About gout (gouty arthritis)

What is gout (gouty arthritis)?

Gout is a type of arthritis that causes inflammation, usually in one joint, that begins suddenly.

  • Gouty arthritis is caused by the deposition of crystals of uric acid in a joint.
  • Gout can cause symptoms and signs such as
    • nodules under the skin called tophi,
    • joint redness,
    • swollen joints,
    • joint pain,
    • warmth of the joint.
  • The most reliable method to diagnose gout is to have fluid removed from an inflamed joint and examined under a microscope for uric acid crystals.
  • Chronic gout is treated using medications that lower the uric acid level in the body.
  • Left untreated, gout can cause irreversible joint damage, kidney problems, and tophi.
  • Triggers for gout attacks include surgery, dehydration, beverages sweetened with sugar or high fructose corn syrup, beer, liquor, red meat, and seafood.
  • Cherries may help prevent gout attacks.

What is gout?

Gout is a type of arthritis that causes sudden joint inflammation, usually in one joint. Severe gout can sometimes affect many joints at once. This is known as polyarticular gout.



What are the symptoms for gout (gouty arthritis)?

Tenderness. symptom was found in the gout (gouty arthritis) condition

Gout causes intense pain and swelling around one or more joints. Gout most commonly affects the joint at the base of the big toe.

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

  • Intense joint pain. Gout usually affects the big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
  • Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
  • Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
  • Limited range of motion. As gout progresses, you may not be able to move your joints normally.



What are the causes for gout (gouty arthritis)?

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.

Purines are also found in certain foods, including red meat and organ meats, such as liver. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout and tuna. Alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose) promote higher levels of uric acid.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.



What are the treatments for gout (gouty arthritis)?

When should gout be treated?

Changes in lifestyle, such as limiting foods associated with gout, should be initiated in anyone who has had gouty attacks. Treatment of gout with medications is necessary when frequent disabling gouty attacks occur, when kidney stones caused by uric acid are present, when there is evidence of joint damage from gout on X-rays, or when tophi are present. Treatment should be individualized to the patient.

What is the treatment for gout?

When gout is mild, infrequent, and uncomplicated, it can be treated with diet and lifestyle changes. 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.

Medications for the treatment of gout generally fall into one of three categories: uric-acid-lowering medications, prophylactic medications (medications used in conjunction with uric-acid-lowering medications to prevent a gout flare), and rescue medications to provide immediate relief from gout pain.

Uric-acid-lowering medications are the primary treatment for gout. These medications decrease the total amount of uric acid in the body and s lower the serum uric acid level. For most patients, the goal of uric-acid-lowering medication is to achieve a serum uric acid level of less than 6 mg/dl. These medications also are effective treatments to decrease the size of tophi, with the ultimate goal of eradicating them. Uric-acid-lowering medications include allopurinol (Zyloprim, Aloprim), febuxostat (Uloric), probenecid, and pegloticase (Krystexxa).

Prophylactic medications are used during approximately the first six months of therapy with a uric-acid-lowering medication to either prevent gout flares or decrease the number and severity of flares. This is because any medication or intervention that either increases or decreases the uric acid level in the bloodstream can trigger a gout attack. Colcrys (colchicine) and any of the NSAIDs (nonsteroidal anti-inflammatory drugs) such as indomethacin (Indocin, Indocin-SR), diclofenac (Voltaren, Cataflam, Voltaren-XR, Cambia), ibuprofen (Advil), or naproxen sodium are frequently used as prophylactic medications to prevent gout flares during uric-acid lowering. By taking one of these prophylactic or preventative medications during the first six months of treatment with allopurinol, febuxostat, or probenecid, the risk of having a gout attack during this time is decreased. Prophylactic medications are not used in combination with Krystexxa.

The third category of medications are those used during an acute gout attack to decrease pain and inflammation. Both colchicine (Colcrys) and NSAIDs can be used during an acute gout attack to decrease inflammation and pain. Steroid medications, such as prednisone and methylprednisolone (Medrol), also can be used during an acute gouty flare. However, the total dose of steroids is generally limited due to potential side effects such as cataract formation and bone loss. Steroid medications are extremely helpful in treating gout flares in patients who are unable to take colchicine or NSAIDs.

Do gout medications have any side effects?

  • Gout medications are well tolerated by most people. However, like other medications, they have potential side effects. Allopurinol is well tolerated by most people, but in some people, it can cause an allergic rash. Very severe rashes rarely can occur after taking allopurinol, and any allergic type rashes that develop while a patient is taking allopurinol are taken seriously.
  • Allopurinol is well tolerated by most people, but in some people, it can cause an allergic rash. Very severe rashes rarely can occur after taking allopurinol, and any allergic type rashes that develop while a patient is taking allopurinol are taken seriously.
  • Colchicine (Colcrys) can cause nausea, diarrhea, and rarely muscle weakness and abnormal blood counts.
  • 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.
  • Febuxostat (Uloric) can cause liver abnormalities, nausea, and rash.
  • NSAIDs can cause irritation of the stomach and ulcers in some cases. The liver and the kidneys are periodically monitored in patients taking NSAIDs over the long term.
  • Krystexxa is administered as an intravenous infusion. Severe allergic reactions have been reported in a minority of people receiving Krystexxa.

What foods should people with gout avoid?

Uric acid is formed when proteins in the food we eat, called purines, are broken down. Therefore, there has been a great deal of interest in dietary management of gout by avoiding foods high in purines. However, a diet very low in purines is extremely difficult to follow, because purines are a natural part of many healthy foods. Even when a diet very low in purines is followed strictly, the uric acid level in the bloodstream is only slightly lowered.

The following dietary principles are important in the management of gout:

  • Gout is associated with obesity, and significant weight loss can dramatically improve the management of gout. A calorie-reduced diet is helpful for weight loss.
  • A diet low in saturated fat, with increased protein and replacement of refined carbohydrates (for example, sugar, white bread, potatoes) with complex carbohydrates (such as vegetables and whole grains) reduces the serum uric acid.
  • Decreased consumption of seafood and red meat.
  • The consumption of low-fat dairy products decreases the risk of gout.
  • Drinking beer and liquor increase the risk of gout. However, drinking wine does not appear to increase the risk of gout.
  • In one study, consumption of fresh cherries was associated with a 35% decreased risk of gout. Some people believe that black cherry juice or dried cherries have the same effect, but this has not been proven.
  • Drinking beverages sweetened with sugar or high fructose corn syrup increases the risk of gout.



What are the risk factors for gout (gouty arthritis)?

You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

  • Diet. Eating a diet rich in red meat and shellfish and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.
  • Weight. If you're overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.
  • Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases.
  • Certain medications. Low-dose aspirin and some medications used to control hypertension — including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers — also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
  • Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.
  • Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women's uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
  • Recent surgery or trauma. Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, receiving a vaccination can trigger a gout flare.



Is there a cure/medications for gout (gouty arthritis)?

Gout (gouty arthritis), a rheumatological disease, can be cured.

  • Gout is characterized by painful redness and swelling of the affected joints that occurs through the deposition of uric acid crystals in joints as a result of hyperuricemia.
  • Gout is an extremely painful and incapacitating disease but is extremely treatable in almost all patients.
  • It is important to identify and treat it early to avoid pain and complications.
  • When there is an increase in the level of uric acid in the blood, sharp crystals of uric acid accumulate in and near joints, causing swelling and pain in the affected joints.


People are susceptible to gout if they have-

  • High BMI or Obesity
  • Congestive heart failure
  • Diabetes
  • Family history of gout
  • Hypertension
  • Kidney disease
  • Medications along with changes in diet and lifestyle are used to manage the symptoms of gout.
  • Some drugs like NSAIDs, Colchicine and corticosteroids are useful in controlling the symptoms of gout.


However, a change in lifestyle and habits goes a long way in managing the disease -

  • Drink plenty of water
  • Exercise regularly to reduce weight
  • Limit the use of alcohol, red meat and shellfish
  • Drink fresh, unsweetened fruit juice
  • Restrict the amount of animal meat in the diet


Symptoms
Intense pain,Redness,Stiffness,Swelling,Tenderness.
A sensation of burning in the affected joint
Conditions
Hyperuricemia,Obesity,Congestive heart failure,Diabetes,Family history of gout,Hypertension,Kidney disease
Drugs
NSAIDs,Colchicine to reduce inflammation and pain,Corticosteroids can relieve pain and swelling,Allopurinol,Febuxostat,Pegloticase injectible,Probenecid,Changes in diet and lifestyle



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