Gout « Disease Spotlights « Jointhealth

Content

• What Is Gout? Know The Signs And Risk Factors
• Gout And Hyperuricemia
• What Foods Should People With Gout Eliminate From Their Diet?
• Gout And Ra Today
• Imaging Techniques As Outcome Measures In Gout

While there is no known cure for gout, people with the disease are usually able to manage their symptoms, or avoid flare-ups of disease activity all together, with lifestyle changes and medications. Doctors may be able to tentatively diagnose gout based on a patient's description of disease onset and sensation of pain and swelling, combined with a physical examination of the affected joint. A number of different groups of people are at higher risk of developing gout.

A diet low in saturated fat, with increased protein and replacement of refined carbohydrates with complex carbohydrates reduces the serum uric acid. 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.

What Is Gout? Know The Signs And Risk Factors

Doses used in trials were 40, 80, and 120 mg/day orally; however, 80 mg may be the best dose in clinical practice. The doses should be based on the patient's serum urate levels, as previously discussed. 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.

Eat a healthy diet, avoid or limit high-purine foods, do regular exercise and lose excess weight to lower your risk of repeated gout attacks. 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.

Gout And Hyperuricemia

The most reliable test for gout is detecting uric acid crystals in the joint fluid obtained by joint aspiration. This common office procedure is performed with topical local anesthesia. Using sterile technique, fluid is withdrawn from the inflamed joint with a syringe and needle. People may experience gout with deposits of uric acid crystals in their finger joints.

The risk of a gout attack increases with increasing uric acid levels, but many patients will have attacks with “normal” levels of uric acid and some will never have an attack despite very high levels of uric acid. For years, gout patients were told they had to follow a purine-restricted diet to stave off attacks, but those diets weren't very effective and people had a difficult time sticking to them. Now the easier-said-than-done advice is to lose weight, and also to cut back on alcohol, especially beer.

What Increases Your Chances For Gout?

Chronic gout can permanently damage a joint’s tissues and decrease its range of motion. For this reason, it is important to recognize symptoms, understand risk factors, get an accurate diagnosis, and treat and prevent gout. Left untreated, patients may suffer from recurrent painful and disabling acute attacks of gout. However, excellent treatments for gout are available, and most patients respond very well to gout treatment with a good prognosis.

It also, possibly through its Vitamin C content, can increase the excretion of uric acid by the kidney. The red and hot joints, coupled with rapid acceleration of joint pain, strongly suggest gout, and identifying tophi, if present (see Figures 7-10) help further. As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow. In mammals other than man and the great apes, the enzyme uricase breaks uric acid into the more soluble allantoin, which can be more easily excreted in the urine. Humans, lacking this enzyme, run higher levels of uric acid and are thus subject to gout.

What Foods Should People With Gout Eliminate From Their Diet?

Proper treatment begins with an accurate diagnosis by a medical professional. For everyone, this includes lowering SUA levels to a target of less than 6 mg/dL. For the majority, this requires taking long-term uric acid-lowering medications.

However, studies have shown that even the most rigorous diet does not lower the serum uric acid enough to control severe gout, and therefore medications are generally necessary. When attacks are frequent, uric acid kidney stones have occurred, tophi are present, or there is evidence of joint damage from gout attacks, medications are typically used to lower the uric acid blood level. When your body has extra uric acid, sharp crystals may form in the big toe or other joints, causing episodes of swelling and pain called gout attacks. Gout is treatable with medications and changes in diet and lifestyle. Sometimes, after repeated severe gout attacks, uric acid crystals collect beneath the skin and form small white or yellow lumps called tophi.

Why did I suddenly get gout?

Research shows that ice is particularly soothing for gout; if you're dealing with a different type of arthritis, a heating pad may be a better choice. Some people also say that eating cherries or drinking tart cherry juice helps during a gout flare.

Changing your diet can help reduce the frequency of gout attacks. Avoiding alcohol may reduce your chance of getting gout attacks. Additionally, researchers also found that adequate water consumption in the 24-hour period before a gout flare was associated with a significant decrease in recurrent gout attacks. Many plant-based foods are low in purines, making them an excellent choice on a gout-friendly diet. Plant-based vegetarian diets have been shown to decrease the risk of gout, according to two separate prospective cohort studies. However, there has been no research to look at the effects of coffee intake on the risk of recurrent gout attacks.

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. These criteria take advantage of the features of gout that separate it from other types of inflammatory arthritis, such as rheumatoid arthritis. For example, the inflammation of gout tends to reach a maximum within 24 hours, while other types of arthritis tend to evolve more slowly.