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 .
Usual Warning Signs Of A Medical Emergency
The American College of Emergency Physicians offers a list of warning signs that point to a medical emergency. The warning signs include:
- Difficulty breathing or shortness of breath
- Chest or upper abdominal pain or pressure
- Fainting, sudden dizziness, weakness
- Confusion or mental status changes
- Sudden or severe pain
- Severe or persistent vomiting or diarrhea
- Coughing or vomiting blood
- Severe infection
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.
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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
How Can I Help Prevent Gout Attacks
- Do not eat high-purine foods. These foods include meats, seafood, asparagus, spinach, cauliflower, and some types of beans. Healthcare providers may tell you to eat more low-fat milk products, such as yogurt. Milk products may decrease your risk for gout attacks. Vitamin C and coffee may also help. Your healthcare provider or dietitian can help you create a meal plan.
- Drink liquids as directed. Liquids such as water help remove uric acid from your body. Ask how much liquid to drink each day and which liquids are best for you.
- Maintain a healthy weight. Weight loss may decrease the amount of uric acid in your body. Ask your healthcare provider what a healthy weight is for you. Ask him or her to help you create a weight loss plan if you are overweight.
- Control your blood sugar level if you have diabetes. Keep your blood sugar level in a normal range. This can help prevent gout attacks.
- Limit or do not drink alcohol as directed. Alcohol can trigger a gout attack. Alcohol also increases your risk for dehydration. Ask your healthcare provider if alcohol is safe for you.
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How The Doctor Would Treat An Acute Gout Attack
Often, on a Monday morning, after indulging in red wine and red meat, people wake up with a painful, warm, red and very uncomfortable big toe. The first time this happens, it may be quite a shock as gout can be very painful, with some people describing it as a burning flame in the joint.
Crystals in the joints
An acute gout attack is anything but a mild discomfort, and is so debilitatingly painful, that patients can barely walk on the affected foot. A gout attack is brought on when uric acid levels in the blood rise and cause crystals to form in a joint. This leads to significant inflammation and joint pain.
How Gout Treatment Prevents Disease Progression
Fortunately, in part because of its long history, gout is one of the most well-understood and most medically treatable forms of arthritis. The progression of gout is preventable by starting appropriate treatment as soon as possible, Dr. Meysami says. Uric acid-lowering agents, such as allopurinol , can decrease uric acid levels and prevent gout attacks.
During flares, gout patients can take NSAIDs or corticosteroids to calm the attack. Local steroid injections may also be given. A medication called colchicine is also often used to stop acute attacks, but its given now at a much lower dose in order to avoid side effects, including stomach upset.
After a flare ends, long-term treatment can begin. Almost all people with gout will need medication to control their urate, Dr. Fields says. To get a good outcome, people with gout need to get their blood urate level below 6.0 mg/dl and keep it there. By doing that, the body will gradually pull the urate crystals out of their joints, and the flares can stop. Tophi will also gradually disappear.
Medications called xanthine oxidase inhibitors limit the amount of uric acid your body produces. These include allopurinol and febuxostat . Colchicine, which decreases the inflammatory response to gout, may also be given along with allopurinol at the start of long-term treatment after a flare subsides.
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How Is It Diagnosed
When you see a doctor for gout symptoms, the first thing he or she will do is a joint aspiration. This is considered the most important test as it determines that your arthritis is caused from gout and not something else.
For this test, a needle will be inserted into the joint to withdraw fluid to test. Also, your doctor may recommend a blood sample to take a look at cell counts, uric acid levels and kidney function.
What To Think About
If the blood uric acid is high but a person has never had an attack of gout, treatment is rarely needed. But people with extremely elevated levels may need regular testing for signs of kidney damage. And they may need long-term treatment to lower their uric acid levels. Your blood uric acid level may be watched by your doctor until it is lowered to normal levels.
Long-term medicine treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future. See Medications to learn more.
After an acute attack of gout, talk with your doctor about the causes of the elevated uric acid levels in your blood. A review of your overall health may reveal diseases, medicines, and habits that could be raising your uric acid levels.
Most doctors will wait several days to weeks after a gout attack is over to begin medicine to lower the high uric acid levels. These medicines can cause uric acid stored elsewhere in the body to begin moving through the bloodstream and could make symptoms worse if treatment begins during a gout attack.
If there is swelling that causes pressure in a large joint such as a knee or ankle, your doctor may relieve the pain and pressure by aspiration. A needle is inserted into the joint and fluid is drawn out with a syringe connected to the needle.
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Know When To Go To The Emergency Room
Youre feeling sick but your doctor is booked and the nearest urgent care center is 45 minutes away. Theres always the hospital emergency room, but your symptoms arent that bad. Should you just tough it out?
Figuring out how and where to handle an illness isnt easy. Its even harder for people with inflammatory types of arthritis, because complications related to the disease and its treatment can be serious, says Uzma Haque, MD, assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore. Heres what she suggests:
Primary Care Provider Or Rheumatologist
Patients on immunosuppressive medications, especially biologics, should understand potential drug side effects. They should be evaluated by one of their doctors if they experience fever or infection. Patients should be aware of medication side effects and know when to reach out to their rheumatologist, Dr. Haque says. Other signs to call or visit your doctor:
- Flu or flu-like symptoms, such as fever, headache and body aches
- Acute joint pain and swelling not typical of a flare
- Mouth sores
- Sudden onset of abdominal pain in patients taking tofacitinib or tocilizumab
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The Role Of Physical Activity In Prevention Of Gout
Along with diet, physical activity can help with weight loss, and gout has been associated with being overweight.7 in patients with well-established gout, especially if X-rays have demonstrated joint damage in the foot, a low-impact exercise program is reasonable. An exercise program combined with diet in gout can reduce risk for attacks.7 If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on.
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
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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.
The Gout Signs Symptoms Treatment & Visiting The Doctor
Hopefully, you will never experience the unwanted symptoms of gout, which can include the immediate onset of torturous discomfort. But if you are ever progressing through your daily activities and are suddenly jolted by the reality of extreme pain in the joint of your big toe, then there is a great likelihood that you have developed a case of gout.
The discomfort can be so agonizing that many patients feel compelled to seek emergency care, and it has been stated that when asked to rate their level of pain on a scale of 1-10, the majority of gout patients have ranked their discomfort at either nine or 10.
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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.
What A Doctor Will Do
While there is not a cure for gout, this condition can be treated and managed efficiently. However, your physician will need to observe your symptoms, and conduct testing in order to ensure that your issue is not an infection that is similar yet different from gout itself.
This could easily involve a blood test, which will determine the amount of uric acid in your blood. If the level is high, then it is very likely that gout is the cause of your condition. There could be additional testing of the fluid that surrounds your joint, as an increased presence of fluid also serves as an indication that gout has developed.
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Purines And Uric Acid
The crystallized uric acid that causes gout pain is created by the breakdown of a substance called purines. Purines are part of every cell that make up all plant and animal food sources. Purines are also produced by the human body itself.
Some foods, namely proteins like meats and beans, are higher in purine content that others. One way that high levels of uric acid accumulate in the blood is by eating these types of foods. Another way is by consuming drinks and foods that are made with a generous amount of high fructose corn syrup.
However, the true problem is that the kidneys are temporarily not able to balance the pH of the body chemistry as they normally do. Kidney function can become impaired for a number of reasons in addition to consuming certain types of foods toxic environmental chemicals in the air and water, stress hormones, dehydration, skin contact with toxic substances, physical over-exertion, and others.
When the kidneys are overloaded, the uric acid may not be properly processed and excreted. Normally, uric acid is produced and used by the body as a protective antioxidant, but when over-abundant, its corrosive nature can become problem.
The alternative that nature has provided is to allow the excess uric acid to crystallize in a joint far from the vital organs to protect them this is the fundamental point to understand when the question, what is gout? comes up.
The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
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You Or Your Child Has Signs Of Rheumatic Fever
Rheumatic fever is another type of inflammatory disease. Although it can happen to patients of any age, it usually affects children ages 5 to 15.
People with rheumatic fever usually develop it after having a streptococcus bacterial infection, such as strep throat or scarlet fever. It usually develops 2 to 4 weeks after the infection.
Rheumatic fever can affect the joints in several ways. It can cause pain, tenderness, swelling, redness and heat at the joint. The pain often appears to move from joint to joint.
Since these joint problems can be symptoms of many different diseases, its important to look for other symptoms of rheumatic fever. These include:
- A flat or slightly raised rash
- Jerky, uncontrollable movements in the face, hands or feet
Fortunately, rheumatic fever is not very common in the U.S. However, when it does occur, it can cause severe heart damage.
Its possible to recover from rheumatic fever and escape significant heart damage. But rheumatic fever tends to be a recurring illness, meaning its likely to come back.
If you or your child is diagnosed with rheumatic fever, the physician may prescribe long-term antibiotics to prevent it from coming back, lowering the risk of further heart damage.
If you or your child has strep throat or scarlet fever, take your medication as directed by your physician rheumatic fever occurs when these illnesses arent treated correctly.
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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Stage : Interval Or Intercritical Gout
Like the calm in the eye of a storm, gout can lie dormant between attacks. Youll usually experience a pain-free period after an attack that can last months or even years.
However, uric acid may continue to build up in your bloodstream and joint spaces, plotting its next assault. Continue to see your doctor regularly and follow his or her orders for eating right, drinking plenty of water, and taking medicine. Losing weight if youre heavy can also prevent future attacks.
Pain And Swelling Are Gouts Calling Cards
The most frequent signs of a gout attack are swelling, tenderness, redness, and a sharp pain in your big toe. These attacks are most common at night when you are sitting still and laying flat on your back. While gout usually manifests in the big toe, you may also experience gout attacks in your foot, ankle, or knees. The attacks can be short or long, anywhere from a few days to weeks and you may not have another attack may for months or years.
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