Managing Gout

Content

• What Is Pseudogout? And How Does Pseudogout Relate To Gout?
• Risk Factors For The Development Of Gout
• Gout Diagnosis
• All About Gout For Primary Care: The Diagnosis
• Sparrow & Community Health Column 3
• Other Symptoms Of Acute Gout Or A Gout Attack

Alcohol appears to play less of a role among older patients, especially among women with gout. About 20% of people with gout have family histories of this condition. Several genes are linked to uric acid metabolism and gout.

And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood. Gout is caused when excess uric acid builds up in the bloodstream, caused by the breakdown of substances called purines, which are found in the tissues of our body and in some of the foods we eat. Normally, uric acid dissolves and passes out of the body. Our immune system reacts to these crystals as a threat, and the result is painful inflammation with swelling, redness, heat, stiffness—and by all accounts, a great deal of pain. Tophi occur when the person’s blood uric acid level remains high over a long period of time. The uric acid deposits in joints and forms precipitates.

What Is Pseudogout? And How Does Pseudogout Relate To Gout?

The crystals cause acute attacks of pain, heat, redness and swelling in these joints, which can be painful and debilitating. Over time, chronic gout occurs when lumps or “tophi” develop on the elbows, earlobes, fingers, knees, ankles and toes. In appropriately selected patients, NSAIDs or cyclooxygenase-2 inhibitors generally are chosen as first-line agents for the management of acute gout attacks. This decision is based on years of clinical experience, because there are few large, placebo-controlled studies quantifying their treatment effect. The differential diagnosis, in the absence of trauma or injury, includes septic arthritis and inflammatory arthritis , as well as crystal-induced arthritis.

If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase (Krystexxa®), since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus. There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.

Risk Factors For The Development Of Gout

Some of the risk factors for gout are genetic, and those are not preventable. However, many of the risk factors for gout, such as obesity and diet, are controllable. Maintaining a healthy weight and a diet low in refined carbohydrates and low in saturated fat and red meat may prevent gout.

How painful is the gout?

Intense joint pain.
Gout usually affects the big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.

In patients with palpable tophi, needling them can easily identify these crystals. Uric acid is the natural end product of purine nucleotide catabolism in humans, where it exists as the urate ion at physiologic pH with a very narrow window of solubility. Humans have higher levels of serum urate, mostly because they lack the enzyme urate oxidase that converts urate to the highly soluble compound allantoin, which is readily excreted by the kidneys. A diet rich in fruits, vegetables, and grains may be beneficial.

When they break through the tophi, they trigger a local immune-mediated inflammatory reaction in macrophages, which is initiated by the NLRP3 inflammasome protein complex. Activation of the NLRP3 inflammasome recruits the enzyme caspase 1, which converts pro-interleukin 1β into active interleukin 1β, one of the key proteins in the inflammatory cascade. An evolutionary loss of urate oxidase , which breaks down uric acid, in humans and higher primates has made this condition common. If you think you’re experiencing a gout attack, see your primary care doctor or a rheumatologist to begin treatment for the disease. It’s important to see a doctor during a gout flare because your doctor may want to remove fluid from the affected joint and look at it under a microscope to check for the presence of uric acid crystals.

Can too much sugar cause gout?

The consumption of too much sugar is associated with a number of health conditions such as obesity, heart disease and diabetes. A particular type of sugar, fructose, is linked to gout.

Symptoms of dehydration include headache, lightheadedness, constipation, and bad breath. Treatment for dehydration is to replace lost fluids and electrolytes. There is ongoing research in using a specialized CT scan known as a dual energy CT scan to diagnose gout. There is also a great deal of research investigating the various uric acid transporter genes that are responsible for uric acid metabolism.

It is not until this point that medications are cost-effective. They are not usually started until one to two weeks after an acute flare has resolved, due to theoretical concerns of worsening the attack. They are often used in combination with either an NSAID or colchicine for the first three to six months. The crystallization of uric acid, often related to relatively high levels in the blood, is the underlying cause of gout. This can occur because of diet, genetic predisposition, or underexcretion of urate, the salts of uric acid. Underexcretion of uric acid by the kidney is the primary cause of hyperuricemia in about 90% of cases, while overproduction is the cause in less than 10%.

How Your Diet Could Be Behind Your Gout Do you have intense joint pain in one of your joints, such as your big toe? Gout attacks can occur suddenly, causing severe and intolerable pain. More often than not, your doctor will perform a physical exam and take a sample of fluid from your joint in order to find uric acid crystals. In some circumstances, doctors will perform a blood test to see how how much uric acid is built up in your bloodstream. For most, signs of gout start with an “attack” during the night—swelling, tenderness, itching, burning, and sharp pain in the big toe.

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