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.
Tophus Formation And Bony Erosions
After five or more years of recurrent flares, people with gout may develop tophi under the skin and around joints. While generally not painful, tophi can be disfiguring and interfere with normal joint function. The presence of tophi close to bones can lead to bone and cartilage destruction creating further deformities in the affected joints.
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.
References
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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
- Colchicine
- Glucocorticoids
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 Causes Ankle Gout
Gout occurs due to the accumulation of urate crystals in the joint, causing inflammation and intense pain. These crystals can form when you have high uric acid in the blood . Your body innately produces uric acid when it breaks down purines-substances that are found naturally in the body, as well as in certain foods, such as steak, organ meats, and seafood. Other foods that promote higher levels of uric acid include alcoholic beverages and drinks sweetened with fructose .
In a normal individual without gout, uric acid dissolves in the blood and passes through the kidneys to be expelled in the urine. But sometimes, the body produces too much uric acid, or the kidneys excrete too little of it. When this happens, uric acid can build up, forming sharp, needle-like urate crystals that become deposited in a joint or surrounding tissue causing pain, inflammation, and swelling.
Uric acid crystals tend to form in cooler temperatures, which is why they tend to form in the distal extremities, such as the hands and feet, which have a higher likelihood of becoming colder than the rest of the body.
Possible medical and health triggers of gout include:
- Infection
- Intense pain
- Possible fever
Symptoms tend to recur anywhere from six months to two years after the initial episode, with approximately 60 percent of gout patients having a recurrence within one year.
Reduced Range Of Motion
Whether youre having an attack or have endured permanent damage, your joints will not fully function. Due to inflammation or damage, your range of motion may be hindered. This means that both the distance and direction that a joint can move, will essentially decrease. This is especially common within ones knee joints, however, some simple exercises can help prevent stiffness. If youre experiencing inflamed joints, its best to seek advice from your physician. Its important to remain active, reducing the possibility of overly stiff joints.
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What Is Chronic Tophaceous Gout
Some people experience gout only in the form of attacks or episodes. These attacks can occur 1-2 times a year or throughout their entire lifetime. In between the attacks, they may have no symptoms at all.
Chronic gout is characterized by recurrent attacks that are accompanied by mild symptoms even between attacks. During the interval between attacks, you may experience pain and other symptoms that are then exacerbated during an attack.
Chronic gout often results in hard deposits or bumps of uric acid crystals under the skin. These hard deposits are referred to as tophi, which are painless but cause inflammation that contributes to bone and cartilage destruction. The condition is called chronic tophaceous gout.
Tophi typically occur around joints in the olecranon bursa, hands, feet, or at the pinna of the ear. Tophi are not always permanent and can be dissolved with treatment.
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.
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Treatments Your Physician May Prescribe
The goals of treatment of gout are to reduce the pain associated with acute attacks, to prevent future attacks from occurring, and to avoid the formation of tophi and kidney stones.Your physician may recommend one or more of the following treatments for acute attacks:
- Rest and elevation of the affected joint
- Anti-inflammatory medications, including ibuprofen, naproxen, or indomethacin
- Colchicine
- Corticosteroids such as triamcinolone injections or prednisone pills
- Low-purine diet
- Allopurinol
- Probenecid
Gout Attack Vs Chronic Gout
It is possible to have a gout flare-up and never experience another. Repeated instances of acute gout are called chronic gout17.
The treatment goals for a gout attack are different than those for chronic gout. When treating a gout attack, the goal is to relieve pain and inflammation. When treating chronic gout, the goal is to prevent future gout attacks and long-term joint damage.
While some people with chronic gout may get frequent gout attacks, others may have years in between attacks. If chronic gout is not treated, attacks may become more frequent and/or last longer.
Left untreated, a gout attack will usually resolve itself within a few days or weeks. Chronic gout can permanently damage a joints tissues and decrease its range of motion. For this reason, it is important to recognize symptoms, understand risk factors, get an accurate diagnosis, and treat and prevent gout.
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Treating A Gout Attack
The methods of stopping an attack of gout can vary depending on the severity of pain. Your orthopedic physician may give you a shot of corticosteroids. They may also prescribe other types of medications that are specifically designed to treat gout. To ease the pain during a gout attack, rest the joint that hurts. Non-steroidal anti-inflammatory medicine may also be prescribed to help reduce the pain. The good news is that following treatment, relief from the pain and discomfort of a gout attack often begins within 24 hours. It is important to still make an appointment with your orthopedic physician even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints. An orthopedic physician will help you get relief from the pain of gout attacks and learn ways to prevent flare-ups in the future.
*The blog is for general information and educational purposes only regarding musculoskeletal conditions. The information provided does not constitute the practice of medicine or other healthcare professional services, including the giving of medical advice, and no doctor-patient relationship is formed. Readers with musculoskeletal conditions should seek the advice of their healthcare professionals without delay for any condition they have. The use of the information is at the readers own risk. The content is not intended to replace diagnosis, treatment or medical advice from your treating healthcare professional.
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How To Prevent Bursitis In The Knee Joints
To keep your small fluid-filled sac healthy, avoid kneeling for long periods of time. Frequent pressure on the bursa is the most common cause of bursitis.
Here are a few other tips to help prevent bursitis:
- Avoid repetitive activities. Or, try to do them differently to reduce the friction on the bursa.
- Do some exercise. This will keep your joints healthy and may prevent a knee replacement.
- If your BMI is above > 25, a 10% decrease in weight can reduce knee pain and improve overall health.
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What Is The Fastest Way To Get Rid Of Gout Flares
Treat the pain as soon as it starts with a non-steroidal anti-inflammatory drug, colchicine, or a corticosteroid, depending on what is suggested or prescribed by your doctor. You should always have some type of this medication on hand so that you can start treatment as early as possible. When tolerable, a cool compress or ice can help relieve pain and swelling caused by a gout attack.
Full anti-inflammatory doses of NSAIDs, colchicine or corticosteroids are needed to improve symptoms, but should only be continued for seven to 10 days, or at least two to three days after the gout attack resolves.
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.
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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.
Can You Have High Blood Uric Acid Levels But No Gout Symptoms
Gout typically causes high uric acid levels in your blood, a condition called hyperuricemia. However, in some cases you may have high uric acid levels in your blood without developing symptoms of gout. This is called asymptomatic hyperuricemia.
Even if you have asymptomatic hyperuricemia and are at increased risk of developing gout, doctors typically do not recommend treatment during this period. They may, however, suggest lifestyle changes such as exercise, a healthy diet, and limiting alcohol to help lower uric acid levels. If you have asymptomatic hyperuricemia, your doctor will conduct tests to rule out other causes.
Hyperuricemia does not always lead to gout attacks. You may have normal uric acid levels in your blood during an attack.
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Should You See A Doctor
If you experience sharp, sudden pain in your foot or toe joint or notice any other signs of gout, its best to contact a physician. Untreated gout can lead to worsened pain and potentially permanent joint damage. And if you have a fever in addition to swelling and severe gout pain, you should seek immediate care, as it could be a sign of a serious infection.
Is It Gout Or Something Else
The pain and redness of gout can look like an infection or other conditions.
- Pseudogout is another form arthritis. The crystals formed in this condition are made of calcium pyrophospate, not uric acid. But like regular gout, the attack comes on all of a sudden. Joints become swollen, warm, painful, and stiff.
- Reactive arthritis is a reaction to infection that has similar signs.
- Psoriatic arthritis and infectious arthritis can look like gout, too.
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Uric Acid Is The Cause
When there is an overabundance of uric acid in the blood it is called gout. Usually, having too much uric acid in the blood is not harmful. In fact many people with high levels in their blood never know about it. When uric acid levels in the blood become extremely high, the uric acid may start to form crystals. These crystals most commonly form in the joints, especially the joints in the big toe. Your odds of experiencing the pain of gout are higher if you are overweight, drink excessive amounts of alcohol, or have a diet that is comprised of meat and fish that are high in chemicals called purines.
What Are The Symptoms Of Gout In The Knee
The main symptom of gout in the knee is pain and discomfort in the surrounding area. Keep in mind that gout is often unpredictable, regardless of the joint its affecting. You might go weeks or even months without any symptoms, only to wake up with a burning pain in your knee.
In some cases, gout starts out in one of your big toes before moving on to other areas, such as your knee. Over time, these flare-ups may last longer than previous episodes.
Other symptoms you might feel from gout in your knee include:
- tenderness
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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:
- Pseudogout
- 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.
Who Is At Risk Of Gout
Gout is sometimes called the disease of kings because of a false link to overindulgence in food and alcohol. Anyone can get the condition, but certain factors can increase your risk:
- Gender: Males are more likely to get gout than females.
- Age: Middle-aged and older men and women after menopause are more at risk for gout.
- Obesity
- Family history
- Diet: A diet high in purines, which are broken down into uric acid, can lead to gout. High purine foods include meats like bacon, turkey, veal, venison, and liver, and seafood like anchovies, sardines, mussels, codfish, scallops, trout, and haddock. High fructose foods and drinks such as soda pop also can increase your risk.
- Alcohol use
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