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
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.
Key Points About Gout
Gout causes inflamed, painful joints due to urate crystal deposits at the joints.
Gout can also cause urate crystal deposits that cause lumps under the skin.
Gout can be triggered by eating foods high in purines and drinking alcohol.
Treatment of gout is aimed at reducing pain and the risk of future flare-ups.
Gout can be managed with medicines and lifestyle changes.
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Medications For Acute Gout
What Is The Main Cause Of Gout
When it comes to what causes gout, higher levels of uric acid in your body may be caused due to various reasons including obesity, diet pattern, genetic reasons etc. Higher levels of uric acid are also termed as Hyperuricaemia. If you are more than the normal weight, then the fatty tissues in your body also enhance the production of uric acid in your body.
We also get lots of purines through our diet and it has been proven that around 15% of purine is sourced from our diets. Foods that are rich in purines, main gout causing chemicals include red meat, sugary beverages, asparagus, spinach, turkey, beer, herring and scallops.
Our body also produces its own uric acid and normally most of the excess ones are eliminated from our body, but in certain conditions, it is not able to eliminate the uric acid content thus increasing the levels of uric acid in the body. The reason why your body couldnt remove the uric acid may vary including obesity, being diabetic, alcoholic and consuming certain kind of diuretics.
Major factors that cause higher levels of uric acid in your blood include:
- Drinking too much alcohol
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Avoid Foods That May Trigger Gout
Purines are found in certain high-protein foods, such as certain types of seafood ,and red meat and organ meat . Avoid drinks that may trigger gout:
- Alcoholic beverages
- Sugary drinks
- Coffee and other caffeinated beverages. While some studies show that caffeine can actually protect against gout pain, others find that sudden spikes in caffeine intake can trigger an attack.
Wearing Poorly Fitted Shoes
Wearing the wrong-sized shoes can set off a gout attack. This is because the shoe can rub on the toe thats affected. Most people experience pain in their feet due to incorrectly sized footwear. Dont make that mistake again the next time you buy new shoes.
When shoe shopping, dont just measure the length of your foot, measure the width and arch as well. Also, you might want to shop later in the day when your feet are at their biggest. This will save you from buying shoes that are too tight.
Here are a few more shoe shopping tips if you have gout:
- Stand when trying on a shoe since your feet will spread out more.
- Get the shoe size that fits the larger foot! Yup, no two feet are the same size.
- Leave at least half an inch at the front of the shoe, and -inch at the back of the shoe.
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Who Is Affected By Gout
Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
- Obesity, or a lot of extra weight.
You are also more likely to develop gout if you:
- Consume a diet high in animal proteins
- Consume a significant amount of alcohol
- Are on water pills .
First Foods That Can Help
- There are actually several types of foods that may help protect against gout attacks. These include low-fat dairy foods, complex carbohydrates, coffee, and fruits, especially citrus fruits. You should also be sure to get 12 to 16 cups of fluid daily.
- You don’t necessarily have to drink only wateryou can choose non-sweetened juice, tea, and coffee too.
- Any kind of fluid that keeps that blood flowing and urine flowing is a good choice, says Lona Sandon, PhD, RDN, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas.
Next up: The foods to avoid. Read on for a list of potentially problematic eats.
Scallops are okay for an occasional indulgence, but you should cut back on themand all types of meat and seafoodduring a flare-up, says Sandon. These animal foods are rich in purines, which your body breaks down into uric acid.
You have a little more freedom in your food choices when your gout is at bay, but its still a good idea to keep meat and seafood intake to a minimum4 to 6 ounces daily at most.
All meat is not created equal when it comes to purine content: White meat is generally better than red.
But it is okay to eat some types of red meat once in a while. Youre a bit better off if your occasional indulgence is beef or pork rather than lamb, says Dr. Zashin.
And lamb chops are a better choice than leg meat.
Organ meats, such as liver, kidneys, and sweetbreads, are a major no-no.
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What Causes A Gout Attack
Many gout sufferers get confused about the reasons for gout attacks.
People talk of gout triggers, but this is largely pointless. There is only one cause of gout attacks high uric acid. But there are many reasons for high uric acid. So there are many reasons why high uric acid can cause a gout attack.
But trying to avoid gout triggers is pointless. Once you have high uric acid, there are too many things that can cause a gout attack. Trying to avoid them is like trying to avoid life itself. What you must do is understand how gout attacks happen, understand that the only controllable factor is excess uric acid, then do all you can to remove the excess uric acid. This way, you tackle the root of gout attacks, and with a few months patience, they simply cannot happen.
The reason for gout attacks is an immune reaction to uric acid crystals. During that reaction, our white blood cells surround uric acid crystals. Once hidden in this way, uric acid crystals become invisible, and the painful swelling subsides. However, deposits increase with every attack, and so each day that uric acid is left untreated, more deposits form. Eventually, these will cause unsightly lumps under the skin.
We can stop this process immediately by getting uric acid below 6mg/dL . For safety, it is best to aim for no higher than 5mg/dL, which gives a margin to cover natural daily fluctuations.
Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
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What Does The Future Hold For Gout
Research is ongoing to find new strategies to prevent gout. New drugs are being developed to keep the body from having high uric acid levels and decrease the likelihood of a painful gout attack.
What Procedure Is Used To Diagnose Gouty Arthritis
Gout is usually diagnosed by a doctor based on the location of the inflamed joint and a history of having similar non-traumatic attacks of pain and swelling. The most reliable test for confirming gout is an arthrocentesis. Arthrocentesis is a procedure where fluid is withdrawn from an inflamed joint with a needle and syringe, using a sterile technique and a local anesthetic such as lidocaine. The fluid is sent to a lab where it is analyzed for the presence of uric acid crystals.
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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
Treatment To Reduce Pain And Swelling
Gout is usually treated with anti-inflammatory medicine like ibuprofen.
If the gout does not improve after 3 to 4 days, you might be given steroids as tablets or an injection.
- take any medicine you’ve been prescribed as soon as possible, it should start to work within 3 days
- rest and raise the affected limb
- keep the joint cool apply an ice pack, or a bag of frozen peas wrapped in a towel, for up to 20 minutes at a time
- drink lots of water, unless advised not to by your GP
- try to keep bedclothes off the affected joint at night
Do not knock the joint or put pressure on it.
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Blood Test For Uric Acid Level
A blood test may be done to measure uric acid level in the blood. Since uric acid can fall during an attack, the uric acid may not be elevated at that time. Some doctors may wait until several days after the attack to order a blood test. Nearly all people with gout have elevated uric acid in this case, although not all people with elevated uric acid have gout. Therefore the blood uric acid is only one part of making the diagnosis.
What Is Uric Acid
Uric acid is a waste byproduct of purine breakdown in the body. Purines are naturally produced in the body, as well as found in some foods. As purines are broken down, uric acid is created. Normally uric acid is either reabsorbed in the body or excreted via the urine and feces.
When there are more purines in the body than it can process, uric acid builds up in the bloodstream. This is called hyperuricemia. Hyperuricemia can cause gout and/or kidney stones in some people, while others have no signs or symptoms at all.
Verywell / Alexandra Gordon
Treatment for gout often includes medications, diet modification, and lifestyle changes, such as managing weight and quitting smoking. The foods you eat can have a direct impact on gout flares.
During a gout attack, modifying your diet may help decrease the length of the flare. Continuing to follow a gout-friendly diet, specifically a low-purine diet, may help prevent the risk of future gout attacks up to five fold.
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What Are Symptoms Of Gout
The large joint at the base of the big toe is the most common site for a gout attack, however, any other joint can be affected. Most commonly, other joints affected are the ankles, knees, wrists, fingers, and elbows.
Patients with gout attacks suffer a rapid onset of pain in the affected joint followed by swelling, redness, and severe tenderness. Some experience pain so intense that even the light touch of a bed sheet on the joint is excruciating. These painful attacks can last from hours to several days. In cases of chronic inflammation, the attack may last for weeks. Unfortunately, patients with gout are at risk for repeated attacks of gouty arthritis.
What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achilles’ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
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The Final Stages Of Gout
After a few years, and after enduring an increasing number of attacks, how you characterize the types of gout, really doesnt matter its dangerous, both directly and indirectly.
Having a gout attack in a joint is like having a joint injury too many injuries in the same joint can produce permanent damage.
Beyond that, gout is a painful omen of worse things to come diabetes, heart disease, stroke, cancer, and more. Gout is the easy part its time to pay attention to what your body is trying to tell you.
Finally, if gout is left completely unattended, deposits of urate crystals called Tophi will start to form ugly and grotesque looking lumps around the joints of the fingers, toes, knees, elbows and even on the ears.
To make matters worse, kidney stones can be formed from urate crystals as well, caused potentially fatal renal complications.
+ Remember! Gout can progress from one stage to another without much notice be proactive!