remedies For Gout Flares
While you taking medication to fight the pain and inflammation during a gout flare, there are a few other simple gout home remedies you can use to ease the discomfort. Rest is important try to keep the impacted joint higher than your heart. Ice may also be helpful, because it brings down swelling. Research shows that ice is particularly soothing for gout if youre dealing with a different type of arthritis, a heating pad may be a better choice.
Some people also say that eating cherries or drinking tart cherry juice helps during a gout flare. While studies have shown that cherry lovers may be less likely to have frequent gout flares, its not clear whether loading up on this fruit during an attack will make an immediate difference. Cherries may be helpful because theyre rich in antioxidants, and tart cherries may help lower uric acid levels .
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Health Conditions Responsible For Gout Flare Ups:
Sometimes, stress due to health conditions like pneumonia or medical procedures such as visiting the hospital or undergoing a surgery may also increase your uric acid levels. If you are visiting the doctor or have fallen sick or are going to the hospital for a surgery, make sure that you tell your doctor that you have gout.
What Causes Pseudo Gout To Flare Up: What You Should Know
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- What is Gout & can you get rid of it?
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Being Overweight Or Obese
Being obese quadruples your likelihood of gout. Obesity, diabetes, and elevated cholesterol are conditions commonly seen together and when present in the same patient are referred to as metabolic syndrome. Patients with these conditions frequently also have elevated uric acid in their blood, says Herbert S.B. Baraf, MD, clinical professor of medicine at George Washington University and senior partner at Arthritis and Rheumatism Associates in the Washington, D.C. area.
Sometimes diuretics prescribed to treat high blood pressure can cause the high levels of uric acid, but sometimes high levels are present just because of issues related to these health concerns. Weight loss can often help reduce uric acid levels and therefore gout risk, but the amount of pounds shed must be significant.
Can Gout Be Cured
Gout cannot be cured. However, most patients can manage their symptoms and largely avoid gout flare-ups. Your doctor will discuss diet and lifestyle changes that may help. If symptoms are intense, persistent, or highly resistant to these changes, prescription medication can reduce the level of uric acid in the body. Anti-inflammatory medication is used during 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
The Difference Between Acute And Chronic Gout
The first step we should take is to differentiate acute and chronic gout. They are different manifestations of the same disease. Gout is not only diagnosed after blood tests with high levels of uric acid. This is called hyperuricemia. The diagnosis of gout requires a physical and functional examination to evidence that the articulations of the patient are being affected by such levels of uric acid in the blood. Otherwise, hyperuricemia is not diagnosed as gout.
Circled in Red is a Patient with Gout caused by Excessive Allopurinol
Acute gout is characterized by severe pain located in the toes or hands, but not limited to them. The symptoms appear suddenly, sometimes in the middle of the night, and become unbearable and very severe.
The area becomes swollen, red, tender, and very warm because theres a severe inflammatory process triggered by uric acid crystals. Pain in acute gout may last for hours, days, and sometimes a whole week. But after the attack has gone, the patient does not display any symptoms.
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So What Kind Of Exercises Can I Do
There are 4 major areas you should be covering in your exercise regimen:
- Range of Motion Exercises: Which consist of keeping your joints flexible and mobile in order to reduce stiffness, a good motion exercise for your foot is to rotate your ankle in a circular motion. Other exercises include rotating your head and neck, ankles or wrists.
- Strength Exercises: Devised to increase and maintain the strength of your muscles by using weights or doing resistance exercises. Remember strong muscles help to support and take the pressure off sore joints, strengthening your bones. Consider yoga or tai chi as low impact strength exercising, see stretching exercises below.
- Endurance or Cardiovascular Exercises: These exercises are may help improve your heart, increasing blood circulation, controlling your weight and giving your energy a boost. It is important to choose low impact aerobic exercises like walking, stair climbing, dancing, cycling which I love doing and swimming. Swimming offers the best aerobic exercise for the gout sufferer since this exercise does not put any stress on your joints since youre moving in water.
- Stretching Exercises: This will help your flexibility as well as your muscle strength. Yoga, pilates and tai chi are the most popular. Examples include muscle stretches and moving a joint as far as you can.
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What Causes Gout Flare Ups
As already mentioned, uric acid is produced due to the breakdown of purines hence, it is very important that you avoid the foods that are high in purines. The more purines you consume, the higher will be the uric acid levels in your blood.
Though it is quite difficult to absolutely eliminate all foods that contain purines, here is a list of the foods that are high in purine levels and avoiding them as much as possible is always advised.
The Importance Of Exercise For The Gout Sufferer
Its a new year and yes the time for new years resolutions and what is the most popular new years resolution for people? Yes, exercise! Lose weight! Eat better! Most of you though will subscribe to a gym in January, only to give it up after a couple of months or when spring comes around and that good weather makes you lazier to get your butt in the gym.
But if you have gout, you have to exercise. Let me repeat myself for emphasis added: If you have gout, you should be exercising. Period. So make it a new years resolution and change your bad habit of not exercising and get moving! You dont need a gym to exercise, you can do it from the comfort of your own home or outdoors where it costs you nothing. We all know the benefits of exercise like improving the fitness of your heart, lungs, bone strength, mental well-being, improves energy levels and your sleep!
So you ask me the question, how can I exercise when I suffer from gout and my joints are so sensitive? And I reply to you that a lack of exercise will only worsen the disease and intensify the pain of gout down the road. Why? Because since your joints hurt, that makes you less likely to get up moving or exercising. This inactivity makes you less flexible, weakens your joints and muscles which may result in bone loss by the way intensifying the painful symptoms of gout.
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Ruling Out Other Disorders
As part of the diagnosis, other disorders that cause gout-like symptoms or cause hyperuricemia should be ruled out. In general, it is easy to distinguish acute gout that occurs in one joint from other arthritic conditions. The two disorders that may confuse this diagnosis are pseudogout and septic arthritis. Pseudogout is a condition most likely to be confused with gout.
Chronic gout can often resemble rheumatoid arthritis. Other conditions may at some point in their course resemble gout.
Other Risk Factors For Gout
As mentioned, eating a lot of foods high in purines and taking certain medications can cause gout. However, there are other risk factors that can increase your chances of developing gout. Here are some of them:
- High blood pressure
- Kidney disease
Gout tends to run in families. If you have a close relative with gout, youre more likely to develop it as well.
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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
How To Get Rid Of Gout Flare Ups
If you have had gout flare ups earlier and want to prevent it further, it is very important that you have a check on your diet or what you are eating. Avoid or eliminate all the foods that are high in purines or may increase your chances of gout flare ups.
Indulge in a healthy lifestyle. Eat properly. Avoid gorging into rich, oily or fatty food and rely on lean, fat free, healthy foods. Do not drink at all if possible. Otherwise, make sure that you do not indulge in more than two drinks per day. Drink plenty of water and maintain a healthy body weight. This will help you to cope with the gout pain, if any occurs.
|Written, Edited or Reviewed By:Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc.This article does not provide medical advice. See disclaimerLast Modified On: August 29, 2018|
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Frequent Consumption Of Certain Fruits May Trigger Recurrent Gout Attacks
High sugar drinks may not be the only stimulant of gout flare ups.
Certain fruits which are a natural source of fructose have also been linked with gout.
This is a highly contentious area, because several studies have linked higher fruit intake with less incidence of gout. This is probably due to their high fibre content .
And unlike fruit juice and other sugar-sweetened drinks, whole fruits are nutritious and generally good for health. There is no disputing this.
However, if you continually have gout attacks despite cutting out alcohol and sugar-sweetened drinks then Im not convinced a large amount of fruits are safe for you. Especially if you are overweight and eat a Western diet.
So cutting back on certain very high-fructose fruits is like a Plan D, if you will.
The link comes back to fructose, which stimulates uric acid production in a similar manner to alcohol. Fructose is naturally found in fruit and honey.
One study found that the consumption of apples or oranges the most popular fruits in this study was linked with an increased risk of gout compared to those who consume less than one serving of fruit per month. No link was found with other fruits however .
While most fruits are very low in fructose, a few are very high. Frequent consumption of these could theoretically causes problems for gout sufferers.
Foods Highest in Fructose per 200 Calories :
Note this list is ranked on a per calorie basis, not per serving.