Understanding Gout

Content

• Avoid Joint Injury
• Which Joints Are Involved In Gouty Arthritis, And Why Is It Most Common In The Foot?
• Gout Symptoms
• Diagnosis
• Who Is At Risk Of Pseudogout?
• Complications Of Gout
• Tests And Diagnosis

Longstanding untreated gout can lead to joint damage and physical deformity. Gouty arthritis is caused by the deposition of needle-like crystals of uric acid in a joint. Probenecid, sulfinpyrazone and allopurinol also may cause you to have more frequent gout episodes at first. During this time, you may have to take colchicine or an NSAID for the first three to six months to prevent an episode. While the skin rash sometimes can be serious, other side effects usually are not serious and may go away as your body gets used to the medicine. If any side effects continue to bother you, contact your doctor.

Rheumatologists often adjust allopurinol doses higher than 300mg when needed to reach uric acid goal, although the literature on higher doses of allopurinol is limited. Certain carbohydrates, such as oatmeal, wheat germ, and bran have moderate purine content but have not been shown to be significant gout risk factors. For those interested in achieving the maximal lowering of uric acid by dietary means, two “Gout Haters Cookbooks” are listed in the “Books about Gout” section below.

Avoid Joint Injury

Other differentials include trauma, bleeding, and other crystal-deposit diseases. Calcium pyrophosphate deposition disease may mimic polymyalgia rheumatica. Adverse effects include rash, precipitation of acute gouty arthritis, GI intolerance, and uric acid stones. Probenecid increases urinary calcium excretion in patients with gout and, thus, is contraindicated in patients with a history of calcium or urate nephrolithiasis. Drug interactions with probenecid include interference with penicillin and ampicillin excretion and autoimmune hemolytic anemia. Serum urate levels are not helpful indicators during acute gouty attacks because they can fluctuate from low to high.

Which Joints Are Involved In Gouty Arthritis, And Why Is It Most Common In The Foot?

Other risk factors associated with gout are age and sex, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout is more common in men than in women (although women certainly do get gout; it more commonly affects women after menopause). And while gout usually develops in middle age, it can affect younger people too. Some gout flares in hand joints have also been documented in patients who experience an injury or surgery to their hand, according to the American Society for Surgery of the Hand. Health conditions such as obesity, insulin resistance, high cholesterol, heart disease, and kidney disease are linked with gout, and should be looked for in people with gout.

Test your knowledge about taking acetaminophen and nonsteroidal anti-inflammatory drugs . Our present agents, such as allopurinol and probenecid, are so effective, and reasonably safe and predictable, that it seems unlikely that they will be fully displaced in the future. However, there are a small but very important group of patients who cannot tolerate these present agents. The development of new uric acid-lowering treatments, with even fewer side-effects than our present agents, would be heartily welcomed.

Gout Symptoms

This rise is believed to be due to increasing life expectancy, changes in diet and an increase in diseases associated with gout, such as metabolic syndrome and high blood pressure. Factors that influence rates of gout include age, race, and the season of the year. With proper treatment, most people with gout are able to control their symptoms. High doses ofnon-steroidal anti-inflammatory drugs and injections ofcorticosteroid drugsinto the affected joint are the most common treatments.

Chronic Uric Acid Interstitial Nephropathy Chronic uric acid interstitial nephropathy occurs when crystals slowly form in the structures and tubes that carry fluid from the kidney. But they can cause pain and stiffness in the affected joint. In time, they can also damage cartilage and bone and destroy the joint. Large tophi under the skin of the hands and feet can cause severe deformities. Normally these processes keep the level of uric acid in the blood below 6.8 mg/dL.

In addition to medications, physicians also highly recommend making lifestyle changes that can reduce the likelihood of gout flare-ups. Recommendations often include achieving and maintaining a healthy weight, limiting alcohol consumption, and avoiding or limiting high-purine foods, which can increase uric acid levels. Seniors who have other medical problems, such as high blood pressure or high blood triglycerides , may find that the drugs they take for those conditions can also be useful for controlling gout. Both losartan, a blood pressure medication, and fenofibrate, a triglyceride-lowering drug, help reduce blood levels of uric acid.

Over-the-counter dosage levels, for example, ibuprofen at 200mg, two tabs three times a day, are often insufficient. Patients who experience multiple attacks of acute gouty arthritis are predisposed to the development of polyarticular gouty arthritis . Attacks can then occur in more than one joint simultaneously, especially in the lower extremity. This emphasizes the unusual presentation in this case of an isolated attack of gout in the wrist. Acute onset of polyarticular gouty arthritis is more frequently seen in older patients most of whom are receiving diuretics for the management of hypertension . Radiographic findings also tend to lag behind the clinical manifestations of gout by 5–10 years .

It is caused when there is too much uric acid in the blood. Uric acid is a breakdown product of normal metabolism in the body and is normally excreted through urine. Buildup of uric acid results in needlelike crystals forming in the joints, soft tissues, and organs. "Obviously, if the patient has a high level of rheumatoid factor and anti-CCP, that helps. However, a few patients may have concomitant RA and gout."

What are the stages of gout?

The 4 Stages of Gout Progression (and How to Stop Gout from Getting Worse)Stage 1: High Uric Acid Levels.
Stage 2: Acute Gout.
Stage 3: Intercritical Gout.
Stage 4: Chronic Gout.
How to Know If Your Gout Is Progressing.
What Makes Gout Get Worse.
How Gout Treatment Prevents Disease Progression.
Can Gout Be Cured?

If the affected joint becomes hot to the touch and you develop a fever, this may be a sign that the joint has become infected, such as in the case of septic arthritis, and you should seek medical care immediately. If you are having repeated attacks that respond poorly to treatment, you should ask your primary care physician to refer you to a rheumatologist – a doctor that specializes in diseases of the joints and muscles. However, if diagnosed early, the disabling effects of gout can be prevented with medications, proper diet, weight loss, limiting or avoiding alcohol and drinking plenty of fluids. MSU crystals can be deposited in the kidneys producing inflammation and scarring . Sulfinpyrazone , another uricosuric agent, is preferred by some physicians because of its added antiplatelet effects. Therapy is initiated at a dosage of 50 mg three times a day, which is gradually increased until the serum urate level is lowered.

Complications Of Gout

If your joints have been damaged, you may have joint stiffness and limited motion after an attack. Talk to your doctor.You can play an active role in controlling your arthritis by attending regular appointments with your health care provider and following your recommended treatment plan. This is especially important if you also have other chronic conditions, like diabetes or heart disease. These flares are followed by long periods of remission—weeks, months, or years—without symptoms before another flare begins. Along with the big toe, joints that are commonly affected are the lesser toe joints, the ankle, and the knee.

Some available medications increase uric acid excretion and may alter this test result. Also called "gouty arthritis," gout is a painful form of arthritis caused by too much uric acid in the body. The treatment of these conditions is different than those used in the management of gout. Probenecid is used to lower uric acid levels in the blood by increasing the amount of uric acid excreted into the urine by the kidneys. Probenecid is much less effective in people with kidney disease.

Pegloticase is a recombinant form of the uricase enzyme that breaks down uric acid so it is removed through the urine. The FDA recommends that an antihistamine and corticosteroid be given prior to the injection to prevent reactions and that other urate-lowering medicines be stopped. Pre-infusion testing can be done to identify patients at a higher risk for an adverse reaction to pegloticase. Rheumatoid arthritis can cause deformations of the joints of the fingers and cause inflammation and pain that may be similar to gout.

Other medications also prevent future attacks by lowering uric acid in the body. If MSU crystals cannot be identified on the wet preparation after 5 to 10 minutes, the remaining SF should be centrifuged and the pellet examined. This technique can increase yield if only a few crystals are present. Gouty tophi should be examined by smearing a small amount of tophaceous material onto a slide. A smear from gouty tophi will show a mass of brilliantly birefringent, needle-shaped crystals.