What To Do If You Think You Have Pain Due To Gout
The good news is that there are effective medications to treat gout, Dr. FitzGerald says. In some mild cases, gout can be self-managed with lifestyle changes, such as weight loss if needed and eating fewer high-purine foods .
However, many people with gout should be on a preventive medication to lower uric acid levels and stop flares from occurring. According to the 2020 gout treatment guidelines from the American College of Rheumatology, uric acid-lowering medication is recommended for people who:
- Have two or more gout flares a year
- Have gout tophi
- Have evidence on X-rays of joint damage due to gout
The guidelines, of which Dr. FitzGerald is a coauthor, recommend a treat-to-target strategy, which means treating gout with medication until a target uric acid level is reached.
Unfortunately, gaps in quality care for gout continue to persist and many patients do not take uric acid-lowering medication, which can leave people suffering the intense and persistent pain of gout without relief. This is why it is important to seek medical care if you experience pain that you think could be gout, Dr. FitzGerald stresses.
Gout can be diagnosed several ways, including:
- Removing fluid from the joint to identify urate crystals.
- Using ultrasound to identify several common characteristics of gout, such as collections of crystals in or around joints.
- Using dual-energy CT to detect urate crystal deposits in cases that are more advanced.
How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
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
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The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
How Are Gout Attacks Prevented
Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.
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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
Alternative And Complementary Therapies
Many complementary and alternative medicine approaches for managing gout focus on diet, weight loss, and exercise.
Your risk of gout goes up when your diet is high in naturally occurring compounds called purines. When purines break down in the body, they cause uric acid to form. In most cases, people who have gout will still need medication even when they follow a diet for gout. That said, tweaking your diet can be a powerful way to help manage gout and gout symptoms. Some research suggests that food changes alone can lower your uric acid levels by up to 15 percent, according to the Institute for Quality and Efficiency in Health Care.
The main principles of a gout diet are basically the same as those of any healthy diet: Reduce calorie consumption if you are overweight opt for unrefined carbohydrates like fruits, vegetables, and whole grains limit your intake of sugar, organ meats , and saturated fats.
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Research And Statistics: How Prevalent Is Gout In The United States
Research published in the journal Arthritis & Rheumatology found that gout rates in the United States have been climbing steadily over the past 50 years, likely because of increases in obesity and high blood pressure.
Gout is the most common type of inflammatory arthritis among men. Its more common in men than women. About 6 percent of men in the United States have gout, while only about 2 percent of women have it. Women rarely develop gout before reaching menopause.
Gout is rare in children and young adults.
What Foods Cause Gout
Diet is a leading cause of gout. Certain foods contain purines, crystalline compounds that create uric acid when metabolized. When you eat foods high in purines, it can increase uric acid levels in the body and elevate your risk of developing gout.
Foods that can increase urate levels include:
- Red meat
- Shellfish and other types of seafood
- Beer and other types of alcohol
Eating fresh fruit isnt typically a cause for concern. However, fruit juice and fructose-sweetened drinks could be an issue when consumed in high volumes.
The good news is that certain foods can actually help lower uric acid levels and potentially keep future gout attacks at bay. This includes whole grains, vegetables, and low-fat dairy products.
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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.
What Does Gout Look Like
Now that youre up to speed on what gout feels like, you might be wondering if there are any visible symptoms to look out for. In some cases, you might notice one or more lumps around the joint.
Sometimes called tophi, these hard protrusions are caused by a buildup of uric acid around the soft tissue lining a joint. They may become infected, which could ultimately result in further damage to the joint or, in severe cases, a physical disability. And as mentioned above, the inflammation can cause swelling or redness.
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Gout Vs Rheumatoid Arthritis
Rheumatoid arthritis, commonly abbreviated as RA, is an autoimmune disorder that causes inflammation. While RA primarily affects joints, inflammatory responses may also occur in the skin, heart, lungs, and other organs. Though some hypotheses exist, there is currently no known single cause for RA. Gout is a form of acute arthritis that has a known cause, namely the buildup crystalline uric acid deposits in the blood and joints. These crystals cause an inflammatory response, often in a big toe.
RA and gout can be very painful disorders, but gout tends to be more treatable and has a better prognosis in most cases. To diagnose the presence of either RA or gout, a physician must perform a series of diagnostic imaging tests. To differentiate between gout and pseudogout, fluid may also be drawn from inflamed joints for testing.
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What Are The Late Signs Of Crohns Disease
- Bowel obstruction: Inflammatory swelling and spasms cause transient bowel obstruction. Over time, inflammation can cause scarring, thickening and narrowing in parts of the bowel, which may block the flow of digestive contents.
- Ulcers: Chronic inflammation may lead to erosion anywhere in the lining of the digestive tract.
- Fistulas: Sometimes, ulcers extend completely through the intestinal wall, creating an abnormal connection between different body parts . Fistulas can develop between the intestine and skin, or between the intestine and another organ. Fistulas can become infected.
- Anal fissure: A tear in the tissue that lines the anus or in the skin around the anus. This causes painful bowel movements.
- Malnutrition and nutritional deficiency: This is due to poor absorption of nutrients, diarrhea, and the inability to eat due to abdominal pain, nausea and vomiting.
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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.
Now Its Your Turn To Understand What Is The Difference Between Gout And Cellulitis
Theres today a large number of us who no longer undergo gout because we tackled it at its cause. Of simply trying out the symptoms Alternatively.
Im one of them.
Remember, I got gout for exactly the same factors you own it today.
An unsafe gut microbiome recommended that bacteria that should have been getting rid of another of my bodys uric acid just wasnt.
That bacteria got diminished to the point that my kidneys were trying to deal with the acid on their own.
And they couldnt cope.
Nor can yours.
It wasnt that I was suddenly generating an excessive amount of uric acid. Its that my gut has been no able to help my kidneys remove it from my own body more lengthy.
Plus the transformation from gout to no gout nearly believed 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.
No wanting to know if some potential event will be messed up because Im laid up in agony with another strike.
Just as pleasing is the fact Ive in addition substantially decreased my hazards of troubled diabetes, kidney failure, heart disease and some cancers.
Shellys program lays it all out for us. No special knowledge is required. I found it easy.
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What Does A Mild Gout Attack Feel Like: You Need To Know This
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So lets get into it. Sound good?
Does The Location Of The Gout Attack Affect Treatment
No matter the location of gout attacks, the treatment is the samelower uric acid levels so gout crystals disappear and tophi dissolve. Your doctor can test your urine and blood to determine your current levels. Normal uric acid levels typically range between 3.5 and 7.2 mg in men and between 2.6 and 6.0 mg in premenopausal women.
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Gout And Your Kidneys
An overabundance of uric acid can lead to both kidney problems and gout. Uric acid that collects in the kidneys can form kidney stones, which can lead to complications like kidney disease and kidney failure, and also can indicate a likelihood of developing gout. If youve been diagnosed with gout, your uric acid levels are elevated and you should also be checked for kidney disease.
Causes Of Gout In Your Shoulder
An excess of uric acid in your bloodstream is thought to trigger gout by forming needle-shaped crystals that build up in your tissues and joints. Excess uric acid is technically known as hyperuricemia.
Uric acid is a waste product produced by the breakdown of purines, chemical compounds naturally present in your body. Uric acid is also produced when you digest foods containing purines.
Normally your kidneys remove uric acid waste via your urine. If your kidneys arent functioning properly, uric acid levels can build up in your bloodstream.
The crystals that form from this excess uric acid are attacked by your immune system as foreign bodies. Infection-fighting cells go to the area of the crystals, causing inflammation.
A of gout reports that only 10 percent of cases are caused by your bodys increased production of uric acid. The other 90 percent are caused by the failure of the kidneys to eliminate enough uric acid.
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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.
Gout Story Starts With The Knee
Most gout sufferers stories dont start in their knees. So they suffered in silence, until the knee joints come under fire. Then gout in the knee prompts them to reach out to fellow sufferers
- Knee Pain from Gout at night
Knees are tough to diagnose. If months of allopurinol tends to make the knee feel better, then a gouty knee is suspect. But there are just SO many conditions and injuries that cause knee pain it is often very hard to diagnose.
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What Can Be Mistaken For Uric Acid Collection In Gout
A condition called pseudogout can sometimes be mistaken for gout. This is a condition in which there is deposition of calcium pyrophosphate in the joints . Also, septic arthritis is in the differential diagnosis for gout. Septic arthritis is joint pain and inflammation due to an infectious agent in the joint. Doctors can use blood tests and radiographic imaging to make the correct diagnosis.
Effective Medical Treatment For Gout
The American College of Rheumatology released gout management guidelines in 2012 and updated them in 2020. They recommend drugs classified as urate-lowering therapy for those who have experienced two or more gout attacks in a year as well as for those with joint damage from gout.
Specifically, the organization recommends allopurinol as a first-line treatment for all gout patients, even those with chronic kidney disease. Next in line is febuxostat both are a class of drugs called xanthine oxidase inhibitors.
In addition, the guidelines recommend use of anti-inflammatory medications including NSAIDs, prednisone, or colchicine along with the other medication.
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Rheumatoid Arthritis Vs Gout
We dont know the exact cause of rheumatoid arthritis, but we know that changes in some of the bodys proteins can set off activation of the immune system, which leads to the release of multiple inflammatory chemicals that cause joint inflammation and damage, with swelling, warmth, tenderness, and discomfort.
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