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Monday, July 26, 2021
What Is Gout? Symptoms, Causes, Diagnosis, Treatment, And Prevention
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Febuxostat, a nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to allopurinol in patients with gout. Febuxostat is administered orally and is metabolized mainly in the liver. In contrast, allopurinol and its metabolites are excreted primarily by the kidney. Therefore, febuxostat can be used in patients with renal impairment with no dosage adjustment. When a patient experiences a first attack of gout, any medication regimens that may have contributed to the gout attack must be altered, and any predisposing medical conditions or habits must be addressed. Patients should be instructed to go on a diet if obese, to stop drinking beer, and to avoid purine-rich foods.
Combination Therapy
It is caused by excess uric acid crystals accumulating in joint fluid, cartilage, bones, tendons, and other sites. Patients experience joint swelling and pain during gout attacks. Risk factors for gout include being male, being overweight, excess alcohol intake, diuretic use, a diet rich in meat and shellfish, food or drinks high in fructose, and poor kidney function. An estimated $1 billion is spent on ambulatory care for gout, largely on treatments and prescription medications. The acute gout attacks are painful and potentially disabling, needing immediate treatment.
People diagnosed with obstructive sleep apnea face a higher risk of developing gout, the most common type of arthritis, according to new research. Gout is the most common type of inflammatory arthritis among men. About 6 percent of men in the United States have gout, while only about 2 percent of women have it. While some studies show that caffeine can actually protect against gout pain, others find that sudden spikes in caffeine intake can trigger an attack. CorticosteroidsTaken orally or injected directly into affected joint, the most common corticosteroids used for gout are prednisone, prednisolone, andmethylprednisolone.
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They also will examine the affected joint and may take a fluid sample from the joint to look for uric acid crystals. If needed, your doctor may prescribe a medicine to treat tophi. They may first appear as nodules on the hands, elbows, or ears. Drugs called xanthine oxidase inhibitors may shrink the tophi until they disappear. In rare cases, surgery may be done to remove large tophi that are causing deformity.
Are bananas good for gout?
Bananas are low in purines and high in vitamin C, which make them a good food to eat if you have gout. Changing your diet to include more low-purine foods, like bananas, can lower the amount of uric acid in your blood and reduce your risk of recurrent gout attacks.
The optimal therapy is towards controlling pain and inflammation Drug therapy for gout has become an important part of the therapeutic approach to the disease, which includes lifestyle modifications. Current standards for first-line treatment for acute attacks include nonsteroidal anti-inflammatory drugs , colchicine and corticosteroids. Urate-lowering treatment is usually recommended after the acute attack has resolved. Hypertension reduces renal excretion of urate4,30 leading to hyperuricemia.
If you are not overweight, watch your diet carefully so you don't become overweight. Your doctor may check for other types of arthritis such as CPPD deposition disease and infectious arthritis. These conditions resemble gout but are not caused by uric acid crystals. To determine which type of arthritis you might have, your doctor may have to remove fluid from an affected joint and examine it for crystals. In most patients, it is not clearly necessary, based on the evidence, to start uric acid-lowering therapy in cases where the individuals would have no or infrequent recurrences, ACP states in the guideline. If your uric acid levels remain high after a gout attack, doctors may prescribe medication that can lower your levels.
A gout attack can happen without warning, but medications taken at the first sign of pain and inflammation can help reduce your symptoms and the length of the attack. 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. However, there is tentative evidence that febuxostat may bring down urate levels more than allopurinol.
2 Pharmacological Treatment
Taking medicines may reduce pain and prevent attacks in the future. There are also some things you can do at home to relieve symptoms. A 2002 study in the Journal of Rheumatology found that the use of cryrotherapy to alleviate the pain associated with acute bouts of gout may be effective. Gout and pseudogout are the 2 most common crystal-induced arthropathies.
Further improvements were observed in 23 out of 25 patients after 3 days. Overall, subjective improvement was more than 90% in 19 out of 25 patients after 6 days. Important recent molecular biologic advances in this field have given us a clear picture of the mechanistic basis of how gouty inflammation is triggered.
When it comes to taking medications for gout, everyone is different. You may need 1 medication to treat gout or you may need a combination of medications. As of 2020, allopurinol is generally the recommended preventative treatment if medications are used. A number of other medications may occasionally be considered to prevent further episodes of gout, including probenecid, febuxostat, benzbromarone, and colchicine. Long term medications are not recommended until a person has had two attacks of gout, unless destructive joint changes, tophi, or urate nephropathy exist.
If you have a family history of gout or suspect you may have it, schedule an appointment with your doctor. Although it can’t be cured, gout can be managed effectively with medicine and lifestyle changes. Sometimes a buildup can occur if too much uric acid is produced or the kidneys can’t properly dispose of it. CareersOur team is growing all the time, so we’re always on the lookout for smart people who want to help us reshape the world of scientific publishing. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the world’s most-cited researchers.
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. Special effort should be made to distinguish gout from the other crystal-induced types of arthritis. For example, pseudogout, caused by a different type of crystal , causes the same type of hot, red joint, and the same rapid acceleration of pain as does gout. Pseudogout can be distinguished by seeing calcium deposits within the joints on X-ray, which deposits in a different way than it does in gout. When fluid is examined from an inflamed joint in pseudogout, the specific causative crystal can be seen.
The fluid must be examined relatively soon after aspiration, as temperature and pH affect solubility. Gout frequently occurs in combination with other medical problems. Metabolic syndrome, a combination of abdominal obesity, hypertension, insulin resistance, and abnormal lipid levels, occurs in nearly 75% of cases. Other conditions commonly complicated by gout include lead poisoning, kidney failure, hemolytic anemia, psoriasis, solid organ transplants, and myeloproliferative disorders such as polycythemia.
Acute Gout Characteristics
Intense joint inflammation occurs when white blood cells engulf the crystals of uric acid and release chemicals that promote inflammation. The resulting inflammation causes pain, heat, and redness of the joint. A prophylactic dose of colchicine for gout in patients with severe renal impairment should be 0.3 mg/d. Any increase in dose warrants caution and requires regular monitoring of renal function. A starting dose of Colchicine 0.6 mg PO BID co-administered with xanthine oxidase inhibitors has been shown to reduce acute gouty flares.
Unlike allopurinol, which interacts with warfarin (Coumadin®), febuxostat did not have this interaction when studied. Febuxostat is approved by the FDA to start at 40mg daily, and if the uric acid has not reached goal (less than 6.0mg/dL) after two weeks of treatment the dose can be increased to 80mg daily. The 80mg dose of febuxostat brought more patients to less than 6mg/dL of uric acid than 300mg of allopurinol, the dose of allopurinol most commonly used. Rheumatologists often adjust allopurinol doses higher than 300mg when needed to reach uric acid goal, although the literature on higher doses of allopurinol is limited. Corticosteroids, such as prednisone and methylprednisolone (Medrol®), are anti-inflammatory agents that are quite effective against gout attacks.
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