Myths About Gout Are Hampering Its Treatment

Content

• Wake Forest Baptist Health Managed Care
• Synovial Fluid Analysis
• Medications
• Living With Gout
• Are There Foods Or Medications That Might Increase The Risk Of Gout?

With an aggressive treatment strategy, pain from attacks often subside after 24 hours or so. If you have had an attack of gouty arthritis, you should do all of the above and follow the regimen prescribed by your physician. Optimal prevention of gouty arthritis may involve lifelong medical therapy. X-rays are primarily used to assess underlying joint damage, especially in those who have had multiple episodes of gouty arthritis.

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. Long-term medicine treatment depends on how high your uric acid levels are and how likely other gout attacks are.

Wake Forest Baptist Health Managed Care

However, excellent treatments for gout are available, and most patients respond very well to gout treatment with a good prognosis. Uric acid is formed when proteins in the food we eat, called purines, are broken down. Therefore, there has been a great deal of interest in dietary management of gout by avoiding high-purine (purine-rich) foods. However, a diet very low in purines is extremely difficult to follow, because purines are a natural part of many healthy foods.

The role of genetic predisposition is becoming more evident. The clinical picture of gout is divided into asymptomatic hyperuricemia, acute gouty arthritis, intercritical period, and chronic tophaceous gout. Diagnosis is based on laboratory and radiological features. The gold standard of diagnosis is identification of characteristic MSU crystals in the synovial fluid using polarized light microscopy. Imaging modalities include conventional radiography, ultrasonography, conventional CT, Dual-Energy CT, Magnetic Resonance Imaging, nuclear scintigraphy, and positron emission tomography.

Synovial Fluid Analysis

Finding the characteristic crystals in the fluid of joints allows health care providers to correctly diagnose gout. In short, anyone can get gout, provided your body doesn’t properly break down uric acid properly so it has a chance to crystallize in the joints. It is important to note that uric acid levels in the blood naturally fluctuate, and what is considered "normal" may vary depending on the lab doing the analysis. Febuxostat is only recommended in those who cannot tolerate allopurinol. There are concerns about more deaths with febuxostat compared to allopurinol. Febuxostat may also increase the rate of gout flares during early treatment.

Synovial Fluid

Since cells contain DNA, and DNA contains purines, anything that increases the breakdown of cells in the body can lead to more uric acid and gout. High concentrations of uric acid levels in the blood — the medical term is hyperuricemia — are necessary for the crystals to form. Yet many people with hyperuricemia never develop gout, and even when they do, they often have had high levels of uric acid in their blood for years without any symptoms. People with hyperuricemia with no symptoms might be coached to make lifestyle changes — losing weight would often top the list — but hyperuricemia by itself is usually not treated.

In addition, the higher susceptibility of children to chemotherapeutic agents places them at greater risk than adult patients for tumor lysis syndrome . Familial juvenile hyperuricemic nephropathy is characterized by juvenile onset of hyperuricemia, gout, and progressive nephropathy . Hart et al. first determined that a mutation in the uromodulin gene is responsible for FJHN . A genome-wide association study revealed that single-nucleotide polymorphisms in the uric acid transporter genes cause hyperuricemia and gout by altering urinary uric acid clearance . Apolipoprotein E gene polymorphisms are also associated with primary hyperuricemia, as identified by Wu et al. in a Chinese pediatric population of 770 subjects . Some medications may also raise the risk of developing gout.

Medications

Patients who continue to have high levels of uric acid in the blood may benefit from medications that control uric acid levels. Having lower uric acid levels can reduce and prevent joint destruction. Most people with hyperuricemia never develop gout, and people with gout may have varying levels of uric acid in their blood. It is important to see a doctor if you experience gout symptoms. With treatment you may be able to control the disease and prevent joint damage.

How can I check my uric acid levels at home?

A uric acid test measures the amount of uric acid in the body. Uric acid is a chemical that's produced when your body breaks down purines.
How is a uric acid urine test performed? 1. On day 1, urinate into the toilet after waking up.
2. After that, take note of the time and collect all urine for the remaining 24 hours.

These medications include such agents as naproxen (Naprosyn®), ibuprofen (Motrin®), celecoxib (Celebrex®), indomethacin (Indocin®) and many others. These agents reliably decrease the inflammation and pain of gout. However, patients with ulcers, hypertension, coronary disease, and fluid retention must be careful with these agents, even for the short courses (usually 3-7 days) needed to resolve a gout attack. The doses of non-steroidal anti-inflammatory agents needed to resolve a gout attack are on the higher side, since full anti-inflammatory effect is needed. Over-the-counter dosage levels, for example, ibuprofen at 200mg, two tabs three times a day, are often insufficient.

One of the most valuable health care professionals when assisting clinicians in the treatment of gout is the pharmacist. Pharmacists can appreciate that the optimal treatment for gout requires both adjunctive nonpharmacologic as well as pharmacologic interventional therapies . Gout is variable in its manifestations, and may affect different joints and the kidneys. Broadly, gout may cause acute or chronic inflammation of the joints, accumulation of urate crystals in soft tissues , kidney stones, or chronic kidney disease. Patients may also have more general symptoms like fevers or malaise. Elevated levels of uric acid in the blood have to be present for the formation of monosodium urate crystals in gout to occur.

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