Related Conditions And Causes Of Gout
Other conditions that are sometimes confused with gout include:
- Reactive arthritis
- Infectious arthritis
- Psoriatic arthritis
- Rheumatoid arthritis , which occurs when the body releases too many inflammatory chemicals . Gout is caused by too much uric acid.
- Osteoarthritis , known as wear-and-tear arthritis.
Questions About Managing Gout
Treating gout includes both medication and lifestyle modifications. Knowing the right questions to ask your doctor can help you figure out the best treatment plan.
Gout is a disease that can flare without warning. Asking your doctor these 10 questions can help you better manage the condition.
Why do I have gout?
Gout is caused by deposits of sharp, needle-like crystals of uric acid in the joints that create inflammation, redness, and heat around the joint, along with extreme pain. Uric acid comes from two main sources: internally from the destruction of old or damaged body cells and externally from foods, such as red meat and seafood, that contain a lot of a substance called purines.
A number of factors can increase your chances of getting gout, including genetics, gender, age, weight, and medical conditions, including hypertension. Some medications, like diuretics, can also cause gouts.
Your doctor may feel that some combination of these factors has put you at high risk, or that your diet has contributed to the problem.
What other medical conditions are linked to gout?
High uric acid levels are linked to hypertension, diabetes, high cholesterol levels, and obesity. Treating these conditions may improve gout.
How long will a gout attack last and how often will I get one?
What are my gout medication options?
After the attack subsides, many people will need ongoing treatment designed to keep uric acid levels in a normal range to prevent further attacks.
Can Gout Be Prevented
Some people with gout experience recurrent attacks, which may be prevented by using prescription medications. These medicines work by lowering uric acid levels in the blood. The most commonly used is allopurinol. This helps to lower uric acid levels by reducing the body’s production of uric acid.
You can also reduce your chance of having further attacks of gout by adopting some sensible lifestyle changes, such as:
- reducing alcohol intake avoid binge drinking, in particular
- gradually losing weight if you are overweight, while avoiding fad diets
- eating a healthy, balanced diet
- drinking plenty of water, especially when at risk of dehydration
There is no scientific evidence that particular foods cause gout, but some studies have shown that people who are prone to gout are more likely to eat foods rich in purines a substance that’s converted into uric acid within the body.
Foods with high levels of purines include:
- red meat and offal such as liver, kidneys and heart
- seafood, especially shellfish, scallops, mussels, herring, mackerel, sardines and anchovies
- foods containing yeast such as Vegemite and beer
It’s best to seek the advice of your doctor or an accredited practising dietitian before making any changes to your diet. Most people with gout find that a healthy, balanced diet along with medication is enough to reduce their uric acid levels.
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Gout Frequently Flares In Your Knee But You May Not Always Know That Your Knee Pain Is Due To Gout Heres How To Tell Since Prompt Treatment Can Reduce Your Risk Of Complications
Knee pain can be a common symptom of several types of arthritis, as well as many other conditions or injuries. If your knee stiffness is accompanied by a burning pain and is warm to touch, you may have a gout flare in the knee.
Though gout is most often associated with the big toe, gout tends to flare in areas that already have arthritis, says Robert Keenan, MD, a rheumatologist with Articularis Healthcare in Summerville, South Carolina. Although gout can strike in many different joints, as a general rule, gout works its way up the body. If its not treated, it works its way up from the big toe, through the ankle, to the knee, and then to the lower spine and so on.
Gout can affect both knees, but typically is felt more strongly in one knee say, where you may have arthritis wear-and-tear to begin with.
Learn more about what causes gout in the knee, as well as ways to treat the pain and prevent it in the future.
Different Pain Intensity Is Noticed
The first thing I will reveal is that the pain you feel wont always be the same. It is the strongest during the first 12-24 hours, but after that, it will start declining, until you are finally free of it. Most people experience a gout attack which lasts between 3 days and 1 week, but as I have mentioned, this matter cannot be generalized. It is possible that your gout attack lasts for a few weeks, even 2 months! During that time, you will be trapped in a bed at home and you wont be able to go to work or to continue with your daily routine.
I also must add the fact that gout and its attacks must be treated as soon as possible. Ideally, you would use some method for prevention, but if still, an attack occurs make sure you start a treatment at the same moment. Take ibuprofen or colchicine. Stay calm and continue using some of the preventives I have revealed so far.
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If you have frequent gout attacks, make sure to find the main cause of it. As we all know, gout is a progressive disease which can be triggered by numerous factors, so always try to find the solution and use it straight away.
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What To Do During An Attack
- take any medication you’ve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
- rest and raise the limb
- avoid knocking or damaging the affected joint
- keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
- ensure you’re well hydrated
Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.
What Are The Risk Factors For Gout
Risk factors for gout include:
- taking medications that increase water excretion by the kidneys
- being overweight
- eating a diet with a lot of meat, offal and shellfish
- having kidney disease, high blood pressure, diabetes or abnormal levels of fat and cholesterol in the blood
- drinking a lot of alcohol, especially beer, port or spirits
- going on a crash diet or fasting
- being of Maori or Pacific Islander origin, which can predispose a person to high uric acid levels
Gout is more common in men than in women, and among women its more common after menopause. Its more likely to occur in older people, but can affect anyone.
It can also affect people with certain types of blood disorder and people in treatment for cancer.
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What Is Chronic Gout
Chronic is the clinical name of a long-lasting disease, as opposed to acute, which is usually sudden and limited to a short period. After a single primary acute attack described above, some patients never experience a secondary attack, but others may progress to chronic gout. Chronic gout is associated with chronic pain of the joint, but milder than acute episodes of gouty arthritis. It also features structural and functional damage of the articulation. Many chronic cases are due to uncontrollable hyperuricemia, which leads to multiple attacks of acute gout and hence progresses to chronic gout. The chronicity of gout is more common in seniors. In addition to the deposition in the joints, in chronic cases uric acid crystals are deposited in the soft tissues around the joints, forming irregular nodular swellings known as tophi. These lesions have a whitish appearance, and may ulcerate with a gritty white discharge.
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Risk Factors For Gout
Some people are more susceptible to gout than others and there is often little correlation between the levels of uric acid in the blood and knee gout symptoms.
In fact, approximately 50% of people with gout do NOT have hyperuricemia, high uric acid levels.
There are a number of other factors that increase your risk of developing gout knee pain:
- Genetics: there is thought to be a genetic link inabout 20% of cases
- Age: most commonly affects people over 40 with the peakincidence at 75
- Obesity: especially rapid weight gain. A BMI greater than 35 increases the risk three times
- Diet: accounts for approximately 12% of cases. Risk factors include excessive alcohol intakeespecially binge drinking, fructose-based drinks and seafood
- Medical Conditions: Kidney disease and/or metabolism problems
- Drug Treatments: mostcommonly diuretics used to treat high blood pressure,heart failure and oedema
- Trauma: gout knee may develop after an injury or surgery
Gout knee can develop any time after puberty, although in women, ittends to be after the menopause. This is thought to be due to the positiveeffect of oestrogen until then.
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Other Symptoms Of Acute Gout Or A Gout Attack
- Sudden crushing or throbbing pain in one or a few joints that may last for a few days
- Sometimes an acute gouty arthritis attack has a sudden onset at nighttime. The big toe joint pain may be so severe that even the weight of bedsheets causes discomfort.
- Joints that appear swollen and inflamed, with reddish-purple skin that may feel warm
Pseudogout Symptoms & Signs
Pseudogout is a type of arthritis . Pseudogout has this name because its cause and symptoms resemble those of true gout, but gout is related to the presence or urate crystals. Pseudogout is related to aging and is linked to degenerative arthritis.
Signs and symptoms of pseudogout can include
- sudden, intense joint pain,
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Who Is Affected By Gout
Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
You are also more likely to develop gout if you:
- Consume a diet high in animal proteins.
- Consume a significant amount of alcohol.
- Are on water pills .
What Is The Prognosis Of Pseudogout
The outlook of pseudogout is generally very good. Aggressive treatment of the inflammation can lead to complete resolution of the inflammation, pain, tenderness, and loss of joint function. While this can last for weeks, the inflammation of resolves within days with proper treatment.
Recurrent attacks of pseudogout and chronic joint inflammation can lead to injury to the affected cartilage and bone.
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When To Call A Doctor
if you have:
- Severe pain in a single joint that comes on very quickly.
- Swollen, tender joints with warm, red skin over them.
It’s important to see your doctor even if the pain from gout has stopped. The uric acid buildup that caused your gout attack may still be irritating your joints. It could cause serious damage over time. Your doctor can prescribe medicines that can prevent and even reverse the uric acid buildup.
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. 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 , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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Build Muscle With Strength Exercises
Having strong muscles can protect your joint from wear and tear, especially for joints affected by gout. Beyond weight training, simple resistance exercises can be effective to build muscle. For example, try an elastic resistance band by holding each end and putting your foot in the middle, then repeat your flexibility exercises while pushing against the force of the band.
The key with any exercise after a gout flare is to go slow and listen to your body, Dr. Iversen stresses.
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Acute Attack Pain Management
Home remedies. Reducing inflammation during an acute gout attack will provide pain relief.
- Ice. Apply ice to the affected area to reduce swelling. Do not apply ice directly to the skin. Use an ice pack or wrap a towel around the ice. Apply ice for about 20 minutes at a time.
- Elevate. Frequently raise and keep the affected area above the level of the heart.
- Rest. Move the affected area as little as possible while symptoms are present.
- Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs even the over-the-counter strength be sure to check with your doctor before taking them.
Prescription medications. Your doctor may recommend a prescription-strength non-steroidal anti-inflammatory medicine such as indomethacin.
Colchicine is also given to reduce inflammation during an acute gout attack. This drug has recently been approved by the Federal Drug Administration for treatment of gout. Like all medications, colchicine has side effects that you will need to discuss with your doctor.
Your doctor may also prescribe corticosteroids for acute gout attacks. These are strong anti-inflammatory medications that can be taken either in pill form, intravenously, or injected into the painful joint. Cortisone may improve the severe inflammation very quickly.
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What Might Be Causing My Gout
Youre probably wondering what causes the urate crystals to form in the first place. Urate is an acid thats created when the body breaks down purine molecules, some of which come from food and drink. Our bodies dispose of excess purine through the kidneys. But if the resulting uric acid builds up and remains high, it can start to form those crystals.
How Long Does Gout In The Knee Last
Gout flare-ups can last for several hours at a time, but you may feel pain in your knee for days or weeks. Some people only have one flare-up in their life, while others have them several times a year.
Keep in mind that gout is a chronic condition, meaning it lasts for a long time and requires ongoing management. Dietary changes and medications can make a big difference, but youll also be at risk of having a flare-up.
Keep in mind that it can also take some time to find the right combination of diet changes and medication that works for you. Dont be discouraged if things dont seem to be improving right away.
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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.
Chronic Gout Signs And Symptoms
- Compared with the dramatic nature of acute gout pain, chronic gout pain is more of a soreness or persistent ache.
- Pain that tends to be a more continuous feeling of dull aching or soreness in the joints
- Hard white deposits or lumps under the skin, called tophi, found on the elbows, ears, or fingers.
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