The Diagnosis And Treatment Of Gout

Content

• Rheumatoid Arthritis And Gout: Whats The Difference?
• More In Health
• Treatment Overview

If your symptoms do not improve with initial treatments, your doctor may recommend a synovial fluid analysis. During this test, synovial fluid is drawn from your inflamed joint. When you have gout, there is more fluid in the joint and the fluid contains white blood cells. It will also contain uric acid crystals that can be seen with a special microscope. Gout Diet Foods Menu Whether you get gout can depend on your diet.

Rheumatoid Arthritis And Gout: Whats The Difference?

Gout affects a significant portion of the population worldwide annually , and according to the estimates of World Health Organization , 3.9% of people worldwide are suffering from gout . The acute onset of arthritis, joint malformations, chronic joint injuries and the formation of renal calculus not only reduce the quality of life, but also lead to disability . Patients who have repeated gout flares, abnormally high levels of blood uric acid, or tophi or kidney stones should strongly consider medicines to lower blood uric acid levels. These medications do not help the painful flares of acute gout, so most patients should start taking them after acute attacks subside. The drug most often used to return blood levels of uric acid to normal is allopurinol . Colchicine (Colcrys®, Mitigare®) has a role in both the prevention and treatment of gout attacks .

More In Health

In addition, both are high in antioxidants which will help to fight off free radical damage. As many studies are now illustrating, gout is common in people with excessive sugar intake, especially high fructose corn syrup (HFCS.) It’s wise to read the labels of all your food and drinks. In addition, look for sugar added under the guise of other common names for sugar; look for ‘cose’ at the end of words and these are probably types of sugar you don’t want to be consuming. Studies show that many of the dietary items we consume lead to gout as well as other health problems.

Robert T. Keenan, MD, MPH, assistant professor of medicine, division of rheumatology and immunology, Duke University School of Medicine. Rebecca Manno, MD, MHS, assistant professor of medicine, division of rheumatology, Johns Hopkins University School of Medicine. If you can, raise the joint on a pillow or other soft object.

Applying Ice To Affected Joints

If you've had a gout attack before, your physician may have prescribed drugs to treat attacks. This may be your first line of defense or you may decide to use them only when NSAIDs fail to relieve your pain. Some medications, such as diuretics, can increase the risks of a uric acid buildup and gout flare. Limiting these foods is also beneficial for heart health — and people with gout are at higher risk for heart disease. She may prescribe a new medication, or have you come to the office for a joint fluid test or an injection of a corticosteroid to start relieving inflammation quickly.

Humans and other great apes do not have this ability; thus, gout is common. Other animals with uricase include fish, amphibians and most non-primate mammals. The Tyrannosaurus rex specimen known as "Sue" is believed to have suffered from gout.

Create Gout

For the person with too much uric acid, this inflammation can cause painful arthritis, sometimes called gouty arthritis. Gout was the first disease in which researchers recognized that crystals in the synovial fluid could be the cause of joint pain. Patients with gout should avoid excess ingestion of alcoholic drinks, particularly beer, because alcohol use elevates uric acid levels and thus can precipitate attacks of gout. Indeed, heavy drinkers are much more likely to have recurrent gout attacks, even with allopurinol therapy. Moderate wine intake is not associated with increased development of incident gout, but excesses of any form of alcohol in gout patients are associated with acute gout flares.

Gout can develop in a person either because they are producing too much uric acid or because they are unable to put enough of it into the urine . The most common cause of gout (about 90% of cases) is the inability to excrete enough uric acid in the urine. However, a defect in excretion of uric acid can also occur due to medications, such as diuretics, low dose aspirin, or alcohol. Defective uric acid excretion also occurs when the kidneys are functioning poorly. 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. This situation has been mimicked in more recent times when imbibers of “moonshine whiskey,” often made in radiators containing lead, developed a lead poisoning-associated gout (“Saturnine gout”).

The inflammation is precipitated by the deposition of uric acid crystals in the lining of the joint and the fluid within the joint. 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. Unfortunately, the level of uric acid in the blood cannot be reliably used to make a diagnosis of gout. It is normal in approximately 10% of people during an acute attack of gouty arthritis. Moreover, uric acid levels are elevated in 5%-8% of the general population, so the presence of an elevated level does not necessarily mean that gout is the cause of an inflamed joint.

Is Rice OK for gout?

A 2016 study found that reducing the glycemic index lowered uric acid levels in participants. Limiting foods with a high glycemic index such as white bread, pasta, and white rice may help to reduce uric acid levels and possibly prevent gout onset or flares.

Gout that is not treated can also damage the affected joints. The lipid-lowering drug fenofibrate, a fibric acid derivative, lowers serum uric acid levels while reducing very-low-density lipoprotein , total cholesterol, and triglyceride levels. However, the creatinine level increases, and all effects are negated once the drug has been discontinued.

Treatment Overview

By 6 months, the primary endpoint—a serum uric acid level of less than 6.0 mg/dL—was achieved in 45% of subjects on febuxostat 40 mg/day, 67% on febuxostat 80 mg/day, and 42% on allopurinol. In subjects with renal impairment, the primary endpoint was achieved in 50% of subjects on febuxostat 40 mg/day, 72% on febuxostat 80 mg/day, and 42% on allopurinol. Adverse GI effects are uncommon with this dosage, occurring in only 4% of patients.

Reduction of uric acid levels is key to avoiding gout flares. Patients receiving urate-lowering medications should be treated concurrently with nonsteroidal anti-inflammatory drugs, colchicine, or low-dose corticosteroids to prevent flares. Treatment should continue for at least three months after uric acid levels fall below the target goal in those without tophi, and for six months in those with a history of tophi. Gouty arthritis is a common cause of a sudden onset of a painful, hot, red, swollen joint, particularly in the foot at the big toe.