Tuesday, May 17, 2022

What Is The Treatment For Gout

Pain Relief Without Medicine

Acute Gout Treatment – How You Can Relieve the Sudden Onset of Pain (5 of 6)

Use cold. If your pain isn’t too bad, try cold packs or compresses on the joint to lower inflammation and soothe the ache. Wrap ice in a thin towel and apply it to the joint for up to 20 minutes several times a day. Do not apply ice to your hands or feet if you have nerve problems from diabetes or other causes.

Rest the joint. It’s a good idea to rest it until the pain eases up. You probably won’t want to move it much anyway. If you can, raise the joint on a pillow or other soft object.

Drink water. When your body doesn√Ęt have enough water, your uric acid levels rise even higher. Stay hydrated to help keep those levels normal.

Watch what you eat and drink. Foods that are high in substances called purines, such as some seafood, organ meats like liver, and fatty foods, can raise the uric acid in your blood even more. So can fructose-sweetened drinks and alcohol — especially beer.

Take Caution With Supplements For Gout

As for the many supplements and other purported home remedies available for gout, including turmeric and bromelain, there is no significant evidence backing them up as of now, and theres no adequate evidence showing that supplements have any effect even comparable to that of medicines.

From my point of view, says Dr. Fields, the home remedy concept to gout is often harmful because it keeps patients from taking medications that we know are effective.

The Pathology Of Gout

Gout is primarily a metabolic disorder in which uric acid accumulates in blood and tissues. When tissue levels reach saturation, needle-like crystals form, causing inflammation. This occurs most commonly in the cooler joints, notably the metatarsophalangeal joint of the big toe.

Many people with hyperuricemia never develop gout, but those with the highest levels are most likely to suffer episodes. Hyperuricemia may also lead to kidney stones.

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What Other Information Should I Know

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your response to colchicine.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

How Common Is Gout And Who Develops It

Proper Gout Treatment Should Lead to Lower Uric Acid ...

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 .

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Southern Cross Medical Library

The purpose of the Southern Cross Medical Library is to provide information of a general nature to help you better understand certain medical conditions. Always seek specific medical advice for treatment appropriate to you. This information is not intended to relate specifically to insurance or healthcare services provided by Southern Cross. For more articles go to the Medical Library index page.

Uric Acid As A Factor In The Causation Of Gout

Antoni van Leeuwenhoek , one of the pioneers of microscopy, was the first to describe the appearance of the crystals from a gouty tophus, although their chemical composition was unknown at that time. He wrote in 1679 :

“I observed the solid matter which to our eyes resembles chalk, and saw to my great astonishment that I was mistaken in my opinion, for it consisted of nothing but long, transparent little particles, many pointed at both ends and about 4 ‘axes’ of the globules in length. I can not better describe that by supposing that we saw with naked eye pieces from a horse-tail cut to a length of one sixth of an inch.”

Earlier, Seegmiller and colleagues had described the relative roles of excessive urate production and impaired excretion in the pathogenesis of hyperuricemia.

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How Is Gout Treated

Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to

  • Manage the pain of a flare. Treatment for flares consists of nonsteroidal anti-inflammatory drugs like ibuprofen, steroids, and the anti-inflammatory drug colchicine.
  • Prevent future flares. Making changes to your diet and lifestyle, such as losing weight, limiting alcohol, eating less purine-rich food , may help prevent future attacks. Changing or stopping medications associated with hyperuricemia may also help.
  • Prevent tophi and kidney stones from forming as a result of chronic high levels of uric acid. Tophi are hard, uric acid deposits under the skin. For people with frequent acute flares or chronic gout, doctors may recommend preventive therapy to lower uric acid levels in the blood using drugs like allopurinol, febuxostat, and pegloticase.

In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices. The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you.

Who Is Affected By Gout

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Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.

People are more likely to get gout if they have:

You are also more likely to develop gout if you:

  • Consume a diet high in animal proteins
  • Consume a significant amount of alcohol
  • Are on water pills .

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Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot

As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.

The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.

Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.

Figure 5: Location of Gout Attacks

What Is The Evolution Of The Gout

In general, the frequency and numbers of gout pain increased with time. After several years, in addition to joint pain, the disease may cause deposits of crystals under the skin called tophi. They are friable whitish or yellowish masses located on the outside edge of the ear, on the elbows or near the elbows, on fingers, on toes or close to the Achilles tendon. If these tophi is deposited in bone structures then we talk about gouty arthritis. Joints are gradually destroyed, and this is especially characteristic in the hands, wrists, feet… Crystals may also settle in the kidneys. In the absence of treatment, they will interfere with their functioning and ultimately lead to renal failure.

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Hepatic Impairment And Gi Bleeding

Patients with cirrhosis should avoid NSAID use due to the potential increased bleeding risk from underlying coagulopathy. Additionally, colchicine clearance may be reduced in patients with severe liver impairment, mandating close surveillance when this agent is used. If hepatic impairment is mild to moderate, judicious use of any of the first-line therapies may be appropriate.

Patients with GI bleeding or a history of peptic ulcer disease should avoid NSAID use because of increased bleeding risk. If an NSAID is used, proton pump inhibitors decrease the risk of NSAID-associated mucosal damage.

Points To Remember About Gout

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  • Gout is a type of arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then go away.
  • With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
  • The most common symptom of gout is pain in the affected joint, such as the big toe.
  • Your doctor may recommend taking medications to manage the cause of your gout and treat active gout flares, and making changes to your diet and lifestyle.

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Why Is This Medication Prescribed

Colchicine is used to prevent gout attacks in adults. Colchicine is also used to relieve the pain of gout attacks when they occur. Colchicine is also used to treat familial Mediterranean fever in adults and children 4 years of age and older. Colchicine is not a pain reliever and cannot be used to treat pain that is not caused by gout or FMF. Colchicine is in a class of medications called anti-gout agents. It works by stopping the natural processes that cause swelling and other symptoms of gout and FMF.

Are There Home Remedies For Gout

  • Take medications as prescribed.
  • While a joint is hot and swollen, use a cane or similar support to keep weight off that joint.
  • It may be helpful to keep the swollen joint elevated above the chest as much as possible.
  • Ice packs can be helpful in relieving pain and reducing inflammation.
  • Maintain adequate hydration to minimize the frequency and intensity of attacks.
  • Drink cherry juice to decrease the intensity and severity of attacks.
  • Avoid eating red meats, internal organs, yeast, shellfish, and oily fish because these increase the risk for gout.

    While some medications are used to treat the hot, swollen joint, other medications are used to prevent further attacks of gout. With any of these medications, call a doctor if you think they are not working or if you are having other problems with the medication.

    Medicines used to treat acute gout and/or prevent further attacks are as follows:

  • Colchicine
  • This medication is given in two different ways, either to treat the acute attack of arthritis or to prevent recurring attacks.
  • To treat the hot, swollen joint, colchicine is given rapidly .
  • To help prevent an attack from coming back, colchicine can be given once or twice a day. While the chronic use of colchicine can reduce the attacks of gout, it does not prevent the accumulation of uric acid that can lead to joint damage even without attacks of hot, swollen joints.
  • Tell a doctor if you are experiencing any problems with kidney or liver function.
  • Corticosteroids
  • Allopurinol
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    When Should Someone Seek Medical Care For Gout

    Anyone who has a sudden onset of a hot, red, swollen joint should seek medical care, either with a primary care physician, at an emergency department, or with a rheumatologist . These symptoms can also be due to an infection, loss of cartilage in the joint, or other reasons. It is important to make an accurate diagnosis of gouty arthritis for optimal treatment.

    If one has been diagnosed with gout and has had more than one attack of arthritis, take the medication prescribed by a physician for these attacks. The individual should be seen by a physician, in the emergency department, or urgent care center if the attack does not respond to this treatment. The individual may need regular medications to prevent further arthritis flares.

    Attacks of abdominal pain due to kidney stones may be related to uric acid kidney stones from gout.

    Treatment Of Acute Attacks

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    The temptation to treat patients without a proven diagnosis must be resisted. Septic arthritis may clinically resemble gout or pseudogout, and unrecognized septic arthritis can lead to loss of life or limb. Distinguishing septic arthritis from crystal-induced arthritis is not possible without an examination of joint fluid.

    Acute treatment of proven crystal-induced arthritis is directed at relief of the pain and inflammation. Nonsteroidal anti-inflammatory drugs , corticosteroids, colchicine, adrenocorticotropic hormone , and anakinra are treatment options. The choice is based primarily on whether the patient has any concomitant health problems . Colchicine, a classic treatment, is now rarely indicated.

    In patients with a gout flare, the multicenter open-label randomized CONTACT trial found no significant difference in pain relief over 7 days with naproxen versus low-dose colchicine. However, naproxen caused fewer side effects. In CONTACT, adults with a gout flare received either naproxen, 750 mg immediately then 250 mg every 8 hours for 7 days, or low-dose colchicine, 500 mcg three times per day for 4 days. During days 17, diarrhea and headache were more common in the colchicine group than the naproxen group but constipation was less common.

    Furthermore, control of hyperuricemia generally is not pursued for a single attack. If attacks are recurrent or evidence of tophaceous or renal disease is present, therapy for control of hyperuricemia is indicated.

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    William Pitt: Gout Taxes And The American Colonies

    The disabling gouty arthritis of the British statesman William Pitt the Elder was a major factor in Britain’s loss of the American colonies. It was during one of Pitt’s gout-related absences from Parliament that the Stamp Act was passed, which forced the unwilling colonists to pay a tax, determined by the British Parliament, to defray the costs of defending the colonies against French attack. Upon recovering from his gout, Pitt succeeded in getting the Act repealed with the famous words, “The Americans are the sons, not the bastards, of England. As subjects, they are entitled to the right of common representation and cannot be bound to pay taxes without their consent.” Unfortunately, during another of Pitt’s absences due to an episode of gout, Lord Townshend persuaded Parliament to levy a heavy duty on colonial imports of tea to raise the necessary revenues. This precipitated the Boston Tea Party in 1773, and the rest is history!

    What Is Gout Caused By

    Gouts extensive history has been plagued by a common misconception that gout only afflicts the lazy and rich earning the nickname Rich Mans Disease or the Disease of Kings. This misguided notion came about when the very wealthy were the only ones that could afford a regular diet of red meat and alcohol. We now know that this type of diet raises the level of purines in the body, thereby increasing uric acid and increasing the likelihood of gout. In todays society, we see the opposite of the Rich Mans Disease gout is more often seen in lower socioeconomic groups that tend to have less healthy, varied diets.

    In addition to meat and alcohol, other dietary and lifestyle conditions that increase the incidence of gout include:

    • Foods and drinks that are high in fructose
    • Certain seafood and oily fish, such as tuna, trout, scallops and mussels
    • Obesity, or having too much body fat
    • Certain medicines, such as diuretics , which are commonly used for high blood pressure
    • Certain diseases, such as kidney disease, diabetes, hypertension, and congestive heart failure

    Speak to one of our top doctors today to help you understand the possible causes of your gout and discuss treatment options.

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    What Are Causes Of Gout

    Uric acid is generated as we metabolize the food we eat and as the body’s tissues are broken down during normal cell turnover. Some people with gout generate too much uric acid and are medically referred to as “over-producers.” Other people with gout do not effectively eliminate their uric acid into the urine and are medically referred to as “under-excreters.”

    Treatment Of Chronic Gout

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    When a patient experiences a first attack of gout, any medication regimens that may have contributed to the gout attack must be altered, and any predisposing medical conditions or habits must be addressed. Patients should be instructed to go on a diet if obese, to stop drinking beer, and to avoid purine-rich foods.

    In many cases, patients who have a first attack of gout should undergo therapy with agents that lower uric acid, given the high risk for further inflammatory attacks and the potential for destructive tophaceous deposition in the bone, synovium, and kidney, even without episodes of acute inflammation. If the first attack is not severe, however, some rheumatologists advocate waiting for a second attack before initiating such therapy not all patients experience a second attack, and some patients may require convincing that they need life-long therapy.

    The risk of a second attack of gout after the first attack is 62% after 1 year, 78% after 2 years, and 93% after 10 years. The decision to begin therapy depends partly on the baseline serum uric acid levels .

    Controversially, a 2016 guideline from the American College of Physicians does not recommend the “treat to target” approach to controlling serum uric acid levels. The ACP concluded that evidence was insufficient to determine whether the benefits of escalating urate-lowering therapy to reach a serum urate target outweigh the harms associated with repeated monitoring and medication escalation.

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