What Is Gout Exactly
Gout is a condition where excess deposits of a crystalline form of uric acid cause medical problems, says Theodore R. Fields, MD, a rheumatologist at the Hospital for Special Surgery in New York City. Uric acid is a normal byproduct of metabolism you produce it all the time and excrete it through urine. But when your body produces too much uric acid medically termed hyperuricemia it can crystallize and accumulate in your joints, causing gout symptoms including joint pain and kidney stones.
The most common problem is gouty arthritis, where a person suffers from inflammation in a joint, Dr. Fields says. Uric acid crystals can also form in the kidney and cause kidney stones, and can also build up in various locations, such as below the skin. These large, visible bumps below the skin are known as tophi.
As with most conditions, early diagnosis and prompt treatment are key for feeling your best and preventing any complications, including permanent bone and joint damage as well as an increased risk of many other health problems.
If you put off seeing your doctor, your gout flares can become more frequent and start to affect other joints. Youll also increase your risk of developing chronic gouty arthritis, which can lead to permanent joint damage, joint deformity, and persistent pain. Read more here about how gout can progress over time.
When To See A Doctor For Gout
Gout can develop overnight and happen suddenly without much warning or signs. Some people will automatically assume that the inflammation and swelling is related to a minor injury or a sprain, but seasoned Gout sufferers will know what to look out for and when to see a doctor. For those who are experiencing their first Gout attack or are unsure of whether or not they are afflicted with the disease might not know if a doctor’s consultation is necessary.
You should call or see a doctor right away if you have:
- Severe pain in a single joint that occurred rather suddenly and quickly
- Swollen, red and warm joints where the skin is tender and painful upon touch
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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.
Doctors Who Accepted Meals From Drug Makers Prescribed More Of Their Pills
Terkeltaub, a staunch advocate for medication, has received about $35,000 in consulting fees from drug companies that make gout medications in recent years, according to the Open Payments database that tracks such payments. Many of the rheumatologists who have called for treating gout with drugs have also received money from pharmaceutical companies. Edwards, for instance, received about $27,000 in 2015.
Terkeltaub dismissed concerns about a conflict of interest, saying it was unlikely that commercial bias could have tainted three different rheumatology groups that in recent years all came up with similar guidelines for pharmaceutical intervention to treat gout. Others argue that banishing all physicians with ties to drug companies from the debate would mean losing the input of people like Terkeltaub and Edwards, who are considered leaders in the field.
But studies have shown that doctors who receive compensation from pharma companies are more likely to prescribe brand-name drugs than their peers. The Institute of Medicine urges professional physicians groups to limit such conflicts of interest on any panel that writes up treatment guidelines. Most groups do not do that.
The debate frustrates Dr. Tuhina Neogi, a rheumatologist, epidemiologist, and professor of medicine at Boston University. She understands the virtues of high-quality evidence, yet said its myopic to ignore decades of wisdom that specialists have gained from treating actual patients.
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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 .
What Kind Of Doctor Do You Go To For Gout
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To Treat An Acute Attack
To stop a gout attack, your doctor will give you medicines. These are usually pills like colchicine, NSAIDs , or a steroid medicine. Sometimes it’s treated with a steroid shot. The sooner you get started on medicines, the sooner your symptoms will start to get better.
To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. Using ice on the sore joint may also help.
Can Gout Be Prevented Or Avoided
There are several ways you can help lower your risk of gout and prevent future attacks.
- Limit or avoid foods that are rich in purines. These include salmon, sardines, herring, organ meats, asparagus, and mushrooms.
- Try to eat foods that are low in salt and fat.
- Lose weight if youre overweight.
- Limit the amount of alcohol you drink.
- Drink lots of water to help flush uric acid from your body.
- Diuretics used to treat high blood pressure
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Lifestyle And Home Remedies
Medications are often the most effective way to treat gout attacks and prevent recurrent symptom flares. However, lifestyle choices also are important, and you may want to:
- Choose healthier beverages. Limit alcoholic beverages and drinks sweetened with fruit sugar . Instead, drink plenty of nonalcoholic beverages, especially water.
- Avoid foods high in purines. Red meat and organ meats, such as liver, are especially high in purines. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna. Low-fat dairy products may be a better source of protein for people prone to gout.
- Exercise regularly and lose weight. Keeping your body at a healthy weight reduces your risk of gout. Choose low-impact activities such as walking, bicycling and swimming which are easier on your joints.
Prepare For Your Specialist Visit
Take a quiz to see if your gout may be out of control and discuss the results with your specialist. You can also download a list of important questions to ask your specialist.
Terms and Conditions:Horizon is providing this service to help patients find a healthcare professional in their area who is knowledgeable about treating gout and KRYSTEXXA.
No fees have been received by or paid to healthcare professionals for inclusion in this specialist locator directory. Inclusion of a healthcare professional in this directory does not represent an endorsement by or a recommendation from Horizon, nor does it imply that the healthcare professional on the list will determine that KRYSTEXXA is right for you.
You are ultimately responsible for the selection of a healthcare professional and it is an important decision that you should consider carefully. This tool is just one source of information available to you.
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Preparing For An Appointment
Make an appointment with your doctor if you have symptoms that are common to gout. After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of arthritis and other inflammatory joint conditions .
Here’s some information to help you get ready for your appointment, and what to expect from your doctor.
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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Battle Erupts Over How To Treat Gout No Longer The Disease Of Kings
It was once seen as the disease of kings, afflicting only the lazy and gluttonous. These days, however, gout is everywhere and a bitter battle has broken out among physicians about how best to treat it.
A form of arthritis, gout is characterized by unsightly bulges under the skin and incredible pain in the joints. Typically seen in older men, the disease now increasingly afflicts women and younger adults, often accompanied by obesity, diabetes, and high blood pressure.
It used to be the disease of kings, but now its really the disease of the people, said Dr. Robert Terkeltaub, a professor of medicine at the University of California, San Diego.
There are several medicines to combat gout, which is caused by a buildup of uric acid in the blood, and more are on the way.
But the American College of Physicians, the nations largest specialty medical association, this month put out new guidelines that call for less aggressive pharmaceutical treatment. Thats angered many gout specialists, who in recent years have created two new professional groups both backed by drug companies one to bolster gout research and the other to promote long-term use of medication to lower uric acid.
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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.
A Rheumatologist Has Extensive Experience In Treating Gout
Rheumatologists see a higher volume and concentration of patients with gout, and thus are more experienced in treating the condition successfully. Because they see lots of patients with gout, they can add real-world knowledge of the disease to their academic and clinical training. Theyre able to assess how well patients respond to certain treatments, have a deeper understanding of how gout progresses over time, share insight about effectively implementing lifestyle changes, and recognize symptoms that a general practitioner may miss, among other skills.
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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
Diagnosing Gout: What To Expect At The Doctors Office
If youre unsure about whats causing your pain and other symptoms, youll likely visit various health care providers, which could include your internist/general practitioner, orthopedist, or podiatrist.
While your GP or internist may be able to diagnose and manage gout, if the diagnosis of gout is not clear, or if you arent getting better with initial treatment, you may be referred to a rheumatologist. A rheumatologist is a specialist who treats musculoskeletal disease and systemic autoimmune conditions, including gout.
There is no single, simple test to diagnose gout.
First, your doctor will perform a physical examination to assess your overall health and ask about your history of joint pain and other symptoms that suggest gout, as well as your family history and any pre-existing medical conditions you have or medications you take.
The doctor may check for pain in multiple joints. Over half of cases of acute gout occur in the big toe for the first time. Then over time, it can spread to other areas, like the middle of the foot, the ankle, knees, hands, the wrists, the elbows, and other joints as well, says Jonathan Greer, MD, a rheumatologist with Arthritis & Rheumatology Associates of Palm Beach in Florida.
Risk factors of gout that your doctor may consider:
- Family history of gout
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Your Gout Treatment Team
Proper gout treatment probably will involve more than visiting your primary care physician. Other specialists, like a rheumatologist, can help ease the pain and prevent further damage.
Gout is an incredibly painful and chronic form of arthritis that has been around since ancient times. People with gout can expect to experience problems directly and indirectly related to the disease. Because of this, it is important to have a gout treatment team available to make sure you are staying on top of your gout and limiting the harm it does to your body.
“It takes a team effort to get all of this down,” says Larry Edwards, MD, professor of rheumatology and clinical immunology in the department of medicine at the University of Florida in Gainesville.
Gout Treatment: Primary Care Physician
Gout treatment begins with a person’s primary care physician. These front-line doctors are:
- The first to see the warning signs of gout
- Usually the first to diagnose a patient’s pain as stemming from gout
- Often the primary deliverers of gout treatment
But primary care physicians and other internists often aren’t as aggressive as they could be in gout treatment, Edwards says. They focus on alleviating pain through anti-inflammatory drugs, but may not pay enough attention to the real cause of gout, the build-up of uric acid in the bloodstream and joints. “There’s been so little education that the primary care physicians have been poorly treating this disease,” Edwards says.
Gout Treatment: Dietitian