What Is Gout? Symptoms, Causes, Treatment, Medication, Diet, Remedies

Content

• Gout Surgery For Tophi Removal And Joint Damage Repair
• Gout In Children And Teens
• The Causes Of Gout
• Uf Health At Gainesville
• The Rheumatologist's Role In The Treatment Of Gout

Fortunately, while gout is a progressive disease, there are effective medications to treat gout. Some patients only experience acute gout attacks which may be limited to 1-2 times per year (or even 1-2 times in lifetime). However, for some patients, gout can be a chronic, relapsing problem with multiple severe attacks that occur at short intervals and without complete resolution of inflammation between attacks. This form of gout, called chronic gout, can cause significant joint destruction and deformity and may be confused with other forms of chronic inflammatory arthritis such as rheumatoid arthritis. Frequently, uric acid tophi are present and contribute to bone and cartilage destruction.

Gout Surgery For Tophi Removal And Joint Damage Repair

Diuretics have been associated with attacks of gout, but a low dose of hydrochlorothiazide does not seem to increase risk. Other medications that increase the risk include niacin, aspirin , ACE inhibitors, angiotensin receptor blockers, beta blockers, ritonavir, and pyrazinamide. The immunosuppressive drugs ciclosporin and tacrolimus are also associated with gout, the former more so when used in combination with hydrochlorothiazide. Nonsteroidal anti-inflammatory drugs are frequently used to relieve the pain and swelling of an acute gout episode. They can shorten the attack, especially if taken in the first 24 hours.

Some people overproduce uric acid due to a genetic defect in an enzyme in the purine breakdown pathway which leads to overactivity of this pathway. 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. Urate-lowering medications are the primary treatment for gout. These medications decrease the total amount of uric acid in the body and lower the serum uric acid level. For most patients, the goal of uric-acid-lowering medication is to achieve a serum uric acid level of less than 6 mg/dl.

Gout In Children And Teens

Gout is caused by monosodium urate monohydrate crystals; pseudogout is caused by calcium pyrophosphate crystals and is more accurately termed calcium pyrophosphate disease . (See Pathophysiology and Etiology.) Gout is one of the oldest diseases in the medical literature, known since the time of the ancient Greeks. Pseudogout, which may be clinically indistinguishable from gout, was recognized as a distinct disease entity in 1962.

When fluid is examined from an inflamed joint in pseudogout, the specific causative crystal can be seen. Your doctor may take a sample of fluid from an inflamed joint to look for crystals. Gout is acute, painful swelling in the joints from uric acid buildup. Gout treatment aims for a uric acid level of 6 mg/ dL or lower to dissolve or prevent crystals. Research is being done on using medications that block a chemical signal known as interleukin-1 to treat gout flares in patients who do not respond to other therapies. Anakinra and canakinumab are two medications that block interleukin-1.

The Causes Of Gout

A definitive diagnosis of gout is based upon the identification of monosodium urate crystals in synovial fluid or a tophus. All synovial fluid samples obtained from undiagnosed inflamed joints by arthrocentesis should be examined for these crystals. Under polarized light microscopy, they have a needle-like morphology and strong negative birefringence. This test is difficult to perform and requires a trained observer. The fluid must be examined relatively soon after aspiration, as temperature and pH affect solubility. A similar condition, known as pseudogout has similar symptoms.

When excretion is insufficient to maintain serum urate levels below the saturation level of 6.8 mg/dL, hyperuricemia may develop, and urate can crystallize and deposit in soft tissues. Elevated serum uric acid levels are the principal risk factor for developing gout. The risk was most striking in men with severe hyperuricemia, in whom the OR for developing gout was 624.8.

Although at times the rash will reoccur during this process, often a patient can be desensitized in this way and subsequently tolerate allopurinol. It is important to get off the foot if the gout attack is in the lower extremity. Trying to ignore the attack can lead to a more prolonged duration. As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.

Patients can help prevent flares when starting these medications by also using low‐dose colchicine or NSAIDs. Often, doctors advise patients to keep taking colchicine in a low, preventive dose together with the uric acid-lowering medicine for at least six months. This medicine can be effective if given early in the attack. However, colchicine can cause nausea, vomiting, diarrhea and other side effects. Patients with kidney or liver disease, or who take drugs that interact with colchicine, must take lower doses or use other medicines. Colchicine also has an important role in preventing gout attacks .

Population studies from both the Mayo Clinic and from Taiwan have shown significant increases in the prevalence of gout recently as compared to during the early 1990s. The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Cleveland Clinic offers expert diagnosis, treatment and rehabilitation for bone, joint or connective tissue disorders and rheumatic and immunologic diseases. Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout. There is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies. During acute exacerbations the physical therapist should focus on reinforcement of management program and splinting, orthotics, or other assistive devices to protect the affected joint. Illinois Bone & Joint Institute provides a safe alternative to hospitals and emergency rooms for urgent and non-urgent orthopedic treatment and care.

Can drinking coffee cause uric acid?

The results showed that levels of uric acid in the blood significantly decreased with increasing coffee intake, but not with tea intake. In addition, there was no association between total caffeine intake from beverages and uric acid levels.

Avoid foods high in purines such as anchovies, organ meat, red meat, asparagus, mushrooms, spinach, dried beans , and cauliflower. Apply hemorrhoid creams to the skin to temporarily reduce inflammation. Mild attacks usually resolve quickly, but severe attacks can last days or weeks. If you're taking one of these medicines, continue to take the medicine during the attack.

The conditions that cause gout and kidney disease include uromodulin kidney disease and inherited kidney disease due to mutations in renin. The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.