Physicians Often Missing Boat On Gout Therapy
EXPERT ANALYSIS FROM A SYMPOSIUM SPONSORED BY THE AMERICAN COLLEGE OF RHEUMATOLOGY
SNOWMASS, COLO. A disturbing proportion of gout cases are mismanaged by primary care physicians, and the blame falls squarely upon rheumatologists, according to one prominent gout expert.
“As rheumatologists, gout is our disease. The cause and pathophysiology are well understood, we can make the diagnosis with absolute certainty, and weve got great medicines. Yet today we all see people with tophi. Thats tragic. It shouldnt exist. One of our biggest mistakes has been not being able to educate primary care physicians that having a tophus is bad, that its eroding cartilage and bone, and that its something we can prevent if we start urate-lowering therapy soon enough,” Dr. Robert L. Wortmann said at the conference.
Dr. Robert L. Wortmann
An estimated 8.3 million Americans have gout. Yet, the pharmaceutical industry says only 3.1 million of them are prescribed urate-lowering drugs. Five different studies show that a mere 40% of those on allopurinol are prescribed a dose sufficient to drive serum uric acid below 6 mg/dL, a key tenet of gout management, noted Dr. Wortmann, professor of medicine at Dartmouth Medical School in Hanover, N.H.
Moreover, poor treatment adherence is a huge problem in gout. A study of close to 4,200 gout patients started on urate-lowering drug therapy found that 56% of them were nonadherent :R46).
He offered these major take home points:
What Are The Symptoms
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.
See your doctor even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints.
Try To Decrease Stress
A life without stress is impossible these days. There is no single method to avoid it unless you live in the wild. A natural treatment for gout can be to use methods that decrease stress. The best examples are exercising, yoga, meditation, reading, and anything that makes you happy.
But why stress affects gout? Stress decreases the production of pantothenic acid. When this acid is low, the uric acid level will be high and we all know what that means! Try to find a way to decrease stress at all cost.
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The Best Ways To Treat Gout
When you have an acute attack of gout, your doctor will likely focus on treating your immediate symptoms first by prescribing non-steroidal anti-inflammatory drugs to help bring down the pain and swelling. For patients who get frequent flares of gout, long-term treatment with a medication that lowers uric acid levels, such as allopurinol, is recommended, Choi says.
However, “while symptoms of gout can be controlled with medications, it is also important to implement lifestyle changes,” Choi says, adding that a good place to start is adopting a healthy diet and exercise.
Over the long term, losing weight may be an important step to treat gout, as being overweight increases your chances of developing gout. However, you should avoid extreme dieting, as losing weight too quickly can actually trigger gout attacks.
Avoiding high purine foods can help lower uric acid in your body, and consuming certain foods like vitamin C and coffee may help treat gout, according to some research.
Choi says that overall, “the Mediterranean and DASH diets seem to be beneficial for patients with gout.” This means adding more whole grains, vegetables and fruits, and legumes to your diet and eating less meat. For more information about what to eat for each of these diets, check out our articles about the Mediterranean diet and the DASH diet.
What Are The Risk Factors Of Gout
The likelihood of developing gout increases with an increase in the levels of uric acid in a persons body. Some commonly known factors that increase the uric acid level in the body include:
- Age and gender: Men are more prone to developing gout in contrast to women, who generally have lower levels of uric acid. However, once they achieve menopause, the uric acid levels of women approach those of men. Men usually develop gout in the age group of 30 to 50 years and women develop gout post-menopause.
- Diet: Certain food items like meats and seafood and fructose based beverages are known to increase levels of uric acid, and thereby gout.
- Family history: The presence of gout in close relatives in the family increases the persons risk of developing the condition.
- Medical conditions: Certain ailments like uncontrolled hypertension, diabetes and chronic conditions like metabolic syndrome, heart and kidney diseases increase the risk of gout.
- Medications: Prolonged use of certain antihypertensive medications like thiazide diuretics, antiplatelet agents like low-dose aspirin, post-transplant anti-rejection drugs, etc increase the person& #39 s susceptibility of developing gout.
- Obesity: Overweight persons tend to have more uric acid in their bodies and the kidneys are unable to eliminate uric acid.
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Eat A Diet Low In Purines
If you have had more than one episode of gout, make sure you eat a healthy diet that is low in purines. The food groups that contain high levels of purine include: meat , seafood , lentils, specific vegetables, and dried beans. Foods you can enjoy that are lower in purines are eggs, complex carbohydrates, fruits, and low-fat dairy.
What Is Gout How To Know If You Have It And Recommended Treatment
- Gout is the most common type of inflammatory arthritis and causes pain in the joints, particularly the big toe.
- It is caused by a buildup of uric acid, which is produced when your body digests purine, a chemical that is concentrated in foods like shellfish, red meat, and alcohol.
- To treat gout, you may need to take anti-inflammatory medications, avoid foods with purines, and lose weight.
- This article was reviewed by Melissa Rifkin, MS, RD, CDN, owner of Melissa Rifkin Nutrition LLC.
- Visit Insider’s homepage for more stories.
Gout is an intensely painful form of arthritis that affects over 8 million Americans. As our diets change to include more processed foods, and with the increase in popularity of high protein diets, gout is on the rise, especially for older men. Here’s what you need to know about the causes, symptoms, and treatment for gout.
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Warning Signs Of A Gout Flare
Some people with gout, also known as gouty arthritis, say an attack begins with a burning, itching, or tingling feeling in a joint maybe an hour or two before the flare-up starts. The joint may feel a little stiff or a bit sore. Not long after, the telltale signs of gout begin. If you get repeated attacks, you’ll learn your body’s signals that one is about to begin.
Sometimes, people with gout have no early signs that a flare is about to start. They may just wake up in the middle of the night with a very painful joint.
When the flare starts, most people have redness, swelling, and severe pain, usually in one joint. The most common place for gout is the base of the big toe, but it can happen in other joints such as the elbow, knee, wrist, ankle, and instep.
Consider Expanding Your Care Team
To get the best care, people who suffer with gout and other health issues may require treatment from multiple doctors.5 If you suffer with both gout and kidney disease, for example, you might see a rheumatologist and a nephrologist in addition to your family doctor or PCP.5 It is very important for each of your doctors to know how the others are helping you manage your gout and other health concerns. Be sure to mention any significant changes to your health or medications at each of your doctor visits.
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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
When To Visit A Doctor
If you are dealing with the intense pain, swelling, redness, and heat that usually indicates the presence of gout, then you should visit a physician. This is also true for anyone who is contending with chills, or a high fever.
Anyone who has experienced gout can eventually have this condition reemerge, and this is referred to as a gout flare. That might not occur for an extended period of time. But regardless of whether a return takes places months or years after gout has developed for the first time, it is wise to contact a doctor whenever it does.
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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.
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 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.
Additional Tips For Treating Gout Naturally
Studies show that many of the dietary items we consume lead to gout as well as other health problems. Changing your diet and lifestyle may be the easy solution to beating gout. One of the first things to do is eliminate certain foods and beverages from your diet to beat gout.
1. Eliminate or reduce sugar intake
As many studies are now illustrating, gout is common in people with excessive sugar intake, especially high fructose corn syrup Its wise to read the labels of all your food and drinks. If you find HFCS then eliminate that from your diet. In addition, look for sugar added under the guise of other common names for sugar look for cose at the end of words and these are probably types of sugar you dont want to be consuming.
2. Eliminate grains
Grains in the body are converted to sugars so again you want to limit or avoid grains altogether. They are also very inflammatory to your body.
3. Limit alcohol consumption
Again, alcohol becomes sugar once ingested so eliminate this completely unless you have a healthy body already. Any substance that will be converted to one or another type of sugar by the body should be avoided at all costs. In order to get your uric acid levels down you must consistently avoid sugar in your diet.
4. Eliminate soda and diet soda
5. Consume cherries and strawberries daily
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What Are The Best Prescription Drugs For Gout: You Need To Know This
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So I apologize for the delay.
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- What is Gout & can you get rid of it?
- How thousands of people have stopped gout pains
So lets get into it. Sound good?
Who Should Diagnose And Treat Gout
The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.
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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.
Now Its Your Turn To Understand What Are The Best Prescription Drugs For Gout
Presently theres right now thousands of us who no suffer gout because we tackled it at its reason more. Of just trying out the symptoms Alternatively.
Im one of them!
Remember, I acquired gout for exactly the same reasons it really is possessed by you now.
An detrimental gut microbiome supposed that bacteria which should have been taking away a third of my bodys uric acid simply wasnt.
That bacteria acquired diminished to the point that my kidneys have been trying to deal with the acid on their own.
And they couldnt cope.
Nor can yours.
It wasnt i was suddenly creating an excessive amount of uric acid. It alls that my gut was no able to help my kidneys remove it from my own body more.
And the transformation from gout to no gout felt like magic almost.
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 wondering if some long term occasion will be messed up because Im laid up in agony with another attack.
Just as pleasing is the fact that Ive likewise greatly decreased my risks of suffering 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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How Do Doctors Diagnose Gout
- This is the most important diagnostic test. It is the ultimate method of being certain of a diagnosis of gouty arthritis, as opposed to other causes such as an infection in the joint.
- A needle is inserted into the joint to withdraw a sample of fluid for testing.
- The fluid is examined under a microscope to see if there are gout crystals or signs of a bacterial infection present. Sometimes other crystals can be found in the joint fluid, such as calcium pyrophosphate, which is caused by an entirely different condition called pseudogout .
- Gouty arthritis is sometimes diagnosed based on the typical clinical presentation without a joint aspiration.
- A doctor may obtain a blood sample to look at cell counts, uric acid levels, kidney function, etc.
- Unfortunately, the level of uric acid in the blood cannot be reliably used to make a diagnosis of gout. It is normal in approximately 10% of people during an acute attack of gouty arthritis. Moreover, uric acid levels are elevated in 5%-8% of the general population, so the presence of an elevated level does not necessarily mean that gout is the cause of an inflamed joint. Interestingly, the uric acid is typically lowered during a flare of inflammatory gouty arthritis. Therefore, the optimal time to measure the uric acid is after a flare has resolved when acute inflammation is not present.
What Type Of Doctor Should I See For Gout
The best kind of health professional to see for gout is a Rheumatologist, a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions. If you are unable to visit a rheumatologist immediately a general doctor, nurse practitioner or orthopedist can also provide expert consultation on your gout.
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Risk Factors Of Gout:
- Diet: Over-eating purine-rich food can lead to an increase in uric acid in your body, raising your risk of gout. Excessive alcohol consumption, especially beer, can also put you at risk.
- Weight: Obesity is a risk factor for gout, as it decreases your bodys ability to break down uric acid.
- Existing Medical Conditions: Having other chronic conditions, such as high blood pressure or diabetes, may increase your risk of gout.