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
It’s Easy To Get The Care You Need
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If you havegout, youre all too familiar with the sudden, burning joint pain that a gout attack can bring on most commonly in the big toe.
Gout a type ofarthritis is caused by too much uric acid in the blood. Usually, having an excess of uric acid isnt harmful. In fact, many people with high levels in their blood never get gout. But when uricacid levels in your blood are too high, the uric acid may form hard crystals in your joints.
Take Your Prescription Drugs
If you’ve had a gout attack before, your physician may have prescribed drugs to treat attacks. This may be your first line of defense or you may decide to use them only when NSAIDs fail to relieve your pain.
Prescription medications to treat gout include:
- Prednisolone oral tablets, which has been shown to work as well as NSAIDs and often doesnt cause the same stomach upset. Prednisolone is a type of corticosteroid and does carry other potential side effects, particularly if it is taken for longer than the recommended 5 days.4
- Colchicine, which has been shown effective in reducing pain and inflammation if taken in the first 24 hours of an attack. Always follow your physicians instructions regarding dosing to decrease your risk for potential complications and side effects.
Opioid painkillers, such as codeine, hydrocodone, and oxycodone, are not recommended to treat the pain caused by gout.
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Treating The Pain At Home
Lifestyle Changes Can Make Gout Attacks Less Likely
When you consider how much pain gout causes, it makes sense to try and prevent the problem flaring up. A key approach is to consume fewer foods and drinks containing high levels of purines, substances that lead to a uric acid build-up. A low-purine diet means avoiding beer, rich meats such as bacon, pork and liver, as well as many types of fish, seafood and shellfish.
The link between gout and over-indulgence is why the condition was known historically as the rich mans disease. Being a healthy weight, drinking plenty of water to flush out uric acid and exercising regularly can all help you to avoid gout attacks.
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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.
Causes And Risk Factors
Gout occurs due to an excess buildup of uric acid, or hyperuricemia.
According to the National Institutes of Health , hyperuricemia is the main risk factor for developing gout. However, a quarter of those with hyperuricemia do not develop gout.
When the body breaks down purines, it produces uric acid. Typically, the kidneys remove a certain amount of uric acid in the urine. However, when they are unable to remove enough uric acid, uric acid crystals can form in the joints and soft tissues, causing swelling and pain.
Gout typically affects males more than females. However, females have higher levels of uric acid after menopause. NIAMS state that being older also the chance of developing gout.
Genetics can also increase the chance of developing gout.
According to the CDC , other factors that may increase the likelihood of gout include:
- Diet: Food can play a role in the development of gout symptoms. Eating seafood, red meat, and drinking alcohol raises uric acid levels in the body.
- Weight: Having overweight increases the chance of developing gout.
- Medications: Certain medications, including diuretics and low-dose aspirin, are associated with gout risk because they increase the level of uric acid in the body.
- Other medical conditions:High blood pressure, diabetes, and kidney disease can increase gout risk.
According to the National Health Service in the United Kingdom, some people with gout may develop complications, such as:
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What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
What Causes Gout In The Big Toe
Gout is a type of arthritis that commonly occurs in the big toe. It can also cause pain in the ankles, knees, and elbows. A buildup of uric acid that develops into crystals is the cause of gout in the big toe. A person is more likely to get gout in the big toe if he is obese or overweight, drinks too much alcohol, or is on certain medications. Some people also have a genetic propensity to produce excess uric acid.
Many people have high levels of uric acid in their blood but still do not get gout in the big toe. The human body produces uric acid when it breaks down purines, which are found in the body and also come from foods such as asparagus and mushrooms. Typically, the uric acid travels from the blood to the kidneys and out of the body in urine. In some cases, the kidneys do not pass enough uric acid into the urine so that it builds up and crystallizes in the joints, leading to gout. Eating too many foods that are high in purine can cause uric acid to build up as well.
The hard uric acid crystals are what cause pain from gout in the big toe. The crystals can cause sudden, intense pain in the big toe or another joint. The toe may swell and turn red. Pain from an attack of gout can last for months or years.
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How Can An Attack Of Gout Be Treated
The management of an acute attack of gout is very different from the prevention of subsequent attacks.
Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.
There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.
If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.
Table 2: Medications to treat acute attacks of gout
Now Its Your Turn To Understand What To Do For Gout In Big Toe
Now theres nowadays thousands of us who no suffer gout because we tackled it at its cause much longer. Instead of just tinkering with the symptoms.
Im one of them.
Remember, I acquired gout for the same reasons it is possessed by you now.
An poor gut microbiome supposed that bacteria that should have been eliminating one third of my bodys uric acid merely wasnt.
That bacteria had diminished to the stage that my kidneys were trying to deal with the acid independently.
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 more in a position to assist my kidneys take it off from my own body.
Along with the change from gout to no gout almost experienced 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.
Little or no questioning if some potential celebration shall be smudged because Im laid up in agony with another strike.
In the same way pleasing is that Ive as well dramatically decreased my risks of troubled diabetes, kidney failure, cardiovascular disease and some malignancies.
Shellys program lays it all out for us. No special knowledge is required. I found it easy.
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If You Are Having Repeated Attacks See Your Doctor
Some patients can go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some won’t have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about escalating treatment. People think its normal to have flares every now and then, but its not. The gout can be doing damage to your joints. It means you still have too much uric acid, says Shakouri. In particular, ask about allpurinol. It wont help with an acute attack but will help prevent future attacks by reducing uric acid production.
New Guidelines Suggest Doing More Of The Same The Problem Is That Many People Don’t
You never forget your first gout attack. The severe pain, swelling, and redness hits hard and fast. The initial attack often strikes your big toe’s large joint, but later ones might affect the foot or ankle. Other hot spots include the knees, hands, and wrists.
First-line treatment is quite effective and includes anti-inflammatory medications, ice therapy, and rest. A combination of diet and lifestyle changes and prescription drugs an approach called urate-lowering therapy, or ULT is typically recommended if attacks recur or become more severe.
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The End Of Gout Your Quick Start Plan
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 adjustment can correct many years of gout-causing errors in the eating. And you may start this immediately within a few minutes of acquiring the program.That really helped my problem of What To Do For Gout In Big Toe.
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!
Home Remedies For Gout
Because of the rise in health care costs and the popular inclination to try natural home remedies to prevent the need for prescription drugs and surgeries, many people are turning toward alternative remedies to treat gout. A number of these home remedies have been acknowledged for treating gout. But, are they effective or not? We will present a number of them below and discuss their likelihood of success.
1. Apple Cider Vinegar
Apple cider vinegar is used to treat gout because its acidity relieves the acute pain associated with gout and other types of arthritis. The vinegar increases the bodys alkalinity and has anti-inflammatory properties. Some individuals also add honey to the apple cider vinegar because of honeys anti-inflammatory properties.
The bad news is that you take the concoction by the spoonful, and apple cider vinegar isnt exactly known for its amazing taste. To be most effective, you need to take up to two tablespoons of apple cider vinegar three times a day. Scientific results are lacking in evidence that apple cider vinegar really works. There was a study in Japan in 2010 which looked at different diets to improve alkalization of urine to increase the removal of uric acid from the body. Apple cider vinegar was in one of the diets, but was not tested alone.
Success stories are hit or miss with apple cider vinegar and the treatment of gout. We give it two stars.
2. Ginger Root
3. Baking Soda
4. Lemon Juice
5. Epsom Salt
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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
Treating Gout At Home
This section on how to relieve gout pain is a very useful reference for those nights when you wake
up in agony. When you have a gout attack, you need to get the uric acid out of your system and treat
Relax and keep your body calm.
Take proper medication.
For some people an over the counter anti inflammatory such as ibuprofen may be helpful but read the package insert carefully or discuss with the pharmacist.
Ice the affected area and elevate the joint.
If the pain is severe and doesnt diminish, its recommended to seek medical advice.
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