What Parts Of Your Body Does Gout Affect
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Lowering Blood Levels Of Uric Acid
A high level of uric acid in the blood causes problems for people with gout and may increase the risk of kidney disease in people without gout. Lowering the level of uric acid in the blood helps dissolve deposits of uric acid in the tissues and prevent flare-ups.
People with gout who especially need their blood level of uric acid lowered include those who have the following:
Frequent, severe flare-ups despite taking colchicine, an NSAID, or both
Tophi that are found on examination
Uric acid kidney stones
Conditions that make NSAIDs or corticosteroids more complicated to take
People taking drugs to lower the blood level of uric acid should know their level, just as people with high blood pressure should know their blood pressure. The goal of drug therapy is to decrease the level to less than 6 milligrams per deciliter . If the blood level is maintained below 6 , uric acid will stop being deposited in the joints and in soft tissues, and the existing deposits will eventually dissolve, although this may take several years. Most tophi on the ears, hands, or feet shrink slowly when the uric acid level decreases to less than 6 milligrams per deciliter .
is another drug that lowers blood levels of uric acid. It is especially useful in patients who cannot take or have not been helped by allopurinol. As with allopurinol, flare-ups can occur as the uric acid level in the blood first decreases.
What Does A Gout Attack Look And Feel Like
Symptoms of a gout attack on joints are similar no matter which joint is affected. When gout flares up, you will experience extreme pain and stiffness in the affected joints and the area will also be red and warm to the touch. Inflammation from the gout attack can also affect your entire body in the form of a fever, chills, fatigue, and achiness.
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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.
How Can I Self
The methods of managing an acute attack of gout differ from the ongoing methods for managing gout. If youve been diagnosed with gout, youll benefit in the long term from making healthy changes to your lifestyle, such as:
- maintaining a healthy body weight. If you do need to lose weight, make sure your weight loss is gradual as crash diets can increase uric acid levels
- drinking alcohol in moderation and avoiding binge drinking
- drinking plenty of water, and staying hydrated
- avoiding, or eating in moderation, foods that are high in purines. Talk with a dietitian for tips and advice
- exercising regularly aim to complete at least 30 minutes of physical activity most days of the week
- working closely with your GP to prevent further attacks and actively manage your condition.
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Is There A Test For Gout
There is no one test for gout, and its symptoms are similar to several different conditions. To see if you have gout, your health care provider may:
- Ask you to provide your medical history, including:
- Your symptoms.
- Any other medical problems you have.
- Any medications you are taking.
Whats The Outlook For People With Gout
Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.
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What Are The Signs And Symptoms Of Gout
Gout flares start suddenly and can last days or weeks. These flares are followed by long periods of remissionweeks, months, or yearswithout symptoms before another flare begins. Gout usually occurs in only one joint at a time. It is often found in the big toe. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.
Symptoms in the affected joint may include:
- Pain, usually intense
How Long Gout Pain Lasts
Characteristically, gout pain comes on rapidly and the joint becomes red and swollen, with the swelling reaching a peak within the first 24 hours of the attack, Dr. FitzGerald explains.
At first, gout usually affects just one joint, but can affect more than one joint, sometimes adjacent joints. Flares typically resolve on their own over the next seven to 14 days. Treating a gout flare with medications can help it resolve faster. Medications for gout flares typically include:
- Non-steroidal anti-inflammatory drugs , such as ibuprofen or naproxen
A gout attack may occur only one or two times a year or even only a few times ever. However, gout can become chronic, leading to frequent attacks and flares that occur at least a few times a year or never completely resolve. Chronic gout can damage and deform joints and can sometimes be mistaken for other inflammatory diseases like rheumatoid arthritis.
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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.
Signs Your Pain Is Likely Gout And Not Something Else
If you develop sharp sudden pain in a single joint or a couple of joints, if the pain is so debilitating that it is hard to walk or wear shoes, and if you have risk factors for gout , theres good reason to suspect gout as the culprit. However, its important to see a doctor for a thorough exam and proper diagnosis.
Dr. FitzGerald cautions that issues unrelated to gout can cause an angry, inflamed joint. Gout may be confused with several other conditions that can cause similar symptoms, including:
- An infected joint
- Bacterial skin infection
- Rheumatoid arthritis
- Psoriatic arthritis
Pseudogout is caused by a different kind of crystal, calcium pyrophosphate. A flare of pseudogout can resemble gout, but it more often affects your wrist and knee, and is unlikely to involve the big toe. Like gout, pseudogout is also considered a form of inflammatory arthritis. Its more likely to affect people over the age of 40 and those who have a thyroid condition, kidney failure, or disorder that affects calcium, phosphate, or iron metabolism, according to the Cleveland Clinic.
Its also possible to have gout without the classic presentation of red, hot, sharp, burning, sudden pain in the big toe, foot, ankle, or knee. Some patients may have joint pain that is less acute.
People can also have high levels of uric acid but not develop symptoms of gout.
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Gout And Kidney Disease
Gout is more common in kidney disease because the body has difficulty getting rid of uric acid in the urine.
There are several types of inherited kidney disease that are associated with a high frequency of gout. These conditions are studied by the Rare Inherited Kidney Disease Research Team at Wake Forest School of Medicine, led by Anthony Bleyer, M.D., M.S., a professor in the Section of Nephrology. The conditions that cause gout and kidney disease include uromodulin kidney disease and inherited kidney disease due to mutations in renin. These conditions are inherited, often with many family members affected. Sometimes, only a parent and child are affected in a family.
Myth: There Aren’t Effective Medicines For Gout
Truth: Many medications put the brakes on gout. Some control pain and inflammation immediately and others get at the root cause by eliminating the deposited uric acid crystals.
Colchicine is prescribed for acute gout flare-ups. A plant extract, it’s been used to treat gout for 2,000 years, says Reveille. Colchicine works within several minutes to several hours to block gout inflammation. The sooner you start it, the more likely the attack will resolve quickly. An injected steroid also tackles inflammation, usually controlling pain and swelling within 24 hours.
Prescription drugs such as allopurinol , febuxostat and probenecid all alleviate gout by controlling blood levels of uric acid. Also, two years ago the FDA approved an intravenous drug for people with advanced gout pegloticase that lowers uric acid levels and reduces deposits of uric acid crystals in the joints and soft tissue.
Most people who have gout will need to be on a uric-acid-lowering drug for life, usually just one or two pills a day, says George Washington University’s Baraf.
Changing your diet can help reduce the frequency of gout attacks.
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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.
When Should I Call My Doctor
- You have a fever, chills, or body aches.
- You are confused or more tired than usual.
- You have new symptoms, such as a rash, after you start gout treatment.
- Your joint pain and swelling do not go away, even after treatment.
- You are not urinating as much or as often as you usually do.
- You have trouble taking your gout medicines.
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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.
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
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Top 10 Symptoms Of Gout
Gout forms into sharp, needle-like crystals which can cause serious pain in the joints, with the big toe joint being the most affected. However, that is not the only sign of gout. Here are the top 10 gout symptoms and signs to watch out for. If you experience any combination of these symptoms, you may have gout.
1. Toe Pain
Lets start with the most obvious, toe pain or podagra as doctors call it. This is probably one of the most known symptoms of gout. Its furthest from the heart making it the most prone for gout attacks. Flares usually happen in the middle of the night when the temperature is at its coldest.
If you are lucky, your toe will be the only joint that gets affected when you have gout. What happens is that uric acid builds up in this particular area causing the sufferer to feel immense pain during a gout flare. At this point, its best to rest and elevate the affected joint to promote circulation. Recovering from a gout attack will take anywhere between one to two weeks.
Aside from pain, you will also experience swelling and sensitivity. You will notice that the area around the joint or even the whole lower limb becomes very swollen. It becomes so sensitive that even the lightest touch or vibration caused by a person walking in a room can cause immense pain. You would have to take NSAIDs to make the pain subside.
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What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.