Gout is a kind of arthritis. It can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe. These attacks can happen over and over unless gout is treated. Over time, they can harm your joints, tendons, and other tissues. Gout is most common in men.
Gout is caused by too much uric acid in the blood (hyperuricemia). Most of the time, having too much uric acid isn’t harmful. Many people with high levels in their blood never get gout. But when uric acid levels in your blood are too high, the uric acid may form hard crystals in your joints. The exact cause of hyperuricemia sometimes isn’t known, although inherited factors (genes) seem to play a role.
Your chances of getting gout are higher if you are overweight, drink too much alcohol, or eat too much meat and fish that are high in chemicals called purines. Some medicines, such as water pills (diuretics), can also bring on gout.
The most common sign of gout is a nighttime attack of swelling, tenderness, redness, and sharp pain in your big toe. You can also get gout attacks in your foot, ankle, or knees, or other joints. The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years.
See your doctor even if your pain from gout is gone. The buildup of uric acid that led to your gout attack can still harm your joints.
Your doctor will ask questions about your symptoms and do a physical exam. Your doctor may also take a sample of fluid from your joint to look for uric acid crystals. This is the best way to test for gout. Your doctor may also do a blood test to measure the amount of uric acid in your blood.
To stop a gout attack, your doctor can give you a shot of corticosteroids or prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.
Symptoms of Gout:
- Warmth, pain, swelling, and extreme tenderness in a joint, usually a big toe joint . This symptom is called podagra. The pain often starts during the night. It may get worse quickly, last for hours, and be so intense that even light pressure from a sheet is intolerable
- Very red or purplish skin around the affected joint. The joint may appear to be infected
- Limited movement in the affected joint
- Peeling and itching of the skin around the affected joint as the gout gets better
Gout Risk Factors
Things You Can’t Change
- Being male
- Having a family history of gout
- Having been born with a rare condition that causes high blood uric acid levels, such as Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome
Medicines That May Increase Uric Acid
- Regular use of aspirin (more than 1 or 2 aspirin a day) or niacin
- Diuretic medicines
- Chemotherapy medicines (usually used to treat cancer)
- Medicines that suppress the immune system, such as cyclosporine, that are used to prevent your body from rejecting an organ transplant
Conditions Related to Diet and Body Weight
- Obesity (this is the easiest fat loss diet I have found )
- Moderate, regular, or heavy use of alcohol, especially beer
- A diet rich in meat and seafood, which can be high in purines
- Frequent episodes of dehydration
- Very low-calorie diets
Certain other conditions and diseases appear more often in people who have gout than in people who don’t, though studies have not shown a clear relationship. Gout may share risk factors (such as obesity, hypertension, and high levels of triglycerides) with certain diseases, including:
- Lead poisoning
- Hardening of the arteries (atherosclerosis)
- Conditions that cause an abnormal rapid turnover of cells, such as psoriasis, multiple myeloma, hemolytic anemia, or tumors
- Acute illness or infection
- Injury to a joint
- Rapid weight loss, as might happen in hospitalized patients who have changes in diet or medicines
Call or see your doctor right away if you have:
- Severe pain in a single joint that comes on very quickly
- Swollen, tender joints with warm, red skin over them
It’s important to see your doctor even if the pain from gout has stopped. The uric acid buildup that caused your gout attack may still be irritating your joints and could eventually cause serious damage. Your doctor can prescribe medicines that can prevent and even reverse the uric acid buildup.
Exams and Tests for Gout
- A joint fluid analysis (arthrocentesis) to see whether uric acid crystals are present. This is the only certain way to diagnose gout
- A medical history and physical exam
- A test to measure levels of uric acid in blood. This may be done if your doctor cannot safely get fluid from the affected joint
- A test to measure levels of uric acid in urine
While X-rays of extremities (hands and feet) are sometimes useful in the late stages of the disease, X-rays aren’t usually helpful in the early diagnosis. Pain often causes people to seek medical attention before any long-term changes can be seen on an X-ray. But X-rays may help to rule out other causes of arthritis.
Your doctor may evaluate you for lead poisoning if you have been exposed to lead in your job or through hobbies.
The goals of treatment for gout are fast pain relief and prevention of future gout attacks and long-term complications, such as joint destruction and kidney damage. Treatment includes medicines and steps you can take at home to prevent future attacks.
Specific treatment depends on whether you are having an acute attack or are trying to manage long-term gout and prevent future attacks.
To Treat an Acute Attack
- Rest the affected joint(s)
- Use ice to reduce swelling
- Take short-term medicines at the first sign of a gout attack, as prescribed by your doctor
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Oral corticosteroids
If you have been diagnosed with gout, you can do a lot on your own to treat your condition.
To Decrease the pain of an acute attack
Rest the affected joint until the attack eases and for 24 hours after the attack.
Elevate painful joints.
Use ice to reduce swelling.
Relieve inflammation by taking nonsteroidal anti-inflammatory drugs (NSAIDs). But don’t take aspirin, which may abruptly change uric acid levels and may make symptoms worse. Be safe with medicines. Read and follow all instructions on the label.
To Prevent more attacks
- Control your weight. Being overweight increases your risk for gout. If you are overweight, a diet that is low in fat may help you lose weight. But avoid fasting or very low-calorie diets. Very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. See the fat loss diet I recommend.
- Follow a moderate exercise program.
- Limit alcohol, especially beer. Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.
- Limit meat and seafood. Diets high in meat and seafood (high-purine foods) can raise uric acid levels. In the past, gout was thought to be caused by drinking too much alcohol and eating too many rich foods. It is important to note that although eating certain foods and drinking alcohol may trigger a rise in the level of uric acid in the body, these habits may not by themselves cause gout. Gout is most often caused by an overproduction of uric acid (due to metabolism problems) or decreased elimination of uric acid by the kidneys.
- Talk to your doctor about all the medicines you take. Some medicines may raise the uric acid level. Continue to take the medicines prescribed to you for gout. But if you weren’t taking medicines that lower uric acid (such as allopurinol or probenecid) before the attack, don’t start taking them when the attack begins. These medicines won’t help relieve acute pain. They may actually make it worse.
Medicine treatment for gout usually involves some combination of short- and long-term medicines.
Short-term medicine relieves pain and reduces inflammation during an acute attack or prevents a recurrence of an acute attack.
These medicines may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, indomethacin, or naproxen. Do not take aspirin, which should never be used to relieve pain during a gout attack. Aspirin may change uric acid levels in the blood and may make the attack worse. Be safe with medicines. Read and follow all instructions on the label
- Corticosteroids, which may be given in pills or as a shot for cases of gout that don’t respond to NSAIDs or colchicines
If treatment is started right away, relief from symptoms often occurs within 24 hours.
During a gout attack, your doctor will prescribe a maximum daily dose of one or more medicines used for short-term treatment to stop the attack. Doses are then reduced as the symptoms go away.
Long-term treatment uses medicines to lower uric acid levels in the blood. This can reduce how often you have gout attacks and how severe they are. These medicines may include:
- Uricosuric agents, to increase elimination of uric acid by the kidneys
- Xanthine oxidase inhibitors, to decrease production of uric acid by the body
- Colchicine, to prevent flare-ups during the first months that you are taking medicines that lower uric acid
- Pegloticase (Krystexxa). This medicine is for gout that has lasted a long time and hasn’t responded to other treatment
If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people will continue to take this medicine every day. It is also important to know how to take it.
- If you’re taking one of these medicines, continue to take the medicine during the attack
- If you have one of these medicines but have not been taking it, do not start taking the medicine during an attack. Starting these medicines while you are having a gout attack can make your attack much worse
- An herb called devil’s claw have been used as anti-inflammatories. Research shows it may be useful as a complementary medicine to treat gout.
- Eicosapentaenoic acid (EPA) is known to reduce chronic inflammation.
- Some studies show that folic acid may be helpful in inhibiting the enzyme needed to produce uric acid.
If gout symptoms have occurred off and on without treatment for more than 10 years, uric acid crystals may have built up in the joints to form gritty, chalky nodules called tophi. If tophi are causing infection, pain, pressure, and deformed joints, your doctor may be able to treat them with medicine. If this doesn’t work, your doctor may recommend surgery to remove them.
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