Gout « Disease Spotlights « Jointhealth

Content

• Dr Stuart Weisman Covers Causes, Symptoms And Treatment Of Gout Flare
• Managing Gout
• Who Is Affected By Gout?
• Physical Measures In Treating An Acute Attack Of Gout
• New Gout Treatment Guideline Emphasizes Genetic Risks

Having gout, and especially chronic gout, can lead to serious health problems over time if left uncontrolled. Talk to your doctor about ways to prevent gout attacks during your sleep. Kidney disease can lead to gout, and gout may lead to kidney disease. If you have either condition, talk to your doctor about preventing the other. Treatment with NSAIDs should be continued for several days after the pain and inflammation have resolved to prevent them from appearing again . Concerns with these drugs relate to irritation of the stomach, interactions with blood thinners, and temporary decrease in kidney function.

After considering all this data, many patients in this situation have chosen to stay on febuxostat, but each person, with their physician, makes this decision. Corticosteroids, such as prednisone and methylprednisolone (Medrol®), are anti-inflammatory agents that are quite effective against gout attacks. Anti-inflammatory steroids are very different in action and side-effects as compared to male hormone steroids. Anti-inflammatory steroids have long-term risks, such as bone thinning and infection, but their risk for short-term (for example, 3-7 days) therapy is relatively low. These agents can raise blood pressure and blood sugar, so can be a problem for those with uncontrolled hypertension or uncontrolled diabetes mellitus. A third type of crystal-induced arthritis, hydroxyapatite deposition disease, has a type of crystal that needs special studies for identification.

Dr Stuart Weisman Covers Causes, Symptoms And Treatment Of Gout Flare

Full recovery from a gout attack takes approximately 7-14 days. People with gout have a higher risk for kidney stones, due to crystal deposits in the kidneys. Crystal deposits in the joints can cause some disability due to stiffness and pain. 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.

Managing Gout

Gout can develop when your body produces too much uric acid or when it does not eliminate enough of it. When the levels of uric acid in your blood are too high, it is called hyperuricemia. Your doctor will ask you about your medications, diet, alcohol use, and about any family history of gout. Your doctor will examine you, and he or she will look at your painful joints and search your skin for tophi. Pseudogouthas similar symptoms to gout and is often confused with gout. Like gout, it is caused when painful crystals form in the joints.

Lesinurad reduces blood uric acid levels by preventing uric acid absorption in the kidneys. It was approved in the United States for use together with allopurinol, among those who were unable to reach their uric acid level targets. If these medications are in chronic use at the time of an attack, it is recommended that they be continued.

Other medications to lower uric acid, including lesinurad and pegloticase , are prescribed less often because of cost and because allopurinol works so well for most people with gout. If attacks are rare and respond well to treatment, these treatments may not be necessary. Probenecid is the most frequently used uricosuric medication. Probenecid works at the level of the proximal tubule by blocking reabsorption of filtered uric acid. Probenecid should be initiated at a dosage of 250 mg twice daily and increased as needed, up to 3 g per day, to achieve a serum urate level of less than 6 mg per dL (355 μmol per L). The initial side effects of probenecid include possible precipitation of an acute gouty attack and renal calculi.

Some foods contain more purines than others and have been associated with an increase of uric acid, which leads to gout. You may be able to reduce your chances of getting a gout attack by limiting or avoiding shellfish, organ meats (kidney, liver, etc.), red wine, beer and red meat. In addition to following your doctor's treatment plan, there are choices you can make to prevent gout attacks and future joint damage. Most people with hyperuricemia never develop gout, and people with gout may have varying levels of uric acid in their blood.

Usually, uric acid levels are elevated for years before the onset of gout. In men, uric acid levels rise at puberty, and the peak age of onset of gout in men is in the fourth to sixth decade of life. However, onset may occur in men in their early 20s who have a genetic predisposition and lifestyle risk factors. In women, uric acid levels rise at menopause, and peak age of onset is in the sixth to eighth decade of life.

Treatment is difficult and there are limited prescription drug options to treat it. That’s probably because many of the risk factors associated with gout—diabetes, obesity, and high blood pressure—tend to also rise as we age. Plain radiograph showing chronic tophaceous gouty arthritis in hands. Chronic tophaceous gout in untreated patient with end-stage renal disease.

Although at times the rash will reoccur during this process, often a patient can be desensitized in this way and subsequently tolerate allopurinol. One potential advantage of febuxostat is that it is structurally quite different from allopurinol, and therefore likely can be used in patients who are allergic to allopurinol. Only a limited number of patients who were allergic to allopurinol have been studied to date, but the drug was tolerated in those patients. Another advantage is that its excretion is handled more by the liver than the kidney, unlike allopurinol, and febuxostat may thus have some advantage in patients with kidney dysfunction. It is important to get off the foot if the gout attack is in the lower extremity.

What can you not eat with gout?

Foods to Avoid if You Have GoutBeer and grain liquors (like vodka and whiskey)
Red meat, lamb, and pork.
Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads)
Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines.

The treatment of these conditions is different than those used in the management of gout. In their analysis, researchers analysed the risk of advanced chronic kidney disease in 68,897 gout patients followed for an average of 3.7 years and compared them to 554,964 patients without gout. Drug reaction with eosinophilia and systemic symptoms, also called DRESS, is another skin condition that may be associated with Uloric. The drug reaction appears two weeks to eight weeks after a patient starts taking the medication. It may result in a rash, fever and an increased count in certain white blood cells. While gout has painful and distinctive symptoms during flare-ups, its symptoms can be vague during other times.

Gout is associated with obesity, and significant weight loss can dramatically improve the management of gout. Probenecid is generally well tolerated but should not be used in patients who have uric acid kidney stones, as it can worsen the kidney stones and potentially harm the kidneys in these patients. Allopurinol is well tolerated by most people, but in some people, it can cause an allergic rash. Very severe rashes rarely can occur after taking allopurinol, and any allergic type rashes that develop while a patient is taking allopurinol are taken seriously. Some gout treatments have side effects that affect a patient's skin, kidneys, and joints.

Physical Measures In Treating An Acute Attack Of Gout

With gout, however, the acid crystalizes into needle-like forms that can cause great pain. Tenderness, warmth, swelling and redness may also result. The study sheds new light on the importance and potential impact of gout on kidney function. Although previous studies have shown that gout patients have a higher burden of kidney disease, none has convincingly shown that gout can contribute to the development of kidney failure. Patients with gout are at increased risk of chronic kidney disease and kidney failure, according to new University of Limerick , Ireland led research. The most frequent signs of a gout attack are swelling, tenderness, redness, and a sharp pain in your big toe.

Gout is a common condition, but it occurs more frequently in some populations than others. For example, gout occurs in 1 percent of people with Asian ancestry, 3 to 4 percent of people with European ancestry, and 6 to 8 percent of Indigenous Taiwanese peoples and Māori from New Zealand. Being overweight and drinking too much alcohol can increase your risk for gout.