Diagnosis, Treatment, And Prevention Of Gout

Content

• Clinical Algorithms For Diagnosing Gout
• Why Flare
• All About Gout
• Myth: If You Stay Away From Liver And Alcohol, You'll Avoid Gout Attacks
• How Gout Treatment Prevents Disease Progression
• Myth: Gout Pain Always Attacks The Big Toe

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Uric acid is normally found in the body as a byproduct of the way the body breaks down certain proteins called purines. Causes of an elevated blood uric acid level include genetics, obesity, certain medications such as diuretics , and chronic decreased kidney function . A doctor may prescribe medication to keep on hand for use in the event of a future attack. Which medication and dose to use is determined based on a number of factors, includings kidney health, ulcer history and the person’s risk of bleeding. Physiologically, during day time, the synovial fluid is able to maintain a constant concentration of intra-articular monosodium urate crystals. At night, there is an articular dehydration attributed to joint rest, causing the passage of interstitial fluid to the circulatory system.

Clinical Algorithms For Diagnosing Gout

It needs to be taken only once a day and reduces uric acid levels regardless of whether the root problem is overproduction of uric acid or inadequate clearance by the kidneys. Sometimes people develop a mild rash when they start allopurinol, although rarely there's a dangerous allergic reaction. Old guidelines warned against prescribing allopurinol for people with kidney disease, but with proper dosing, the drug is usually well tolerated and effective even for people with kidney disease. Most people can take doses of 400 mg or more without any problems, although higher doses do mean taking extra pills. As is true for many painful conditions, the first-line treatment for a gout attack is taking one of the nonsteroidal anti-inflammatory drugs , such as diclofenac, ibuprofen, or indomethacin. For people who can't take NSAIDs, a drug called colchicine is an alternative.

Are eggs bad for gout?

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

Uric acid is normally carried through the blood and eliminated in the urine. If production of uric acid increases, a person eats a large quantity of foods high in purines, or if the kidneys are unable to adequately eliminate uric acid, then concentrations in the blood can rise . When the crystals accumulate in the joints, they can cause the pain associated with gout. But gout is still very much with us, and the number of Americans affected seems to be increasing, at least partly because of the obesity epidemic. Gout remains a disease that mainly affects middle-aged and older men, although postmenopausal women are vulnerable too, perhaps because they lack the protective effect of estrogen. The diuretics ("water pills") that many people take to control high blood pressure are another contributing factor.

Why Flare

When a painful episode of gout begins, the goal is to decrease swelling, redness, and pain. New episodes of gout are often treated with non-steroidal anti-inflammatory medication or a medicine called colchicine. Steroid pills and shots may be used to treat goutas well.

All About Gout

It’s fine to do other kinds of exercise, for example any exercise involving the upper body, but give the gouty joint a rest. This is another reason to treat gout flares quickly, since starting early often means the flare will be short – and you can limit your time off your feet. High levels of uric acid in the blood are associated with increased risk of kidney disease. Studies are being done to find out whether lowering uric acid reduces the risk for kidney disease.

Urate-lowering medications are the primary pharmacological intervention for managing hyperuricemia. People with gout will sometimes think that the prolonged absence of symptoms means that the disease has spontaneously disappeared. Unless the underlying cause of high uric acid levels is controlled, the disease can advance silently and reap irreversible harm. In severe cases, a condition known as acute uric acid nephropathy may develop, leading to kidney impairment and a rapid reduction in renal function.

When Should You Call Your Doctor?

This condition and its complications occur more often in men, women after menopause, and people with kidney disease. Gout is strongly linked to obesity, hypertension , hyperlipidemia and diabetes. Because of genetic factors, gout tends to run in some families. In order to be effective, these medicines must be taken continuously.

If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase (Krystexxa®), since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus. Now that the FDA has put this warning on febuxostat, even in people with kidney abnormality we would be likely to start allopurinol first.

As with all medications, you should report any side effects to your doctor right away. Watch for skin rashes, itching, fever, nausea, vomiting, diarrhea, or other new symptoms not present before taking the serum uric acid medications. X-rays of the affected joints may show uric acid deposits and damage indicative of gouty arthritis. The encouraging news is that almost all gout cases are treatable.

Most of the time, having too much uric acid isn't harmful. Many people with high levels in their blood never get gout. But when uric acid levels in your blood are too high, the uric acid may form hard crystals in your joints. Low doses of colchicine or anti-inflammatory medications may be used for an acute attack. Follow up with a doctor after the acute attack has resolved to determine if it is necessary to start medications to lower the blood uric acid level.

Gout occurs more commonly in those who regularly drink beer or sugar-sweetened beverages or who eat foods that are high in purines such as liver, shellfish, or anchovies, or are overweight. Diagnosis of gout may be confirmed by the presence of crystals in the joint fluid or in a deposit outside the joint. If you’re experiencing joint pain that seems like possible gout, it would be helpful to get your blood uric acid level tested by your physician. If your uric acid levels are high and your symptoms are similar to those described above, gout is very likely. If the diagnosis of gout is not clear, fluid can be removed from a swollen joint and the uric acid crystals can be seen under a microscope. A diagnosis of gout can be made with the documentation of the presence of uric acid crystals in synovial fluid or from a tophaceous deposit.