How Can I Self
The methods of managing an acute attack of gout differ from the ongoing methods for managing gout. If youve been diagnosed with gout, youll benefit in the long term from making healthy changes to your lifestyle, such as:
- maintaining a healthy body weight. If you do need to lose weight, make sure your weight loss is gradual as crash diets can increase uric acid levels
- drinking alcohol in moderation and avoiding binge drinking
- drinking plenty of water, and staying hydrated
- avoiding, or eating in moderation, foods that are high in purines. Talk with a dietitian for tips and advice
- exercising regularly aim to complete at least 30 minutes of physical activity most days of the week
- working closely with your GP to prevent further attacks and actively manage your condition.
Avoid Sweetened Foods And Drinks
Foods and drinks sweetened with artificial fructose increase the risk of getting gout. These are contained in fizzy drinks and fruit drinks and are usually seen on food labels as corn syrup or glucose-fructose syrup. Other examples of foods sweetened with fructose are bread, cereal and jam. Fructose is found occurs naturally fruit and vegetables. Do not completely avoid these without advice from your doctor or dietitian.
Have A Medication Action Plan To Manage Acute Gout Attacks
- Make sure you have a supply of medications to treat a gout attack if it occurs.
- If you feel a gout attack starting, take this medication as soon as possible to prevent it becoming very severe.
- If you are on uric lowering tablets, do NOT stop these when you get a gout attack. Keep taking them as well as your pain medication.
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Gout And Your Kidneys
An overabundance of uric acid can lead to both kidney problems and gout. Uric acid that collects in the kidneys can form kidney stones, which can lead to complications like kidney disease and kidney failure, and also can indicate a likelihood of developing gout. If youve been diagnosed with gout, your uric acid levels are elevated and you should also be checked for kidney disease.
Your Doctor Also May Order A Test Called A Uric Acid Crystal Analysis Which Can Show Whether You Have Gout
Your doctor also may order a test called a uric acid crystal analysis, which can show whether you have gout.
This test can be done on blood or urine but urine is preferred. For the test, your doctor will ask you to collect all of your urine over a period of 24 hours. The sample is then sent to a lab for analysis to look for uric acid crystals.
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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
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.
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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.
How Can An Attack Of Gout Be Treated
The management of an acute attack of gout is very different from the prevention of subsequent attacks.
Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.
There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.
If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.
Table 2: Medications to treat acute attacks of gout
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What To Do During An Attack
You should:
- take any medication you’ve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
- rest and raise the limb
- avoid knocking or damaging the affected joint
- keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
- ensure you’re well hydrated
Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.
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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Myth: Gout Is Painful But It Won’t Kill You
Truth: Gout can’t kill you directly, but it can cause serious health problems that may eventually kill you, says Robert Keenan, M.D., assistant professor of medicine at Duke University. It can increase your risk of a heart attack or stroke, and it also may be linked to insulin resistance, the body’s shrinking ability to use insulin to lower blood sugar. If gout is untreated, you can develop clumps of uric acid crystals called tophi, which can become infected and life threatening.Join AARP Today Receive access to exclusive information, benefits and discounts.
There are prescription drugs that can treat gout.
Gout Is Caused By A Buildup Of Uric Acid In Your Body
- Uric acid mostly comes from the breakdown of cells in your body. The remainder comes from chemicals called purines that are in your food.
- Normally, your kidneys filter uric acid from your blood and flush it out of your body in urine .
- When uric acid levels in your blood are high, uric acid crystals form in your joints. These crystals cause pain, inflammation and lumps .
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What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
Risk Factors For Gout
Obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, diabetes, and abnormal kidney function are among the risk factors for developing gout. Certain drugs and diseases can also cause elevated levels of uric acid. Also, there is an increased prevalence of abnormally low thyroid hormone levels in patients with gout.
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Does Gout Hurt All The Time
In some people, the acute pain is so intense that even a bed sheet touching the toe causes severe pain. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most people with gout will experience repeated bouts over the years.
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.
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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
Is My Diet Responsible For My Gout
Gout is mainly caused by your body not getting rid of uric acid properly. This could be because of your genes, your weight or kidney problems. Diet has a much smaller role in causing your gout . But if you notice certain foods or drinks trigger your gout attacks, you may benefit from cutting down the amounts of these in your diet.
Follow these dos and don’ts to help reduce gout attacks:
| Do | |
| If you are overweight, get to a healthy weight. Exercise regularly, except during a gout attack. Keep eating a healthy diet. Eat lots of vegetables and some fruit. Eat at least 2 servings of low-fat dairy products every day. Keep yourself hydrated by drinking plenty of water. | Try crash diets that cause rapid weight loss. Dont drink too much beer, RTDs or other alcohol. Dont drink sugary drinks such as energy drinks, ordinary soft drinks, orange juice or powdered drinks. Eat full-fat dairy products. |
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How Are Gout Attacks Prevented
Maintaining adequate fluid intake helps prevent acute gout attacks and decreases the risk of kidney stone formation in people with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by slowing down the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.
Pain In Your Knees Ankles Wrists And/or Elbows
While uric acid crystals tend to deposit themselves near the big toe, they can form in any joint in the body. That means severe, unexplained pain in any joint could be a sign of gout.
Some people develop pain in just one joint , but about 25 percent of gout patients have polyarticular symptoms meaning they strike more than one joint at a time, says Dr. Huffstutter.
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Uric Acid Level Is Considered Normal If It Is Below 6 Milligrams Per Deciliter
Uric acid is a natural waste product from the breakdown of purines, which are found in various foods and drinks as well as in your body. Your blood normally contains uric acid at levels of 3 to 5 mg per deciliter . However, if you have certain conditions or other factors that cause your uric acid level to rise too high, it can form sharp crystals in a joint and cause gout.
Normal Uric Acid Levels Are Important For Optimal Health
Uric acid levels are the amount of uric acid in the blood. Uric acid is a natural byproduct of the digestive system, and some foods can increase or decrease uric acid levels in the body. For example, mushrooms have purines and therefore increase uric acid levels asparagus has antioxidants that lower uric acid levels. Of course, one choice to eat more or less asparagus will not have a large effect on uric acid levels. If you suffered from frequent gout attacks caused by high amounts of uric acid, you might want to consider changing your diet so that it contains more antioxidant-rich fruits and vegetables than purine-rich meat products like fish, meat, poultry and gravies.
While low uric acid levels are not dangerous for most peoplethey wont ever cause gout attacksthey may indicate other conditions such as kidney disease or bone marrow disorders. Normal uric acid levels are important for optimal health because they help prevent gout symptoms from developing when eating high-purine foods.
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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
Can Gout Be Cured
Cure is a very strong word, but we can certainly treat the gout and put it in remission by giving the treatment as mentioned, Dr. Meysami says.
Whether to use the word cure may be a matter of semantics: A patients gout tendency may never go away but can be well-controlled. Treatments for gout are extremely good, and the vast majority of gout patients can expect to be cured, Dr. Fields says. Cured is in quotes since it means that gout flares can completely disappear, but the person would need to stay on their medicine.
Gout progression, though, certainly isnt inevitable, which is close to the best news any gout patient can hear.
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How Common Is Gout In The Knee
As a general rule of thumb, if left untreated, gout tends to work its way up the body, Dr. Keenan explains.
For example, he cites research that shows 50 percent of patients experience their first gout attack in the big toe. If gout worsens, 35 percent of secondary flares occur in the knee, 40 percent in the midfoot and ankle, 30 percent in elbows and wrists, and 15 percent in fingers.
Its not uncommon for a person to experience their first gout flare in their knee and, after an X-ray or ultrasound, show signs of gout in the foot, he adds.
Gout can afflict both knees, but typically is felt more strongly in one knee where arthritis from general wear is worse.
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.
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