What Can Increase Your Risk
A high level of uric acid in the blood is the main factor that increases your risk of developing gout. However, it’s still uncertain why some people with a high level of uric acid in the blood develop gout, while others with an equally high level don’t.
Other factors that may increase your risk of developing gout are outlined below.
What Types Of Doctors Treat Gout
Rheumatologists traditionally have expertise in diagnosing and treating gout, especially complicated situations. Other specialists such as internists, general practitioners, family medicine doctors, and orthopedists can manage straightforward cases of gout. Nephrologists may treat patients with uric-acid-lowering medications such as allopurinol in order to prevent damage to the kidneys, which can occur with elevated uric acid levels .
A Rare Cause Of Knee Pain In Gout Patients: Tophi Of Patella
Ayhan AKIN1, Rahime NC2, Özlem AKAN1, Seçil DEMRDAL1, Korhan BAYRAM1
1Department of Physical Medicine and Rehabilitation, Katip Çelebi University Atatürk Training and Research Hospital, zmir, Turkey2Department of Dermatology, Katip Çelebi University Atatürk Training and Research Hospital, zmir, Turkey
Keywords: Gout, patella, tophi
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Genes And Family History
Research over the past decade has increasingly identified a link between a genetic predisposition and high uric acid levels. For example,;in a 2012 study, researchers looking at a large number of peoples unique genomes found that patients with gout often shared a similar variation on a gene that affects kidney function. A;2018 study;further identified several genes that influence how the body gets rid of uric acid.
Other Causes Of Knee Pain
Arthritis isnt the only condition that causes knee pain. Your doctor may try to rule out other conditions that can mimic arthritis.
Examples include illnesses that affect the whole body such as lupus, or sepsis, a severe infection. Inflammation of the protective areas around the joint, such as the tendons, can also cause symptoms that are like arthritis.
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Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
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Get An Accurate Diagnosis And Treatment
While gout attack symptoms do resolve on their own, people are advised to seek medical treatment. If left untreated, gout can become chronic and cause lasting joint damage.
Diagnosis begins with a clinical exam and interview. Patients are encouraged to be honest with their health care providers about their eating, drinking, and other lifestyle habits. This honesty can be helpful both for diagnosing gout and creating a treatment plan. Diagnosis may also involve blood tests, urine tests, and medical imaging, such as x-rays and ultrasound.
See Gout Diagnosis
Treatment typically involves advice to avoid alcohol and certain foods known to trigger gout, such as foods and drink high in sugar, seafood, red meat, and organ meats.19 Medications to lower urate levels in the bloodâwhich can lead to gout attacksâare often recommended. Losing excess weight is another effective way to reduce the risk of a gout attack and chronic gout.20
See Gout Treatment
Foods To Limit Or Avoid
Cutting out or limiting foods that contain purines may help further reduce the amount of uric acid in the bloodstream and the risk of developing gout or experiencing gout flare-ups in the future.
Some foods rich in purines are the following:
- alcohol, especially beer and spirits
- certain meats, such as turkey, bacon, veal, liver, venison, and organ meats
- some types of fish and seafood, such as haddock, trout, scallops, cod, mussels, anchovies, sardines, and herring
Foods moderately high in purines include:
- beef
- avoiding extreme diets, especially diets low in carbohydrates and high in proteins
- eating a healthy diet that reduces the risk of diabetes, high blood pressure, and obesity, such as one that includes a lot of fruits, vegetables, nuts, and plant proteins
People with joint damage or tophi from gout may require surgery.
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Age Raises The Risk Of Pseudogout
Anyone can develop pseudogout, but the risk increases significantly with age. The crystal deposits associated with pseudogout affect about 3 percent of people in their 60s. The percentage increases to about 50 percent of people in their 90s. The condition is equally prevalent among women and men.;
The risk of developing the condition is also increased if the patient has any of the following metabolic disorders:
- Hyperparathyroidism
- Ochronosis
- High iron levels;
- Hypercalcemia
Gout May Be Your Second Arthritis
Did you know that it is possible to have more than one form of arthritis? Get more information about gout, the inflammatory condition that can occur with osteoarthritis, rheumatoid arthritis and psoriatic arthritis.
It is possible to have more than one type of arthritis, and knowing what you have can help in treating your symptoms.Gout, which can occur with OA, rheumatoid arthritis and psoriatic arthritis , results when uric acid crystals are deposited in joint tissue. It causes sudden, severe pain, swelling and tenderness, usually in the big toe, but it also can occur in the feet, ankles, hands, knees, wrists, elbows or other joints. Its typically in only one joint, but chronic gout can affect multiple joints.;Differentiating between gout and other forms of arthritis is critical because the treatments are very different. If you think you have gout, see your doctor. The sooner its treated, the sooner youll get pain relief.
How Gout may Affect Other Arthritis Conditions
Gout and RA
For decades, rheumatoid arthritis and gout were thought to be mutually exclusive. But some people with RA also get gout as both conditions share obesity as a common risk factor and may cause kidney problems. Diagnostic tools like synovial fluid analysis and dual-energy CT scans are especially helpful in making the correct diagnosis.
Gout and OA
Gout and PsA
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Gout And Oawhats The Connection
A swollen, stiff knee might immediately lead you to suspect you have osteoarthritis , but the culprit could also be gout. Like many close relatives, the two conditions share common features. And because they often occur together, you might wonder which one is causing your symptoms.
Its definitely possible for people to have both conditions at the same time. Theyre the two most common types of arthritis, says Svetlana Krasnokutsky, MD, assistant professor of medicine in the Division of Rheumatology at NYU Langone Health. They can affect the same joints.
OA is a degenerative disease that gradually breaks down the cartilage that cushions bones. It causes pain, swelling, and stiffness in joints like the knees, hips, fingers, lower back, and neck. In gout, uric acid crystals build up in the joints. Gout often affects the big toe joint, but the ankles, knees, hands, and wrists can also be involved.
Knowing which condition you haveor whether youve got both gout and osteoarthritis can help your doctor fine-tune your treatment.
Treating A Gout Attack
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. It’s been used for centuries maybe even longer specifically for gout. The trouble with colchicine is its side effects, especially the copious diarrhea. If neither an NSAID nor colchicine is an option, then gout attacks can be treated with an oral corticosteroid, such as prednisone, or with corticosteroid injections into the joints.
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Can It Lead To Any Complications
If left unmanaged, gout-related inflammation can cause permanent damage to your knee joint, especially if you have frequent flare-ups.
Over time, lumps of uric acid crystals, called tophi, can also form around your knee. These lumps arent painful, but they can cause additional swelling and tenderness during a flare-up.
Symptoms Of Arthritis Of The Knee
Symptoms commonly linked to knee arthritis include:
- Crepitus, a clicking or popping of the knee joint with movement
- Pain that is worse in the morning
- Pain that seems to be weather-related and gets worse with rain
- Stiffness
- Swelling
- Weakness in the knee joint that may cause it to buckle
Warmth and redness over the joint are often symptoms of gouty arthritis, but can be seen with almost any kind of arthritis depending on the degree of inflammation.
Knee arthritis symptoms typically worsen over time. Later-stage arthritis symptoms may include visible joint deformities and stiffness that makes movement nearly impossible. However, its possible for a person to suddenly experience severe knee arthritis symptoms.
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Diet Has No Effect On Pseudogout
Whereas gout is often exacerbated by consuming meat, seafood, and alcohol,;diet does not affect the onset or development of pseudogout;or control symptoms. Though the crystals associated with pseudogout are partly calcium, it is a myth that consuming foods high in calcium provokes the development of pseudogout.;
What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
References
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The Causes Of Gout And The Real Causes Of Gout
After my first encounter with gout my doctor gave me the standard explanation of its causes.
He said that gout was caused by excess uric acid in the blood.
Uric acid is a byproduct of the processing of certain foods.
The uric acid comes from the liver as a waste product. Its sent to the kidneys from where it is supposed to be removed from the body.
I had gout because, in a nutshell, gout is what you get when your body isnt expelling all its uric acid.
The excess uric acid forms tiny, spike-shaped crystals.
Those crystals get into your bloodstream.
From there, they find their way into your joints.
And from time-to-time the immune system attacks them.
And when the immune system does that the inflammation that results is experienced as a gout attack.
Also known as excruciating, awful pain.;;
If you suffer from gout then I truly feel for you. I know what youre going through.
Its been just over 2 years now since my final gout attack. But I still remember what it felt like.
Anyway, that was the doctors explanation of gout. So far, so simple.
Can Gout Spread To Other Toes /joints
Gout is not contagious disease, so it cannot spread to others. It has nothing to do with viral or bacterial infection. It is a type of arthritis, but it can be more painful if compared to other types of arthritis. Many times, it often affects the big toe. The next question, can it spread to other toes or other joints of the body?
Causes of gout
It is triggered by having too much uric acid in the body. There are two major possibilities why the levels of uric acid in the bloodstream can increase higher than normal:
The failure of the body in keeping the level of uric acid normal will increase the chance for this acid to move to ;the joints. Over time, the high accumulation of this acid can make needle-like crystals around the joints, causing inflammation and you will notice the symptoms of gout such as pain, heat, swelling, and redness.
Though gout is commonly linked to high uric acid, but the exact cause of this arthritis is not fully understood yet. In fact, not all people whose uric acid levels in the blood are high develop gout.
Gender can be a risk factor since it affects more men, though the amount of women with it increases significantly after menopause.
The habit of too much drinking alcohol can have an effect, too. Alcohol contains high purines. See also the correlation between drinking alcohol and gouty arthritis!
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What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achilles’ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
Gout In Children And Teens
If a child or teenager has gout, it is important that blood and urine tests be done to determine why gout has occurred. It is usually a sign of an underlying problem that is often easily treated.
In children, the first test to do if gout is suspected is to measure the blood uric acid level.; If this is elevated , this could be a sign that gout is present.; Other important procedures are for a doctor to insert a needle into the affected joint, withdraw fluid, and examine this fluid for uric acid crystals.
Causes of gout in children and teenagers include:
- Inherited conditions that cause over-production of uric acid. These include HPRT deficiency and PRPP synthetase overactivity. These disorders are uncommon but are easily tested for. Patients produce extra uric acid and can have gout and kidney stones containing uric acid. These conditions usually occur in boys but can occasionally happen in girls as well.
- Kidney diseases resulting in decreased ability of the body to get rid of uric acid. These can include:
– The most common type is due to mutations in the gene that produces a protein called uromodulin. In this condition, patients develop gout in their teenage years and have slow worsening of kidney failure over time. There are usually many other family members who have had gout or kidney disease.;
– Any type of kidney disease can also cause gout in childhood.
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Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints;towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in;one or more;joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint;;
Symptoms develop rapidly;over a few hours and typically last;three to 10 days. After this time the pain should pass and the joint;should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the complications of gout.
The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
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What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.