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.
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
Treatment: Acute Gout Attack
Acute attacks of gout and long-term treatment of gout and hyperuricemia require different approaches. Treatment usually involves medication. After the first attack, some health care providers advise patients to keep a supply of medicines on hand to take at the first sign of symptoms of a second attack.
Treatments are prescribed for conditions associated with gout, including uric acid nephropathy and uric acid nephrolithiasis.
Supportive measures include applying ice and resting the affected joint.
Many patients do not require medication. Often lifestyle and dietary measures are enough to prevent attacks. Measures include not eating foods high in purines, not drinking alcohol, and maintaining a healthy weight.
Medicines for gout attacks are aimed at relieving pain and reducing inflammation. These include:
- Nonsteroidal anti-inflammatory drugs
These medicines may be combined to treat a gout attack.
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Additional Tips For Treating Gout Naturally
Studies show that many of the dietary items we consume lead to gout as well as other health problems. Changing your diet and lifestyle may be the easy solution to beating gout. One of the first things to do is eliminate certain foods and beverages from your diet to beat gout.
1. Eliminate or reduce sugar intake
As many studies are now illustrating, gout is common in people with excessive sugar intake, especially high fructose corn syrup Its wise to read the labels of all your food and drinks. If you find HFCS then eliminate that from your diet. In addition, look for sugar added under the guise of other common names for sugar look for cose at the end of words and these are probably types of sugar you dont want to be consuming.
2. Eliminate grains
Grains in the body are converted to sugars so again you want to limit or avoid grains altogether. They are also very inflammatory to your body.
3. Limit alcohol consumption
Again, alcohol becomes sugar once ingested so eliminate this completely unless you have a healthy body already. Any substance that will be converted to one or another type of sugar by the body should be avoided at all costs. In order to get your uric acid levels down you must consistently avoid sugar in your diet.
4. Eliminate soda and diet soda
5. Consume cherries and strawberries daily
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How Is Pseudogout Treated
There is no cure for removing the calcium deposits that cause pseudogout. It is a progressive disorder that can eventually destroy joints. Treatments for acute attacks of pseudogout are similar to those for gout and are aimed at relieving the pain and inflammation and reducing the frequency of attacks.
- Nonsteroidal anti-inflammatory drugs are effective for treating inflammation and pain from pseudogout.
- For acute attacks in large joints, fluid aspiration alone or with corticosteroids may help.
- Colchicine may be used for acute attacks.
- Magnesium carbonate may help dissolve crystals, but existing hard deposits may remain.
- Surgery may be required for joint replacement.
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Gout Statistics And Facts
- 8.3 million people in the United States have gout .*
- Among people who have gout attacks, 90% have kidneys that dont remove enough uric acid from their urine while 10% make too much uric acid in their system.
- 90% of gout attacks start in a single joint. Most often, it is the bunion joint of the big toe.
- 90% of gout patients have one or more of the following conditions , which make it more difficult to manage gout: kidney dysfunction, coronary heart disease, obesity, high cholesterol and/or triglycerides, diabetes mellitus.**
*Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Zhu Y, Pandya BJ, Choi HK. Arthritis Rheum. 2011.**Comorbidities of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Zhu Y, Pandya BJ, Choi HK. Am J Med. 2012.
How Can I Manage My Gout And Improve My Quality Of Life
Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.
For gout in particular:
- Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.
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Myth: If You Stay Away From Liver And Alcohol You’ll Avoid Gout Attacks
Truth: Alcoholic drinks especially beer and organ meats such as liver and some fish, including anchovies and sardines, are very high in a class of natural substances known as purines. When the body breaks down purines it creates uric acid, so eating a lot of purine-rich foods does increase the risk of an attack. But while avoiding these foods may reduce attacks, it won’t halt them, says Reveille.
Gout can be life threatening if left untreated.
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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How Hyperuricemia And Gout Develop
Metabolism of Purines
The process leading to hyperuricemia and gout begins with the metabolism, or breakdown, of purines. Purines are compounds that are important for energy. They are part of the nucleic acids that are present in all cells of the body. Purines can be divided into two types:
- Endogenous purines are produced within human cells.
- Exogenous purines are obtained from food.
The process of breaking down purines results in the formation of uric acid in the body. Most mammals, except humans, have an enzyme called uricase. Uricase breaks down uric acid so it can be easily removed from the body. Because humans lack uricase, uric acid is not easily removed and can build up in body tissues.
Uric Acid and Hyperuricemia
Purines in the liver are converted to uric acid. The uric acid enters the bloodstream. Most of the uric acid goes through the kidneys and is excreted in urine. The remaining uric acid travels through the intestines where bacteria help break it down.
The enzyme responsible for production of uric acid from purines is xanthine oxidase. This enzyme is the target of urate-lowering treatments such as allopurinol.
Normally these processes keep the level of uric acid in the blood below 6.8 mg/dL. But sometimes the body produces too much uric acid or removes too little. In either case, the level of uric acid increases in the blood. This condition is known as hyperuricemia.
Is Allopurinol Forbidden For Acute Gout
Treatment for acute gout includes medications to improve pain, which is very severe. Nonsteroidal anti-inflammatory drugs are often combined with glucocorticoids and colchicine to treat pain. Other biologic agents may also be used to inhibit interleukin-1 beta. This treatment is maintained for as long as the flare-up lasts and depending on each patient and his risk factors. When pain symptoms have improved, the patient is maintained with a low dose of anti-inflammatories to prevent additional flares.
If we go through the recommendations for acute gout, we will never find allopurinol as a suitable treatment to reduce gouty pain. Moreover, studies show that allopurinol does not have any effect on acute gout pain. It only works in chronic gout and it is meant to reduce uric acid levels and prevent a gout flare.
So, it is not recommended to start allopurinol in recently diagnosed patients who have their first acute flare-up. However, patients who are already on allopurinol should continue their treatment with this medication, even during the treatment of acute flare-ups. These patients have been already diagnosed with chronic gout, and only then will be allopurinol indicated for their therapy.
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Clinical Significance And Research
In human , the of uric acid is typically 3.47.2 mg per 100 mLl for men, and 2.46.1 mg per 100 ml for women . Uric acid concentrations in blood plasma above and below the normal range are known as, respectively, and . Likewise, uric acid concentrations in urine above and below normal are known as and . Uric acid levels in saliva may be associated with blood uric acid levels.
Allopurinol And Gout Attackes
7 years ago
I’m sorry Allopurinol isn’t working for you. Apart for the heavy sleeping, it has been O/K so far.
I see you are taking vinegar, does that not add to the acid in your body?
I am drinking pure Cherry Juice from a farm in the South of England.
It hasn’t worked miracles yet, fingers crossed.
I hope things work out well for you.
Posted 7 years ago
I have taken Allopurinol for about fifteen years, I too have side effects such as dry flaking skin patches, reflux, . Also I have been on a course of Colchicine with another tablet, forgotten the name, both of which gave me diorrhea so bad it became almost impossible to leave the house or even venture into the garden. Recently my regular Allopurinol tablets were changed for another brand, the dry skin began to be replaced by healthy non-flaking skin and scalp irritation began to clear-up but that was short lived as I am back on the regular brand now. Well, it was good while it lasted. I have never tried so called natural remedies and am unlikely to now as my gout attacks have reduced from a three-four weekly occurence to having had only two attacks this year, both quite mild. I take great care of my diet eating anything I like but, seriously but only in moderation, Steak, twice a year, Christmas and birthday, half glass of wine Sundays, half measure of Plymouth Gin as a treat once a week etc: but then I am also diabetic.
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How Is Gout Diagnosed
Gout is diagnosed using a number of tests including:
- medical history
- physical examination
- blood test to measure urate levels although this cannot confirm gout
- removing a sample of fluid from the joint if you have gout, uric acid crystals can be seen under a microscope. This is the most definitive test
- ultrasound scan can identify early crystal formation in the fluid between your joints.
Early diagnosis and treatment is very important. The main goal for everyday management of gout is to reduce the level of uric acid in your blood so it cant form crystals in the tissues or joints and cause joint damage.
Contrast With Ra Mortality
Lead study author Hyon K. Choi, MD, director of the gout and crystal arthropathy center at Massachusetts General Hospital in Boston, says the lack of improvement in gouts mortality rate is in stark contrast to what has happened to mortality rates in rheumatoid arthritis. Dr. Chois group conducted a similar study of RA, also published recently in Annals of the Rheumatic Diseases, using the same database and the same time period.
They found that in the early group, people with RA were 56 percent more likely to die prematurely compared to those without RA. But in the late group, the mortality rate of people with RA was much lower: They were 29 percent more likely to die prematurely.
Dr. Choi says the improvement is most likely due to better treatment options available for people with RA and a trend for doctors to use medications earlier and more aggressively in order to reach certain treatment goals an approach called treat to target.
N. Lawrence Edwards, MD, vice chairman and professor in the department of medicine at the University of Florida in Gainesville agrees. He says, When you treat-to-target for rheumatoid arthritis, you really get to the basis of inflammation. Why that hasnt happened with gout is very important. It is because we do an absolutely crummy job as a profession of treating-to-target with gout. We do a very good job at treating to target with RA.
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How To Know If Your Gout Is Progressing
As you become more familiar with gout symptoms, you may be able to sense that a gout attack is coming on. Worsening of pain, swelling, redness, and warmth of the affected joint during the attack is the sign of progression of that attack, Dr. Meysami says.
In addition, the disease overall may progress with recurrent or more frequent gout attacks with longer duration, the involvement of more joints, and the presence of tophi, Dr. Meysami says.
If you have more than one gout flare a year, its really important to get on a regular gout medication, says Dr. Fields.
The Difference Between Acute And Chronic Gout
The first step we should take is to differentiate acute and chronic gout. They are different manifestations of the same disease. Gout is not only diagnosed after blood tests with high levels of uric acid. This is called hyperuricemia. The diagnosis of gout requires a physical and functional examination to evidence that the articulations of the patient are being affected by such levels of uric acid in the blood. Otherwise, hyperuricemia is not diagnosed as gout.
Circled in Red is a Patient with Gout caused by Excessive Allopurinol
Acute gout is characterized by severe pain located in the toes or hands, but not limited to them. The symptoms appear suddenly, sometimes in the middle of the night, and become unbearable and very severe.
The area becomes swollen, red, tender, and very warm because theres a severe inflammatory process triggered by uric acid crystals. Pain in acute gout may last for hours, days, and sometimes a whole week. But after the attack has gone, the patient does not display any symptoms.
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Who Should Diagnose And Treat Gout
The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.