Gout And Pseudogout Treatment & Management

Content

• Wake Forest Baptist Health, Medical Center Boulevard, Winston
• Preventing Gout Attacks
• Diet
• Chronic Tophaceous Gout
• Differential Diagnosis
• Tophi

Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website. Once you start taking these medicines, you’ll need to take them for life so that your uric acid stays at the right levels. If you don’t have a gout specialist, use this “Find a Gout Specialist” tool to identify healthcare professionals who are experienced treating chronic gout.

Wake Forest Baptist Health, Medical Center Boulevard, Winston

The increase in younger people is not explained, but the increase in older people, at least in part, relates to increased life span, increased weight and increased use of diuretics. Diuretics are used commonly for hypertension, for example, and they elevate the blood levels of uric acid and can increase the risk of gout. Although alcohol can bring on gout attacks, genetics are much more important than alcohol in defining who gets gout, and many who never drink alcohol suffer from gout.

Although indomethacin is the NSAID traditionally chosen for acute gout, most of the other NSAIDs can be used as well. Do not use aspirin, because it can alter uric acid levels and potentially prolong and intensify an acute attack. Low-dose aspirin alters uric acid levels, increasing the risk of gout attacks and requiring close uric acid monitoring when aspirin is added to a uric acid/gout treatment regimen. Sometimes during an acute gout attack, uric acid levels may test normal because the uric acid has left your bloodstream and entered the inflamed tissue.

Preventing Gout Attacks

Prescriptions, such as allopurinol, colchicine, and febuxostat, are also available to help control the levels of uric acid in the blood. Long-term management of gout is focused on lowering uric acid levels. The goal of therapy is to reduce serum uric acid levels to below 6 mg/dL, at minimum.

Some medicines, such as water pills , can also bring on gout. Plain radiograph showing chronic tophaceous gouty arthritis in hands. Chronic tophaceous gout in untreated patient with end-stage renal disease.

Diet

Nonsteroidal anti-inflammatory drugs to ease pain and inflammation of an acute gout attack. These medicines can also be used to prevent gout when you start taking medicine to lower your uric acid level. Some people with gout have continuing problems because they don't take their prescribed medicine. Most people will need treatment every day to keep the uric acid levels in their blood normal. But they may feel perfectly healthy most of the time and wonder why they should keep taking their medicine. If you stop taking your prescribed medicine, nothing may happen at first.

Are eggs bad for gout?

Eggs are a good protein source for people with gout, because eggs are naturally low in purines.

Large tophi in areas with healthy skin may be removed surgically; all others should slowly resolve under adequate hypouricemic therapy. treatment begins with 250 mg orally 2 times a day, with doses increased as needed, to a maximum of 1 g orally 3 times a day. Hyperuricemia is not usually treated in the absence of gout flares. to treat an acute flare within the past 2 weeks, an NSAID should be used instead to try to abort the flare. Joint space is typically preserved until very late in the course of disease. Synovial fluid findings from chronic effusions are usually diagnostic.

Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective.

What is the main cause of gout?

Gout is caused by a condition known as hyperuricemia, where there is too much uric acid in the body. The body makes uric acid when it breaks down purines, which are found in your body and the foods you eat.

The regimen currently favored consists of 1.2 mg of colchicine, followed by 0.6 mg 1 hour later to initiate treatment of the early gout flare. Furthermore, control of hyperuricemia generally is not pursued for a single attack. If attacks are recurrent or evidence of tophaceous or renal disease is present, therapy for control of hyperuricemia is indicated. Many types of arthritis cannot be prevented and lack medical treatments that reliably work. Gout is different - the treatment is usually straightforward and highly effective.

Urinary excretion amounting to less than 800 mg per 24-hour period on an unrestricted diet is considered underexcretion. Underexcreting patients are candidates for uricosuric therapy with probenecid. The dosage is increased at monthly intervals until the uric acid level is lowered to target.

Prevention Tips

Gout is a disease caused by high uric acid levels in the blood leading to crystal formation in the joints, most commonly joints of the lower limbs such as the big toe, heels, ankles and knees. Gout usually presents as acute attacks causing joint swelling and pain, but also can lead to chronic arthritis. While there is no cure for the disease, treatment can prevent recurrent gout attacks and improve its chronic form. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes.

Gout is clearly associated with a buildup of uric acid. People can usually treat tophaceous gout by using uric acid-lowering medications and changing certain everyday habits. Making these changes can also help a person prevent gout from developing in the first place. The body makes approximately 66% of its uric acid supply naturally.

Differential Diagnosis

If gout is untreated, the frequency of attacks usually increases with time. Some people may not experience gout as many painful attacks. Chronic gout in older adults may be less painful and can be confused with other forms of arthritis.

This includes over-the-counter drugs such as aspirin or diuretics. Some of the gout medications will not work properly if you are taking other drugs at the same time. Don't start any new drugs without being sure they will work properly with the ones you're already taking. The amount of medications you take will depend upon your symptoms and laboratory test results. On the other hand, it may be necessary to take a combination of the drugs listed here. Whether you take these drugs depends on your doctor's judgment and your willingness to make a lifelong commitment to taking daily medications.

If an attack seems to be coming on in the lower extremity, patients are well-advised to try to get off their feet, since impact seems to worsen gout attacks. Clues to an attack of gout coming on include local swelling, heat, redness, and tenderness in a joint, especially in the foot, ankle, or knee. Some patients have fever and chills as the first warning that an attack of gout is coming on. A third type of crystal-induced arthritis, hydroxyapatite deposition disease, has a type of crystal that needs special studies for identification.