What Are Symptoms Of Gout
Chances are you wont even know you have gout until youve experienced your first painful attack, often at night. Symptoms may not develop for years, but these often include:
- Arthritis that develops quickly, resulting in a swollen, red, and warm joint with limited movement
- An arthritis attack in only one joint often the big toe, as well as a foot, ankle, or knee
- Bright red or purplish skin around the affected joint
- More than one attack of acute arthritis
When To Get Help For A Gout Flare
It’s always a good idea to let your doctor know that you are having a flare. Sometimes, you may need to follow up to make sure your treatment plan is working or if your symptoms don’t improve. Call your doctor if:
This is your first flare-up. There are several other conditions, such as a joint infection, that have some of the same symptoms as gout attacks.
You have a highfever and chills. Gout attack symptoms may include a mild fever, but a higher temperature may be a sign of an infection.
Your symptoms don’t get any better after 48 hours or don’t end after about a week. If you don’t start to feel somewhat better after a few days, call your doctor. They may suggest a different treatment. Most gout attacks will go away by themselves in several weeks, even without treatment.
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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Neck And Waist Circumference Are Also Relevant In Sleep Apnea
It should further be noted that in some cases neck and waist circumference, rather than BMI, may be better correlates of sleep apnea as they take into account obesity distribution and are therefore associated with visceral obesity, which is associated with risk of OSA among others, Blagojevic-Bucknall points out.
Treating And Preventing Gout Pain
Gout pain is generally treated in two ways:
- Medications to relieve gout attacks in the short-term
- Preventive medications taken regularly to lower uric acid and stop gout attacks from occurring
While inflammation-fighting drugs are used to relieve pain during gout flares, different medicines are used to lower uric acid levels to prevent future attacks. These include:
- Allopurinol
- Probenecid
Another medication called pegloticase may be recommended for people with chronic gout who have not responded to other uric acid-lowering medication.
While many people with gout can be treated by their primary care physician, if gout is not responding to medication or is progressing with worsening or frequent flares or developing tophi gout deposits, then your primary care physician may refer you to see a rheumatologist who specializes in treating diseases that affect joints, muscles, bones and the immune system.
Taking medication to reduce uric acid levels and reduce the risk of gout progression is important, Dr. FitzGerald stresses. If you have risk factors for bad gout, such as kidney disease, or are experiencing frequent attacks, early treatment is better.
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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.
How Does The Alkaline Diet Help Gout
So what does the alkaline diet have to do with gout? It raises the pH of urine, which increases the elimination of uric acid from your body 2.
So what does the alkaline diet have to do with gout?
- It raises the pH of urine, which increases the elimination of uric acid from your body 2.
- Less sodium and more potassium in the alkaline diet tends to prevent high amounts of uric acid 1.
- It contains substantially less purines, the compounds found in high amounts in animal products that form uric acid.
- It eliminates animal products, which decreases uric acid excretion in urine 3.
- It benefits kidney function the kidneys are responsible for processing uric acid 4.
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Who Is At Risk Of Gout
Gout is sometimes called the disease of kings because of a false link to overindulgence in food and alcohol. Anyone can get the condition, but certain factors can increase your risk:
- Gender: Males are more likely to get gout than females.
- Age: Middle-aged and older men and women after menopause are more at risk for gout.
- Obesity
- Family history
- Diet: A diet high in purines, which are broken down into uric acid, can lead to gout. High purine foods include meats like bacon, turkey, veal, venison, and liver, and seafood like anchovies, sardines, mussels, codfish, scallops, trout, and haddock. High fructose foods and drinks such as soda pop also can increase your risk.
- Alcohol use
Gout Risk Higher In People With Normal Body Weight But Why
The results looked at people with normal body mass index and those who were overweight or obese. Interestingly, the risk was higher in those with normal weight. But this is because severity of OSA plays an important part in interpretation of the findings.
Those with moderate or severe OSA are given CPAP therapy they are likely to be those who are more obese than those with mild OSA, for whom weight loss, jaw advancement devices, and sleeping position are recommended first line of treatment, with CPAP therapy given only if these fail.
This is perhaps the reason why those with lower BMI have a longer-term risk of gout, as CPAP is very effective and reverses OSA pathology, including improvements in hypertension. Since this risk was highest in people with normal BMI, people experiencing sleep apnea should be aware of the possibility of gout regardless of body mass index, notes Dr. Blagojevic-Bucknall, adding further research is needed to establish more firmly the relationship between CPAP and its impact on reduction of risk of gout.
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How Can A Gout Attack Be Prevented
Diet plays a key role diet in gout prevention: Since foods can directly set off gout attacks, patients with gout should receive counseling as to which foods are more likely to induce attacks. Losing weight is often also helpful. However, as important as diet is in gout, for most people with gout diet, and even weight loss, are not enough, and medications will be needed to get to their uric acid goal.
Is A Cortisone Shot For Gout An Option For Immediate Gout Pain Relief
Cortisone is a powerful anti-inflammatory steroid drug that works almost immediately to stop acute gout. Cortisone can be taken by mouth, but side effects are common. In some cases, a cortisone injection into an inflamed joint is very effective. It is important to use ultrasound to guide a needle into the joint to improve accuracy and effect.
Generally, a cortisone shot for gout often takes a few days to start working. If given early in an acute attack, it can stop it in its tracks.
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Is Marijuana Good Or Bad For You
As always, I cannot give you a single answer that will satisfy your interest here. Marijuana has been used by people for over 3000 years to treat various issues, symptoms, and conditions. It was banned in most states and most countries, but this is changing as we speak.
In essence, . There was plenty of research across the globe and all of them found the same thing. It can be used and it is beneficial in this case scenario.
In 2018, the FDA approved using a medication that contains CBD for treating a particular type of epilepsy called Dravet and Lennox-Gastaut syndromes. Keep in mind that they were referring to medicinal marijuana, and it wont get you high. CBD doesnt contain psychoactive properties, only THC does.
Some risk is present and it is linked to testicular cancer, chronic cough, and also the development of the bipolar disorder. However, the risk for all of these conditions is very low, and there is no single, major link discovered. What about marijuana and gout?
What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
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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 .
How Does Food Affect Gout
If you have gout, certain foods may trigger an attack by raising your uric acid levels.
Trigger foods are commonly high in purines, a substance found naturally in foods. When you digest purines, your body makes uric acid as a waste product .
This is not a concern for healthy people, as they efficiently remove excess uric acid from the body.
However, people with gout cant efficiently remove excess uric acid. Thus, a high-purine diet may let uric acid accumulate and cause a gout attack (
10 ).
Foods that commonly trigger gout attacks include organ meats, red meats, seafood, alcohol and beer. They contain a moderate-to-high amount of purines .
However, there is one exception to this rule. Research shows that high-purine vegetables do not trigger gout attacks .
And interestingly, fructose and sugar-sweetened beverages can increase the risk of gout and gout attacks, even though theyre not purine-rich (
16 ).
For instance, a study including over 125,000 participants found that people who consumed the most fructose had a 62% higher risk of developing gout .
On the other hand, research shows that low-fat dairy products, soy products and vitamin C supplements may help prevent gout attacks by reducing blood uric acid levels (
Summary: Foods can either raise or lower your uric acid levels, depending on their purine content. However, fructose can raise your uric acid levels even though it is not purine-rich.
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What Is Uric Acid
Uric acid is a waste byproduct of purine breakdown in the body. Purines are naturally produced in the body, as well as found in some foods. As purines are broken down, uric acid is created. Normally uric acid is either reabsorbed in the body or excreted via the urine and feces.
When there are more purines in the body than it can process, uric acid builds up in the bloodstream. This is called hyperuricemia. Hyperuricemia can cause gout and/or kidney stones in some people, while others have no signs or symptoms at all.
Treatment for gout often includes medications, diet modification, and lifestyle changes, such as managing weight and quitting smoking. The foods you eat can have a direct impact on gout flares.
During a gout attack, modifying your diet may help decrease the length of the flare. Continuing to follow a gout-friendly diet, specifically a low-purine diet, may help prevent the risk of future gout attacks up to five fold.
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
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Treatment For Gout And Gout Attacks
As soon as youve been diagnosed with gout, your doctor will aim to reduce your pain ASAP. In May 2020, the American College of Rheumatology updated its guidelines for gout treatment for the first time in eight years. There is more evidence in support of early diagnosis and treatment treat-to-target protocols and allopurinol as a first-line agent.
Test To Limit The Risk Of An Allergic Reaction To Medication
Some people have a genetic marker that can predict a severe drug rash called allopurinol hypersensitivity syndrome. In the 2012 guideline, Asian groups were recommended to be tested prior to starting allopurinol. Based on newer data, the 2020 guideline has added African American patients to that group.
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Medication Options For Uric Acid Lowering
It is important to note that whenever starting a uric acid lowering treatment, there is a risk of precipitating a gout flare. A plan should be in place for management if this occurs. This generally can be avoided with the co-administration of prophylactic medications along with the uric acid lowering therapy.
Probenecid
Probenecid may be given to patients with decreased clearance of uric acid by the kidney and normal renal function. In general its use should be limited to patients under the age of 60. Probenecid acts by inhibiting reabsorption of uric acid in the proximal tubules of the kidney. Starting dose is at 500 mg to 1000 mg daily and increased to 1500 mg to 2000 mg as needed. Occasionally higher doses are needed. Probenecid may precipitate renal stone formation and good oral hydration should be encouraged. Probenecid is contraindicated in patients with renal stones and in patients with urate nephropathy. Probenecid given inappropriately to patients with hyperuricemia due to overproduction of uric acid can cause renal stones and urate nephropathy.
- uricosuric
- useful in patients with decreased renal clearance of uric acid
- can only be used if creatinine clearance > 40 cc/min
- must have 24 hour urine for uric acid < 800 mg/dl
- can be used in renal failure
- increased risk of renal stones
Allopurinol
Pegloticase
- pegylated porcine uricase
Gout Remedies For Pain
1. Drink More WaterThe more water you drink, the more level youre able to keep the uric acid levels in your body. When you dont drink enough water, the uric acid levels rise and cause more pain. Drink water throughout the day to keep the levels normalized and to reduce pain.
2. Apply a Cold CompressApplying a cold compress to the affected area can help ease pain and inflammation. Apply the cold compress to the area for 20-30 minutes several times a day- you can make one using a bag of crushed ice or a pack of peas and a dish cloth.
3. Rest and RelaxIf youve had a gout attack, one of the best things you can do is rest your body. Stress can aggravate gout, so relax as much as you can- watch Netflix, call a friend, read a book or listen to music to get you into a relaxed state. Whatever you do, dont go on any long walks or stand for a long time- this will make the pain much worse.
4. MedicationIf you feel the symptoms of a gout attack coming on, use what you have on hand right away. Over-the-counter ibuprofen or naproxen will help relieve the pain, but never take Aspirin, which can actually make your symptoms worse. If youve been prescribed an anti-inflammatory by your doctor for your gout flare-ups, make sure to take the recommended dose. If you have frequent pain and flare-ups, you may be prescribed a daily medication of a uric acid lowering drug.
If youve been dealing with gout, we hope these prevention tips and remedies help ease the pain and discomfort!
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Where Does A Gout Attack Occur
Gout often attacks the largest joint in your big toe. However, it can also attack the foot, ankle knees, hands, or wrists. Intense pain, redness, and swelling can start with no warning, although you may have warning signs of an impending attack. If you start to feel tingling, burning, or itching in a joint, your body is giving you a warning signal that a flare-up is imminent.