Medications That Can Trigger Gout
Some medications can trigger gout symptoms. This includes common pain medications. Even small amounts of these drugs can impact gout. Your doctor may recommend changing these medications if you notice more gout symptoms.
Aspirin or acetylsalicylic acid raises uric acid in your blood. Even low doses of aspirin can trigger gout. Research shows that this effect of aspirin is more common in women than in men.
Diuretics or water pills help to treat conditions such as high blood pressure and edema or swelling in the legs. These medications work by getting rid of excess water and salt from the body. However, they can also cause a side effect of too much uric acid in the body, triggering gout. Diuretic drugs include:
Sugary Beverages Rich In Fructose
Research also indicates that intake of sugary beverages that contain high levels of fructose also increase the production of uric acid in your body. Also, fructose when trying to get eliminated out of the body through the kidney stops uric acid from eliminating and causes the build-up of uric acid too. Fructose is also known to stimulate the production of uric acid in the body with the help if glycine, an amino acid precursor.
Gout Symptoms And Complications
Gout is not gout until symptoms occur. When they do, they usually come on suddenly and, at least initially, affect a single joint. Within hours, that joint becomes red, swollen, hot, and painful they’re called gout attacks for a reason. It’s easy to mistake a gout attack for a localized infection of a joint. The metatarsophalangeal joint at the base of the big toe is often the site of the first attack, but the knees, ankles, and joints between the many small bones that form the foot are also common sites. People who already have osteoarthritis the most common form of arthritis often experience their gout attacks in the joints of the finger
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Gout Statistics And Facts
- 8.3 million people in the United States have gout .*
- Among people who have gout attacks, 90% have kidneys that dont remove enough uric acid from their urine while 10% make too much uric acid in their system.
- 90% of gout attacks start in a single joint. Most often, it is the bunion joint of the big toe.
- 90% of gout patients have one or more of the following conditions , which make it more difficult to manage gout: kidney dysfunction, coronary heart disease, obesity, high cholesterol and/or triglycerides, diabetes mellitus.**
*Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Zhu Y, Pandya BJ, Choi HK. Arthritis Rheum. 2011.**Comorbidities of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Zhu Y, Pandya BJ, Choi HK. Am J Med. 2012.
Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in one or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the complications of gout.
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Why Does Uric Acid Build Up
Normally, there is a fine balance between the amount of uric acid that you make and the amount that you pass out in the urine and stools. This keeps the level of uric acid in the blood in check. However, in most people with gout, their kidneys do not pass out enough uric acid and the blood level may rise. They are said to be under-excreters of uric acid. Their kidneys usually work otherwise normally.
In some people, the build-up of uric acid may due to other factors – for example:
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 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 Is The Outcome
A sudden-onset attack of gout usually resolves within 3-10 days. About 2 in every 3 people who have one acute attack will have another acute attack within the following year. Repeated acute attacks and long-lasting gout lead to progressive damage of the joint and therefore to persistent pain and disability.
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When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
What Causes High Uric Acid Levels In The Body
When it comes to what causes gout, higher levels of uric acid in your body may be caused due to various reasons including obesity, diet pattern, genetic reasons etc. Higher levels of uric acid are also termed as Hyperuricaemia. If you are more than the normal weight, then the fatty tissues in your body also enhance the production of uric acid in your body.
We also get lots of purines through our diet and it has been proven that around 15% of purine is sourced from our diets. Foods that are rich in purines, main gout causing chemicals include red meat, sugary beverages, asparagus, spinach, turkey, beer, herring and scallops.
Our body also produces its own uric acid and normally most of the excess ones are eliminated from our body, but in certain conditions, it is not able to eliminate the uric acid content thus increasing the levels of uric acid in the body. The reason why your body couldnt remove the uric acid may vary including obesity, being diabetic, alcoholic and consuming certain kind of diuretics.
Major factors that cause higher levels of uric acid in your blood include:
- Drinking too much alcohol
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United States Unapproved Drugs Initiative
An unintended consequence of the 2006 U.S. safety program called the through which the FDA sought more rigorous testing of efficacy and safety of colchicine and other unapproved drugswas a price increase of 2000 percent for “a gout remedy so old that the ancient Greeks knew about its effects.” Under Unapproved Drugs Initiative small companies like , a Philadelphia drugmaker, were rewarded with licenses for testing of medicines like colchicine. In 2009, the FDA reviewed a for colchicine submitted by URL Pharma. URL Pharma did the testing, gained FDA formal approval, and was granted rights over colchicine. With this monopoly pricing power, the price of colchicine increased.
In 2012 Asia’s biggest drugmaker, , acquired URL Pharma for $800 million including the rights to colchicine earning $1.2 billion in revenue by raising the price even more.
29 July 2009, colchicine won FDA approval in the United States as a stand-alone drug for the treatment of acute flares of gout and familial Mediterranean fever. It had previously been approved as an ingredient in an FDA-approved combination product for gout. The approval was based on a study in which two doses an hour apart were as effective as higher doses in combating the acute flare of gout.
Chronic Gout Signs And Symptoms
- Compared with the dramatic nature of acute gout pain, chronic gout pain is more of a soreness or persistent ache.
- Pain that tends to be a more continuous feeling of dull aching or soreness in the joints
- Hard white deposits or lumps under the skin, called tophi, found on the elbows, ears, or fingers.
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Clinical Significance And Research
In human , the of uric acid is typically 3.47.2 mg per 100 mLl for men, and 2.46.1 mg per 100 ml for women . Uric acid concentrations in blood plasma above and below the normal range are known as, respectively, and . Likewise, uric acid concentrations in urine above and below normal are known as and . Uric acid levels in saliva may be associated with blood uric acid levels.
What To Do During An Attack
- take any medication you’ve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
- rest and raise the limb
- avoid knocking or damaging the affected joint
- keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
- ensure you’re well hydrated
Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.
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What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
What Foods Should You Avoid
If youre susceptible to sudden gout attacks, avoid the main culprits high-purine foods.
These are foods that contain more than 200 mg of purines per 3.5 ounces .
You should also avoid high-fructose foods, as well as moderately-high-purine foods, which contain 150200 mg of purines per 3.5 ounces. These may trigger a gout attack.
Here are a few major high-purine foods, moderately-high-purine foods and high-fructose foods to avoid (6,
- meats: These include liver, kidneys, sweetbreads and brain
- meats: Examples include pheasant, veal and venison
- Fish: Herring, trout, mackerel, tuna, sardines, anchovies, haddock and more
- seafood: Scallops, crab, shrimp and roe
- Sugary beverages: Especially fruit juices and sugary sodas
- Added sugars: Honey, agave nectar and high-fructose corn syrup
- Yeasts: Nutritional yeast, brewers yeast and other yeast supplements
Additionally, refined carbs like white bread, cakes and cookies should be avoided. Although they are not high in purines or fructose, they are low in nutrients and may raise your uric acid levels (
Summary: If you have gout, you should avoid foods like organ meats, game meats, fish and seafood, sugary beverages, refined carbs, added sugars and yeast.
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How Common Is Gout And Who Develops It
Gout affects about 1 in 100 adults. Men are more commonly affected than women. A first attack of gout typically develops in middle age but it sometimes occurs in younger people. It tends to run in some families, as there is a family history of gout in about 1 in 5 cases. It may be that the genetic makeup that you inherit from your family may be a factor in becoming an under-excreter of uric acid .
Acute Attack Pain Management
Home remedies. Reducing inflammation during an acute gout attack will provide pain relief.
- Ice. Apply ice to the affected area to reduce swelling. Do not apply ice directly to the skin. Use an ice pack or wrap a towel around the ice. Apply ice for about 20 minutes at a time.
- Elevate. Frequently raise and keep the affected area above the level of the heart.
- Rest. Move the affected area as little as possible while symptoms are present.
- Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs even the over-the-counter strength be sure to check with your doctor before taking them.
Prescription medications. Your doctor may recommend a prescription-strength non-steroidal anti-inflammatory medicine such as indomethacin.
Colchicine is also given to reduce inflammation during an acute gout attack. This drug has recently been approved by the Federal Drug Administration for treatment of gout. Like all medications, colchicine has side effects that you will need to discuss with your doctor.
Your doctor may also prescribe corticosteroids for acute gout attacks. These are strong anti-inflammatory medications that can be taken either in pill form, intravenously, or injected into the painful joint. Cortisone may improve the severe inflammation very quickly.
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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.
What Can I Do During A Gout Attack
You should see your doctor when you have your first attack of gout. Your doctor will recommend certain medicines to reduce pain and inflammation caused by gout, including:
Always talk to your doctor or pharmacist before you start taking any medicines. You may also need to protect the affected joint. For example, if your big toe is affected you may need to limit the amount of walking you do and create a bed cradle to keep your sheets off your foot when youre in bed.
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What Are The Main Causes Of Gout
One of the main causes of painful gout attacks is the sudden increase of uric acid in your blood. When the level of uric acid increases, it tends to develop into some form of urate crystals and gets deposited over your joints. One of the major sources for higher levels of production of uric acid is either through dietary sources or through the increase in the synthesis of uric acid in the human body itself. When the crystals form a deposit over the joints, it causes severe to extreme pain in the affected area.
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People having the habit of drinking too much alcohol and having lots of fish and meat are prone to get affected by gout attacks as these drinks and food come with a lot of dangerous gout causing chemicals called purines. When you intake a lot of purines, these purines are broken down into urate crystals that get deposited in the joints, knees and ankles to cause gout. Another major cause of gout is by genetic ways, as there are chances of you getting attacked by gout, if any of your members in your family have already been diagnosed with gout.
What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
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Gout Myths And Misconceptions And The Facts
Gout was once called the disease of kings, because of its propensity to affect overweight, rich men throughout history. Famous gout sufferers have included Alexander the Great, Charlemagne, Henry VIII of England, and Benjamin Franklin.
While gout is no longer thought to be a disease of the wealthy, it is more common in men and people with weight-related health problems including high blood pressure and type 2 diabetes.