Gout

Content

• Our Clinic: Hand & Wrist Care
• New Gout Treatment Guidelines Emphasize Genetic Risk, Need For Medications
• Gout And Kidney Disease
• Facts About Gout
• What Are Causes Of Gout?

Repeated attacks of gouty arthritis, or "flares," can damage the joint and lead to chronic arthritis. Fortunately, while gout is a progressive disease, there are effective medications to treat gout. It is sometimes difficult to differentiate whether a patient with acute arthritis has gout or pseudogout. Pseudogout is one main form of calcium pyrophosphate dihydrate deposition disease, chronic arthritis being the other.

Our Clinic: Hand & Wrist Care

Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs — even the over-the-counter strength — be sure to check with your doctor before taking them. It may wake you up at night with intense pain in your big toe — so intense that you cannot stand to have it touched, even by the sheets.

Exercise Is Important When You Have Gout When you’re not having an attack, exercise is essential for managing gout symptoms. Uric acid can also eventually damage your bones and build up in your kidneys, causing kidney stones and other damage. Like the calm in the eye of a storm, gout can lie dormant between attacks.

New Gout Treatment Guidelines Emphasize Genetic Risk, Need For Medications

Pseudogout attacks can be sudden, and the symptoms may last for days or weeks. Some people who have pseudogout don’t have any symptoms between attacks. In other cases, pseudogout can cause constant pain and discomfort.

How do you get pseudogout?

Factors that can increase your risk of pseudogout include: 1. Older age. The risk of developing pseudogout increases with age.
2. Joint trauma. Trauma to a joint, such as a serious injury or surgery, increases your risk of pseudogout in that joint.
3. Genetic disorder.
4. Mineral imbalances.
5. Other medical conditions.

"Attacks" of osteoarthritis associated with pain, swelling, and redness of the joint may in fact be due to pseudogout. The risk of pseudogout is higher for people who have excessive calcium or iron in their blood or too little magnesium. Each of these painful forms of arthritis is caused by a different type of crystal in the joints, and remedies differ. Information about symptoms, health and lifestyle habits will help determine the type of arthritis you have. The symptoms of pseudogout can last anywhere from a few days to several weeks. Most people are able to manage the symptoms very well with treatment.

Gout And Kidney Disease

The accumulation of urate crystals in soft tissues and joints activates monocytes and macrophages to clear the crystals by phagocytosis. The majority of individuals with gout are initially seen, diagnosed, and treated in primary and urgent care settings. Therefore primary care physicians and emergency medicine physicians are well-positioned to diagnose early-stage gout and implement management strategies. The causes of gout are multifactorial, including a combination of genetic, hormonal, metabolic, pharmacologic, renal disease, and dietary factors. However, the role of diet in the etiology and treatment of gout is a topic of considerable research and will be reviewed in a separate systematic review.

Gout pain occurs when excess uric acid, one of the body’s normal waste products, accumulates because the body makes too much of it or fails to excrete it. In healthy individuals, uric acid dissolves in the blood and passes through the kidneys before it is excreted in urine. With gout, uric acid forms into crystals that accumulate in the fluid that lubricates your joints.

Other differentials include trauma, bleeding, and other crystal-deposit diseases. Calcium pyrophosphate deposition disease may mimic polymyalgia rheumatica. Calcium pyrophosphate deposition disease is a crystal deposition disease in the joints and soft tissue, resulting in inflammation and tissue damage. The clinical presentation resembles gout in its acute attacks of crystal synovitis and, thus, was previously called pseudogout.

If clinical suspicion of gout is raised, investigational studies are needed to confirm the diagnosis; elevated serum urate levels alone are not sufficient to make the diagnosis. The clinical presentation, medical history, and physical examination coupled with supportive evidence from additional testing, preferably synovial fluid analysis, can usually confirm the diagnosis. If inconclusive, additional studies may be needed, such as an x-ray, other imaging studies, or histopathology from surgical resections. Uric acid comes from two places -- produced by the body and from the diet. Any extra uric acid usually filters through the kidneys and gets passed in urine.

This may help determine the causes of joint swelling or arthritis. Hip Bursitis Bursitis of the hip results when the fluid-filled sac near the hip becomes inflamed due to localized soft tissue trauma or strain. If the hip bursa is not infected, hip bursitis can be treated with ice compresses, rest, and anti-inflammatory and pain medications.

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. Occasional side effects include skin rash and stomach upset. Stomach problems usually go away as your body adjusts to the drug.

What is similar to gout?

6 Diseases That Can Mimic Gout (and Delay Your Diagnosis)Pseudogout. It sounds like gout, it looks like gout, but it's not gout.
Infected joint (septic arthritis)
Bacterial skin infection (cellulitis)
Stress fracture.
Rheumatoid arthritis.
Psoriatic arthritis.
2 comments.

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.

Research And Clinical Trials

Both of these conditions can appear suddenly with hot, red, or swollen joints. Sometimes joints look like they are infected, even though they are not. The pain often goes away within 12 hours of starting treatment. The attack may go away in a few days, but may return from time to time. Theodore Fields, MD, is an adviser to CreakyJoints and the clinical director of the Inflammatory Arthritis Center's Early Arthritis Initiative at the Hospital for Special Surgery in New York City.

Steroids can be in the form of a pill or given as an injection. Talk to your doctor about whether steroids are safe for you. The inheritance pattern of gout is unclear because many genetic and environmental factors appear to be involved. However, having a close relative with gout likely increases a person's risk of developing the condition. Long-term management for gout is significantly dependent upon the patient’s adherence to diet and compliance with medical treatment. As the prevalence of gout increases worldwide, urate-lowering therapies and lifestyle changes can help to manage the disease.