To Treat An Acute Attack
To stop a gout attack, your doctor will give you medicines. These are usually pills like colchicine, NSAIDs , or a steroid medicine. Sometimes it’s treated with a steroid shot. The sooner you get started on medicines, the sooner your symptoms will start to get better.
To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. Using ice on the sore joint may also help.
How To Tell If You Have Gout
Most people only find out they have gout when they have their first acute attack. Gout symptoms may come on quickly, often at night, and cause extreme joint pain and inflammation inflammation causes heat, redness, swelling and tenderness in a joint. The skin over your joint may be red and shiny or peel.
After the intense pain is over, you may experience lingering joint discomfort for a few days or weeks. Subsequent gout attacks may be longer and affect more joints. Over time, gout may reduce the range of movement of your affected joints.
Gout symptoms most often affect joints in your limbs, such as your:
- Big toe
You should see your GP if you have any of these symptoms.
If your joint pain is getting worse or you also have no appetite, a fever or feel sick, you should see your GP urgently. These could be signs that you have a joint infection and need urgent treatment.
Get Answers Advice And Medicine
The pain from a gout attack usually gets better in 3 to 10 days. But youâll feel better faster if the gout is treated. If you think you might have it, contact your doctor. An exam and tests will show if itâs gout or something else, like an infection.
Talk with your doctor about the best medicines for you. The type will depend on how well your kidneys work, the possible side effects, and other health issues.
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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
How Can I Test Myself For Gout
After a physical examination and medical history, your doctor may order tests to confirm the diagnosis.Uric acid blood test. The first step in diagnosing gout is usually a uric acid blood test. Joint aspiration. A joint aspiration is usually the next step. X-rays. Dual energy CT scan. Ultrasound.Apr 20, 2021
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How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
What Questions Should I Ask My Doctor About Gout
Asking questions about your gout attack is a good way to be prepared and to know what to expect moving forward. Here are some questions to ask during your visit.
If you are seeing a general doctor, your questions should include:
- What are the possible causes of my symptoms or condition?
- What tests do you recommend?
- Are there any treatments or lifestyle changes that I should consider for recovery and prevention.
- Should I see a specialist?
If you are seeing a rheumatologist, your questions should include:
- What are the possible side effects of the drugs you’re prescribing?
- How soon after beginning treatment should I expect to improve?
- Do I need to take medications long term?
- I have other health conditions, should I be considered about medications interacting and how should I manage them all together?
- Do you recommend any lifestyle changes for recovery and prevention?
- Is it safe for me to drink alcohol?
- Are there resources available in office or online that you’d recommend for me to learn more about my condition?
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The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
Preparing For Your Visit
Many of the readers on our site take our free quiz and bring it to their doctors before they go. You can take it here.
In order to maximize your time and ensure that you are on the path to relief and recovery right away, it’s best to prepare yourself for your visit. As soon as an onset of gout symptoms comes on, you can do the following:
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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.
What Can A Do Doctor Do For Gout
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How Is Gout Treated
Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to
- Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
- Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
- Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.
In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.
What Are The Symptoms Of Gout
An episode of gout is called a gout attack. Gout attacks are very painful and can happen quite suddenly, often overnight. During a gout attack, symptoms in the affected joint may include:
- Intense pain.
- Tenderness, even to light touch, such as from a bedsheet.
- Warmth, or a feeling like the joint is on fire.
- How long does a gout attack last?
A gout attack can last a week or two. Between gout attacks, you may have no symptoms at all.
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Epsom Salt Baths And Ice
Epsom salts are very alkaline, and will penetrate the skin to get inside the body helping to dissolve the uric acid crystals. Soak the affected joint for 20 minutes in an Epsom Salt bath that is warm, not hot.
After the bath, apply an ice pack for 20 minutes. The ice should be wrapped in a towel so that it is not in direct contact with your skin. The ice will help reduce the inflammation that is causing the swelling.
The alternation between hot and cold will increase the blood flow to the area, helping to move the blood and lymph in and out of the joint which will help end the attack.
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What To Expect During Your Visit
Whether you see a general doctor or a specialist for your gout, be prepared to answer a number of questions to help them during your diagnosis. Your doctor may ask:
- What are your symptoms?
- When did you first experience them?
- Is this the first time you have experienced this?
- Do your symptoms come and go? Are they constant?
- Could you identify anything in particular or different that you might have done to trigger these symptoms, such as eating certain foods or your current physical or emotional state?
- Are you currently being treated for any other medical conditions?
- What medications are you currently taking, including prescriptions, over-the-counter drugs as well as vitamins and supplements?
- Do you or are you aware of a history of gout in your family?
- What does your diet typically comprise of?
- Do you drink alcohol? If so, how much and how often?
Depending on your answers and the doctor’s observation, you may have to undergo further exams or testing to confirm the diagnosis of gout. These exams and test may include:
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Diagnosis Treatment And Prevention Of Gout
BARRY L. HAINER, MD ERIC MATHESON, MD and R. TRAVIS WILKES, MD, Medical University of South Carolina, Charleston, South Carolina
Am Fam Physician. 2014 Dec 15 90:831-836.
Gout is the most common inflammatory arthropathy, affecting more than 8 million Americans.1 Gout accounts for approximately 7 million ambulatory visits in the United States annually at a cost of nearly $1 billion.2 Risk factors include genetics, age, sex, and diet.2,3 These factors may contribute to a high serum uric acid level, which is currently defined as a value of at least 6.8 mg per dL .4,5
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Oral corticosteroids and nonsteroidal anti-inflammatory drugs are equally effective in the treatment of acute gout.
To prevent recurrent gout, patients should reduce their consumption of high-fructose corn syrupsweetened soft drinks, fruit juices, and fructose-rich vegetables and fruits . Reducing consumption of meat and seafood, and increasing consumption of dairy products help reduce the frequency of gouty symptoms. Consumption of low-fat or nonfat dairy products may help reduce the frequency of flares.
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
Symptoms And Triggers Of Gout
The most common sign of gout is a nighttime attack of swelling, tenderness, redness, and sharp pain in your big toe. You can also get gout attacks in your foot, ankle, or knees, or other joints. The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years. Gout is more common in men, and often several men of the one family can be affected by gout.
A person with gout is more likely to have an attack when they:
- have elevated levels of urate in the blood
- consume too much alcohol
- consume a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
- are obese
- are unwell with a fever
- crash diet or fast
Gout has become more common in recent decades. The increase is believed to be due to increasing risk factors in the population, such as metabolic syndrome, longer life expectancy, and changes in diet. Gout was historically known as the disease of kings or rich mans disease.
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Risk Factors For Gout
Gout is more likely to occur in:
- Men. Men have a seven to nine times higher risk of gout than women, although the risk increases for women after menopause
- People with a diet high in purine-rich foods such as red meat, organ meats , seafood . Processed foods , refined carbohydrates and beverages high in fructose or sucrose also contribute to gout
- Certain ethnicities
- People who overindulge in alcohol, particularly beer and spirits
- People with certain medical conditions , and with some medications or treatments .
Can I Get Gout Pain Relief Without A Doctor
You can get temporary pain relief by taking anti-inflammatory medications. Some common over-the-counter anti-inflammatory medications are aspirin, ibuprofen and naproxen. The best way to relieve gout pain and prevent future gout attacks is to consider dietary and lifestyle changes to help reduce uric acid production in the body.
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What Can I Do To Avoid Gout Attacks
Your doctor can prescribe medicines to prevent future gout attacks. These medicines wash the uric acid from your joints, reduce the swelling or keep uric acid from forming.
You should lose weight if you need to. If you have high blood pressure or high cholesterol, get treatment and follow a low-salt, low-fat diet.
Stay away from alcohol and foods that are high in purines.
Drinking lots of water can help flush uric acid from your body.
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