How To Treat Gout
It can be excruciating, and many sufferers go undertreated. But you can prevent the pain.
The word gout may make you think of overweight Victorian-era royalty with overly rich diets. But this common form of inflammatory arthritis, which leads to pain and swelling in one or more jointsespecially in the lower bodyaffects people even in the modern era. In fact, more than 9 million adults in the U.S. have been diagnosed with the disease, which occurs when the body produces too much uric acid or the kidneys dont excrete enough.
That surplus forms crystals in and around joints, eventually causing flares or attacks. People with high levels of uric acid can be accumulating crystals and damage to the joints for years before they have their first gout attack, says Larry Edwards, MD, a professor of medicine at the University of Florida.
Gout is on the rise, says John FitzGerald, MD, a professor of medicine at the David Geffen School of Medicine at UCLA and an author of guidelines from the American College of Rheumatology about gout management.
A genetic predisposition, diabetes, kidney disease, and other health problems may increase the chance of developing it. The growing number of people with metabolic syndrome and obesity is increasing the risk of gout, says FitzGerald, adding that some of the treatments for the conditions mentioned above may also raise the risk.
Who Can And Can’t Take Colchicine
Colchicine can be taken by most adults aged 18 and over.
It can sometimes be prescribed for children by a specialist doctor.
Colchicine is not suitable for some people. To make sure it’s safe for you, tell your doctor if you:
- have ever had an allergic reaction to colchicine or any other medicines
- have a severe blood disorder
- have severe kidney or liver problems
- have problems with your heart or digestive system
- are pregnant, think you might be pregnant or are trying for a baby
Women who could become pregnant will usually only be prescribed colchicine if they are using suitable contraception.
What Should I Do If I Forget A Dose
Take the missed dose as soon as you remember it. If you are taking colchicine on a regular basis and it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
However, if you are taking colchicine to treat an attack of gout that happened while you were taking colchicine to prevent gout attacks and you forget to take the second dose, take the missed dose as soon as you remember it. Then wait at least 12 hours before taking your next scheduled dose of colchicine.
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Who Can And Cannot Take Allopurinol
Allopurinol can be taken by adults and sometimes children.
Allopurinol is not suitable for certain people.
Talk to a doctor or pharmacist if you:
- have ever had an allergic reaction to allopurinol or any other medicine
- are of Han Chinese, Thai or Korean origin
- have problems with your liver or kidneys
- currently have an attack of gout
- have thyroid problems
Risk Factors For Gout
Gout is more likely to occur in:
- Men. Men have a seven to nine times higher risk of gout than women, although the risk increases for women after menopause
- People with a diet high in purine-rich foods such as red meat, organ meats , seafood . Processed foods , refined carbohydrates and beverages high in fructose or sucrose also contribute to gout
- Certain ethnicities
- People who overindulge in alcohol, particularly beer and spirits
- People with certain medical conditions , and with some medications or treatments .
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Before Taking This Medicine
You should not use febuxostat if you are allergic to it, or if you also use:
-
azathioprine or
-
mercaptopurine.
Taking febuxostat may increase your risk of serious or fatal heart problems. Talk with your doctor about the risks and benefits of febuxostat.
Tell your doctor if you have ever had:
-
heart problems
-
an organ transplant .
Tell your doctor if you are pregnant or breastfeeding.
Acute Gout Flares: What Else You Can Do
While your prescription gout medication should quickly treat your joint pain, swelling and redness, there are things you can do on your own in addition to taking your medicine:
Ice it. Treat your swollen joint with topical ice for a short period of time if you need a little extra relief. Ice can ease pain and swelling. Wrap ice or an ice pack in a soft towel or cloth before placing it on your skin. Dont place ice directly onto your joint, even if its inside a plastic bag.
Elevate it. If your big toe or foot is affected, prop it up on pillows while you rest on the sofa. Keep your joint elevated above the level of your heart for the best effect.
Give it a rest. Its OK to take it easy for a day or two while your symptoms are at their worst. Rest if you can. Try not to use your affected joint until your medications can reduce the inflammation. Gout flares often get worse if you try to ignore them and stress your affected joint.
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Treatment For Gout Aims To Reduce Pain And Inflammation As Quickly And Safely As Possible
Thinkstock
There are several treatment options for gout. Your doctor will help you find the regimen thats right for you.
If you have a history of gout, its important to keep the right medication on hand in case of a flare-up.
Prompt treatment will help reduce the pain and the severity of the attack. It will also help to prevent damage to your joints.
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Why Do I Suffer From Gout
One word: hyperuricemia. Or, in other words, increased uric acid in your blood. This is the reason why your joints are painful and inflamed. Uric acid is a normal product in your body it is a substance that breaks down purines in your body which are found in certain foods that we eat, in addition to being found in human cells. When your body overproduces uric acid, youre at risk for developing gout. But, why would your body overproduce uric acid?
The triggers of hyperuricemia include:
- Injury
- Excessive alcohol consumption
- Eating large amounts of red meat and shellfish
- Dehydration
- Drinking sugary sodas
It is these types of triggers that can create the hyperuricemia, which can result in gout. When you overproduce uric acid, your kidneys have to work harder to flush out the extra uric acid out of your bloodstream, as they would normally do.
Cherries Or Tart Cherry Juice
According to a , cherries whether sour, sweet, red, black, in extract form, as a juice, or raw are a very popular and potentially successful home remedy for many.
One 2012 study and another that same year also suggest cherries may work to prevent gout attacks.
This research recommends three servings of any cherry form over a two-day period, which was considered the most effective.
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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.
References
How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
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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.”
Who Is Affected By Gout
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:
- Obesity, or a lot of extra weight.
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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What Are The Symptoms
It presents much the same way in these joints as it does in the big toe, with pain, redness and swelling. It comes from the breakdown of purines, found in many different food types and drinks, from red meat and seafood through to beer. Lifestyle Habits to Prevent Warts While warts may not be a major medical concern, they can be painful and unsightly.
Some Side Effects Can Be Serious If You Experience Any Of The Following Symptoms Stop Taking Colchicine And Call Your Doctor Immediately:
- muscle pain or weakness
- numbness or tingling in the fingers or toes
- unusual bruising or bleeding
- sore throat, fever, chills, and other signs of infection
- weakness or tiredness
- paleness or grayness of the lips, tongue, or palms
Colchicine may decrease fertility in men. Talk to your doctor about the risks of taking colchicine.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
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Medicines For Gout Attacks
The main goal of treatment during a gout attack is to decrease pain and swelling. Some medicines are safe for people with kidney disease, and some are not. Talk to your doctor about which medicines make the most sense for you to try.
Nonsteroidal anti-inflammatory drugs
NSAIDs are medicines that decrease pain and swelling. Some NSAIDs are available over-the-counter, like ibuprofen and naproxen sodium. Stronger NSAIDs like indomethacin and celecoxib must be prescribed by a doctor. Taking NSAIDs can lead to kidney disease over time or make kidney disease worse. NSAIDs may not be recommended when you have kidney disease even for the treatment of gout attacks.
Colchine
Colchine is a medicine that can relieve pain. Your doctor may recommend taking colchine during a gout attack, or low doses of colchine every day if you have chronic gout. Colchine may not be recommended for people with kidney disease. Talk to your doctor about whether colchine is right for you.
Corticosteroids, also known as steroids
Steroids are strong medicines used to decrease swelling and pain. Steroids are usually only given for gout if you cannot take NSAIDS or colchine. Steroids can be in the form of a pill or given as an injection. Talk to your doctor about whether steroids are safe for you.
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.
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What Is The Best Thing To Drink If You Have Gout
Drink plenty of water, milk and tart cherry juice. Drinking coffee seems to help as well. Be sure to talk with your doctor before making any dietary changes.
Over time, they can harm your joints, tendons, and other tissues. Treatment of gout flares during postsurgical period, the choice of drug was based on the presence or absence of contraindications and patients previous experience with treatment . For patients with absence of contraindications, we used non-steroidal anti-inflammatory drugs plus proton pump inhibitors if appropriate as a first-line option. In patients with renal impairment, colchicine and NSAIDs were avoided and oral corticosteroid was used.
The Diagnosis And Treatment Of Gout
Robert G. Smith, DPM, MSc, RPh, CPedShoe String PodiatryOrmond Beach, FloridaUS Pharm.
Clinical literature has recently reported that gout is the most common inflammatory arthritis in the United States, with 3 to 5 million sufferers.1,2 Both the incidence and the prevalence of gout appear to be increasing worldwide.3 Gout is perhaps the oldest known type of arthritis it has been colorfully depicted in art and literature along with commentaries on the moral character of the gout sufferer . Literature accounts have referred to gouts association with rich foods and excessive alcohol consumptionthus the description, the disease of kings.
Gout is a monosodium urate, monohydrate crystal deposit disease with a very rich history mirroring the evolution of medicine itself.4,5 It was among the earliest diseases to be recognized as a clinical entity. Since gout has been recognized for so many centuries, its diagnosis and treatment generally have not elicited much interest thus, the management of gout is a challenge for the clinician caring for the patient with this disease.6
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What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achilles’ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
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