Gout
Gout is an inflammatory type of arthritis that more commonly affects men.
Gout causes sudden and severe joint pain that usually starts in the big toe. But other joints and areas around the joints can be affected, such as the ankle, knee and foot. It’s the most common type of inflammatory arthritis. Men are three times more likely than women to develop gout. It tends to affect men after age 40 and women after menopause. Gout symptoms can be confused with another type of arthritis called calcium pyrophosphate deposition (CPPD). However, the crystals that irritate the joint in this condition are calcium phosphate crystals, not uric acid.
More About Gout
Causes & Triggers
When uric acid builds up, either naturally or from a high-purine diet, it can form needle-like crystals that can lodge in joints – often the big toe – causing sudden, severe pain and swelling.
These attacks may last a week or two, and another may not occur for months or even years.
Gout results from genes; other health conditions, like high blood pressure, diabetes, obesity or psoriasis; some medications; being a man or a post-menopausal woman; or a high-purine diet. Surgery, an infection or severe illness can also trigger a flare.
Starting medicine to lower uric acid may trigger a flare, so you may need another medication to prevent it.
Diagnosis & Treatment Options
Tell your doctor how severe the pain is, when it started and which joints hurt.
You may be prescribed a medication to lower your uric acid level.
If you have a gout attack, ice and elevate the joint and drink plenty of non-alcoholic and non-sugary fluids. A prescription drug called colchicine helps relieve pain and swelling and should be taken at the first signs of a flare.
If you don’t have a prescription, take an anti-inflammatory drug, like ibuprofen. Flares usually get better within a week or two.
Work with your doctor and stick with your treatment plan, which may involve medication and lifestyle changes, including a healthy diet, regular physical activity and losing weight, if needed.
Living Well
One of the most important steps to living well with gout is closely following your medication plan.
Eating a healthy diet combined with regular exercise and weight loss, if needed, helps reduce gout attacks.
Although diet alone cannot control gout, choosing healthy foods and avoiding those high in purines, including red and organ meats and certain seafoods, may minimize flares.
Drink plenty of water and avoid beverages sweetened with high-fructose corn syrup and alcoholic beverages, especially beer.
Dropping excess weight helps reduce uric acid and lowers the risks of developing conditions that occur with gout, like diabetes and cardiovascular disease.
Stay physically active to manage weight and help joint and heart health.
Newly Diagnosed
- Learn about your disease, including what triggers your gout flares, what your medications are for and their potential side effects.
- Stick with your treatment plan. Know what to do when you have a gout attack and when to contact your doctor. Get lab work done as ordered by your doctor.
- Work closely with your doctor. Keep a record of your symptoms, activities, foods and other potential triggers to help pinpoint what makes your symptoms better or worse.
- Practice a healthy lifestyle. Take care of yourself by eating a healthy, low-purine diet, staying physically active, losing excess weight, managing stress and getting restful sleep.
- Learn self-management skills, including being prepared for a flare and taking measures to reduce and control uric acid levels.
Emotional Health
The stigma of gout and fear of another painful flare can increase anxiety and stress, which contribute to more inflammation in the body.
Reduce stress by prioritizing self-care and healthy habits.
Try to get at least seven hours of sleep each night.
Get moving every day to improve your sleep, mood and physical health.
Try meditation or listen to music that’s soothing or upbeat.
Avoid negative self-talk, and get support from family, friends, a counselor or support group, like the Live Yes! Arthritis Connect Groups.
Seek help if you have symptoms of anxiety or depression.
The better your mood and outlook, the more able you’ll be to manage gout.
Diagnosis
A medical history, physical examination and blood tests are used to diagnose gout. The doctor needs to know:
- How severe the pain is.
- How quickly it started.
- How long it has been happening.
- Which joints are affected.
The doctor will need to rule out other reasons for the joint pain and inflammation such as an infection, injury or other type of arthritis. The doctor may also take an X-ray, do an ultrasound or order a magnetic resonance imaging scan (MRI) to examine soft tissue and bone. The doctor might also remove fluid from the painful joint and examine it under a microscope for uric acid crystals or bacteria indicating an infection.
Treatment
Treating an Acute Gout Attack
Here are the steps for getting the pain and swelling of a gout attack under control as quickly as possible:
- Call your doctor and make an appointment.
- Ice and elevate the joint.
- Drink plenty of fluids (no alcohol or sweet sodas).
- Reduce stress, which can worsen the attack.
- Ask friends and family to help you with daily tasks to ease stress on joints.
Medications for Acute Gout Attack
Here are the medications that your doctor may prescribe at the first sign of an attack:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to relieve the pain and swelling of an acute gout episode. They can shorten the attack, especially if taken in the first 24 hours.
- Corticosteroids – These drugs can be taken by mouth or injected into an inflamed joint to quickly relieve the pain and swelling of an acute attack. Corticosteroids usually start working within 24 hours after they are taken.
- Colchicine - This anti-inflammatory medicine works best if taken within the first 24 hours of a gout attack.
Reducing Uric Acid Levels
The doctor will wait until the acute attack ends before starting medications to reduce your uric acid levels. Sometimes, these drugs can cause an attack at first because uric acid levels drop and crystals in the joints shift. But sticking with the treatment plan is the best way to prevent future attacks. The doctor may prescribe a low, but regular dose of colchicine along with one of the medications below to prevent attacks.
Medications for Reducing Uric Acid Levels
The doctor will wait until the acute attack ends before starting medications to reduce your uric acid levels. Sometimes, these drugs can cause an attack at first because uric acid levels drop and crystals in the joints shift. But sticking with the treatment plan is the best way to prevent future attacks. The doctor may prescribe a low, but regular dose of colchicine along with one of the medications below to prevent attacks.
- Allopurinol (Zyloprim) reduces how much uric acid the body produces. It is often prescribed at a low daily dose at first, with the which is increased slowly over time if uric acid levels remain high. This drug comes in pill form.
- Febuxostat (Uloric) reduces how much uric acid the body produces. Like allopurinol, it’s started at a lower dose, which may be increased if uric acid levels remain high. This drug comes in pill form.
- Probenecid acts on the kidneys to help the body eliminate uric acid. The medication is taken twice daily and may be combined with febuxostat to boost effectiveness. This drug comes in pill form.
- Pegloticase (Krystexxa) is used when standard medications are unable to lower the uric acid level. It reduces uric acid quickly and to lower levels than other medications. The drug is administered every two weeks by intravenous (IV) infusion.
All drugs come with risks. To learn more about these drugs and their side effects, visit the drug guide.
Diet
Drink lots of water and avoid alcohol, beer, high-purine foods and sugary drinks to help reduce uric acid buildup.
Self Care
Adopting healthy lifestyle habits is a key part of an effective gout treatment plan. 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.
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