Gout

Content

• A Concise History Of Gout And Hyperuricemia And Their Treatment
• Wake Forest Baptist Health Managed Care
• Blood Test
• What Types Of Doctors Treat Gout?
• How Can I Manage A Gout Attack?
• Myth: Only Wealthy And Obese People Get Gout
• Gout Is No Longer the Disease Of Kings
• Why Do Gout Attacks Happen More At Night?

The natural history of untreated gout is to experience acute recurrent flares that become progressively more prolonged but less intense. The end result, after an average of 10 years, is chronic tophaceous disease, characterized by chronic and persistent joint swelling with nodules. Many of these individuals resemble patients with rheumatoid arthritis (RA; see Rheumatoid Arthritis section). Rather, foods high in purines can increase the risk of gout, particularly in someone who is secreting too little uric acid. These include seafoods such as mussels, lobster, sardines and salmon, as well as beer, bacon, liver, sweetbreads, turkey, veal, and high fructose corn syrup. High fructose corn syrup is often found in processed foods such as soft drinks, chips and biscuits, syrups, chutneys and sauces.

The first attack is usually followed by a complete disappearance of symptoms. Over two-thirds of patients have at least one more attack within 2 years of the first attack. By 10 years, over 90% of patients who had one attack are likely to have more attacks. An untreated attack peaks 24 to 48 hours after symptoms first appear and goes away after 5 to 7 days. Some attacks last only hours, while others go on for as long as several weeks.

A Concise History Of Gout And Hyperuricemia And Their Treatment

The doctor will check a 24-hour urine sample to diagnose this problem. These medicines are not used for patients with reduced kidney function or those with tophaceous gout. As part of the diagnosis, other disorders that cause gout-like symptoms or cause hyperuricemia should be ruled out. In general, it is easy to distinguish acute gout that occurs in one joint from other arthritic conditions. The two disorders that may confuse this diagnosis are pseudogout and septic arthritis.

Wake Forest Baptist Health Managed Care

This increase is due to changes in diet and lifestyle, increased use of certain diuretics and increasing obesity. Joint injury, infection, or severe, acute illness can all cause gout attacks. Patients should be aware that some medical treatments may contribute to gout.

Is Onion bad for gout?

If you have gout, dishes like chopped liver and liver and onions are best avoiding, along with other organ meats like kidney, heart, sweetbread, and tripe, since they're high in purines.

Extra weight increases uric acid in your body and puts more stress on joints. The human body makes uric acid during the breakdown of chemicals called purines found in certain food and drinks. This normal byproduct goes through the kidneys and exits the body when you pee.

Blood Test

If untreated, tophi in and around the joints can burst and discharge chalky masses of uric acid crystals through the skin and may eventually cause deformities and osteoarthritis. The symptoms gradually disappear, joint function returns, and no symptoms appear until the next flare-up. However, if the disorder progresses, untreated flare-ups last longer, occur more frequently, and affect several joints.

In older people, it is hard to tell chronic gout from rheumatoid arthritis. A proper diagnosis can be made with a detailed medical history, laboratory tests, and identification of MSU crystals. Sometimes a urine test is done to check the amount of uric acid in a patient's urine. If uric acid in the urine is higher than a certain value, further tests for an enzyme defect or other cause of gout will be ordered. A high level of uric acid in the urine means that the patient is more likely to develop uric acid kidney stones.

The NSAID that is most widely used to treat acute gout is indomethacin. NSAIDs may also have significant toxicity, but if used for the short-term, are generally well tolerated. Aspirin and aspirin-containing products should be avoided during acute attacks. Certain meats, seafood, dried peas and beans are particularly high in purines. Alcoholic beverages may also significantly increase uric acid levels and precipitate gout attacks.

Is pineapple good for gout?

Adding pineapple to your daily diet may help prevent gout flare-ups and reduce the intensity of your gout symptoms. Aim for one serving of pineapple, which is equal to one cup of fresh pineapple chunks. Avoid sugary drinks containing pineapple, or pineapple desserts. Pineapple is delicious when eaten fresh.

When a tophus is present, it indicates that the body is substantially overloaded with uric acid. When tophi are present, the uric acid level in the bloodstream typically has been high for years. The presence of tophi indicates tophaceous gout and treatment with medications is necessary.

Both nonpharmacologic modalities and pharmacologic therapies have been discussed so that greater patient adherence through medication counseling can be achieved. Chronic kidney diseaseHigh levels of uric acid in the blood can increase the risk of chronic kidney disease. Gout is a crystalline or inflammatory form of arthritis in which high levels of serum urate cause painful, swollen, stiff joints. For some people gout looks like a sudden swelling at the base of the big toe. Without treatment, an acute attack of gout usually resolves in five to seven days; however, 60% of people have a second attack within one year. Those with gout are at increased risk of hypertension, diabetes mellitus, metabolic syndrome, and kidney and cardiovascular disease and thus are at increased risk of death.

Myth: Only Wealthy And Obese People Get Gout

Medication can be used to treat the symptoms of gout attacks, prevent future flares, and reduce the risk of gout complications such as kidney stones and the development of tophi. The treatment goals for a gout attack are different than those for chronic gout. When treating a gout attack, the goal is to relieve pain and inflammation. When treating chronic gout, the goal is to prevent future gout attacks and long-term joint damage. As is true for many painful conditions, the first-line treatment for a gout attack is taking one of the nonsteroidal anti-inflammatory drugs , such as diclofenac, ibuprofen, or indomethacin.

All medication taken should be known by name and dosage, as some drugs can cause a gout attack. If gout has been present for a while, old X-rays related to the illness may be useful in follow-up. Some foods may contribute to high blood levels of urate. Marked rises in urate often follow overindulgence in high protein foods, especially if alcoholic beverages are also consumed.

Uric acid crystal deposits in the joint cause inflammation of the joint leading to pain, redness, heat, and swelling. Uric acid is normally found in the body as a byproduct of the way the body breaks down certain proteins called purines. Causes of an elevated blood uric acid level include genetics, obesity, certain medications such as diuretics , and chronic decreased kidney function . These crystals can attract white blood cells, leading to severe, painful gout attacks and chronic arthritis. Colchicine (Colcrys®, Mitigare®) has a role in both the prevention and treatment of gout attacks .

Other conditions commonly complicated by gout include lead poisoning, kidney failure, hemolytic anemia, psoriasis, solid organ transplants, and myeloproliferative disorders such as polycythemia. A body mass index greater than or equal to 35 increases male risk of gout threefold. Chronic lead exposure and lead-contaminated alcohol are risk factors for gout due to the harmful effect of lead on kidney function. Gout can present in several ways, although the most common is a recurrent attack of acute inflammatory arthritis .

” An occasional patient with very infrequent flares may choose to simply treat him/herself at the first sign of symptoms rather than to chronically take medications. It is important to discuss these decisions with the physician treating your gout to work out the plan that works best for you. Colchicine works very specifically to treat the inflammation of gout and can be given either in pill form or intravenously. While effective, the oral form of colchicine often results in diarrhea when given in large enough doses. In fact, some physicians prefer to give a pill every hour until diarrhea develops. Moderate doses, however, are better tolerated and often effective.

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