How Is Gout Diagnosed
Gout is usually diagnosed if you have the typical gout symptoms and a raised blood level of uric acid . If there is doubt as to the cause of the pain and swelling, your doctor may take some fluid out of a swollen joint. This is done with a needle and syringe. The fluid is looked at under the microscope. Crystals of uric acid can be seen in the fluid to confirm the diagnosis of gout.
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.
Stage : Intercritical Gout
After a first gout flare, 75 percent of people will have a second within a year but some people can go years before another attack, says Dr. Fields. The in-between stage is where a person has already had a gout flare but is presently not having any joint pain or swelling, he says. Almost all gout patients will go through this phase, since it is the nature of gout to have flares and then quiet down for a period of time before the next flare.
Even though it may seem like nothing is happening, this is the point in which patients should begin long-term treatment. Lowering uric acid levels with medication can prevent future gout flares and long-term complications that go with them.
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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
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What Can Increase Your Risk
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it’s still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don’t.
Other factors that may increase your risk of developing gout are outlined below.
Treating Gout With Medications
Certain medications reduce the pain and inflammation of gout attacks, such as anti-inflammatory drugs , colchicine, and corticosteroids. Other medications decrease the level of uric acid in the blood and prevent the deposit of uric acid in joints , the kidneys , and in tissue , helping to prevent further attacks and complications. These drugs include allopurinol, febuxostat, lesinurad, and probenicid.
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Points To Remember About Gout
- Gout is a type of arthritis that causes pain and swelling in your joints, usually as flares that last for a week or two, and then go away.
- With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis.
- The most common symptom of gout is pain in the affected joint, such as the big toe.
- Your doctor may recommend taking medications to manage the cause of your gout and treat active gout flares, and making changes to your diet and lifestyle.
Treatment Of The Gout On The Legs
The main principle of treating the disease is to control the level of uric acid. For the appointment of high-quality drug therapy it is necessary to seek help from a rheumatologist. Often, the treatment of gout on the legs involves the use of non-steroidal anti-inflammatory drugs. Usually appoint: Metindol, Diclofenac and Indomethacin. To normalize the level of uric acid resort to help Allupol, Milurit and Allopurinol.
An important part of the treatment is compliance with the diet. It is necessary to maintain a certain balance between the feeling of hunger and overeating. Sharp weight loss can lead to the development of a large amount of uric acid, leading to the development of gout. A similar action occurs during overeating.
Sports load plays an important role. It is necessary to move more, to do gymnastics, to walk, run and ride a bicycle. Food should be varied, and most importantly, steamed. Salt is excluded completely, if this recommendation is not possible, its daily dose does not exceed a teaspoonful. Spices and spices are removed without fail.
Observance of special rules will allow to remove seizures and ease the condition of a person. For this, it is sufficient to fulfill three recommendations: correct food, medication and sports.
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Why Do Gout Attacks Happen More At Night
Gout attacks happen more often at night and in the early morning than during the day. You may have an attack start during your sleep. Doctors are not entirely sure why this happens, but some of the leading ideas are dehydration, lower body temperature, and changes in hormone levels during sleep.Talk to your doctor about ways to prevent gout attacks during your sleep.
What To Do During An Attack
- 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.
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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.
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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Causes Of The Gout On The Legs
The main cause of the disease is an excessive level of uric acid in the blood. The course of the disease is characterized by a significant deposition in the joints of urate crystals. They can accumulate in organs and other body systems. The causes of gout on the legs are caused by a metabolic disorder. As a result, small particles of sodium urate are freely deposited in the joints, leading to its partial or complete destruction.
Excessive amounts of uric acid occur for two reasons. The first option: healthy kidneys can not cope with the withdrawal of a large amount of this “material”. The second reason: acid production occurs in normal mode, but the kidneys can not withdraw it.
Annually, gout affects more people, and this despite its not prevalence. Physicians associate this phenomenon with the consumption of food rich in purines. This includes alcohol products. Earlier, the gout was not easy, the products provoking its development was almost not there.
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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.
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.
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Gout In Children And Teens
If a child or teenager has gout, it is important that blood and urine tests be done to determine why gout has occurred. It is usually a sign of an underlying problem that is often easily treated.
In children, the first test to do if gout is suspected is to measure the blood uric acid level. If this is elevated , this could be a sign that gout is present. Other important procedures are for a doctor to insert a needle into the affected joint, withdraw fluid, and examine this fluid for uric acid crystals.
Causes of gout in children and teenagers include:
- Inherited conditions that cause over-production of uric acid. These include HPRT deficiency and PRPP synthetase overactivity. These disorders are uncommon but are easily tested for. Patients produce extra uric acid and can have gout and kidney stones containing uric acid. These conditions usually occur in boys but can occasionally happen in girls as well.
- Kidney diseases resulting in decreased ability of the body to get rid of uric acid. These can include:
– The most common type is due to mutations in the gene that produces a protein called uromodulin. In this condition, patients develop gout in their teenage years and have slow worsening of kidney failure over time. There are usually many other family members who have had gout or kidney disease.
– Any type of kidney disease can also cause gout in childhood.
Symptoms And Signs Of Gout In Foot
An attack of gout is often sudden. Symptoms:
- It may present with excruciatingly painful swelling of joints in the big toe, it is known as Podagra. The joint may be stiff and appear red or purple, very swollen, and tender to even light touch. Other gout sites include the instep, wrist, ankle, fingers, and knee.
- Skin may peel and itch as healing begins.
- An attack often begins at night the acute phase lasts up to 12 hours. If untreated, the inflammation may last up to two weeks. In 10 percent of people, acute episodes present in more than one joint.
- Kidney stones precede the onset of gout in 14 percent of patients.
- Chronic gout may develop, and it may affect more than one joint, mimicking rheumatoid arthritis.
- Tophi are soft tissue swellings caused by urate buildup in chronic gout. They may be found in the ear, fingers, toes, kneecap, and elbow.
Some people have a single attack of gout, others are affected intermittently, often when they have overindulged or experienced dehydration.
COMPLICATIONS OF GOUT IN FOOT
Its rare for complications of gout to develop, but they do happen and can include severe degenerative arthritis, secondary infections, kidney stones and kidney damage, nerve or spinal cord impingement, and joint fractures.
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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
Symptoms Of The Gout On The Legs
The first manifestations always bear a short-term character. It all starts suddenly, most often at night. Inflammation covers the big toes. Less often, defeat is observed on the hands, heels, knees and wrist joints. The main symptom of gout development on the legs is a sharp pain. A person simply does not know what to do about it and literally “climbs on the wall”. The affected joint is characterized by redness and swelling. To the touch, the finger is very hot. A light touch to it delivers to the person a lot of unpleasant sensations, including a strong pain syndrome.
Any movement brings unbearable pain, continues all for 4 days. Then everything goes by itself and the person continues to live the same life. After a certain time, the attack repeats again. It is characterized by sudden development and severe course. The situation will be repeated until the person takes action. After all, over time, attacks will be longer and more painful. As a result, there comes a time when pain and inflammation are present constantly, and not periods. Causing the development of chronic arthritic arthritis.
Crystals of urate sodium can be deposited under the skin, leading to the formation of solid nodules. They are filled with a gruel-like mass. Call nodules – tofusami. Their main place of localization of the auricles near the crystals. After the breakthrough of tofus, the wound heals independently.
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