What Can Trigger An Attack
Several thingscancause the crystals to shakelooseinto your joint cavity, triggeringan attack. These include:
- a knock or injury to the joint
- an illnessthat gives you a fever
- havingan operation
- having an unusually largemeal, especially a fatty meal
- drinking too much alcohol
- startingurate lowering therapy, especially at a high dose, or not taking your ULT regularly each day.
Why Do I Get Gout Attacks
Gout occurs when theres too much uric acid in your blood . The resulting crystals of uric acid build up inside and around joints like your big toe or fingers. These crystals cause an inflammatory reaction that leads to sudden attacks of intense pain and swelling called acute gout flares as well as long-term problems such as joint destruction .
Am I At Risk Of Having Gout
Youre more likely to have a gout attack if you:
- have a family history of gout
- have elevated levels of uric acid in the blood
- drink too much alcohol
- eat a diet high in purines such as meat, sweetbreads, offal, shellfish, and fructose
- are overweight or obese
- have type 2 diabetes, high blood pressure or high cholesterol these conditions can mean that your kidneys are less able to flush out the urates
- have kidney disease
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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 it’s more common after menopause. It’s 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.
How Do I Prevent Gout
Preventing gout means addressing the cause of your uric acid build-up as well as any personal risk factors identified by your healthcare team. This means investigating any metabolic disorders and kidney function, as well as promoting lifestyle measures like diet and exercise. Your doctor may also put you on urate-lowering therapy, which looks to medically manage your urate levels to help reduce the likelihood of a flare.
Here at My FootDr, we help our patients by providing them with the right tools and support to maximise their comfort for when their flares do arise. Many of our patients must still continue to work during their flare, and when your occupation involves being on your feet , having some offloading to give you relief by redistributing the pressure away from the big toe and to the lesser toes can make a big difference to your quality of life and ability to work.
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If you havegout, youre all too familiar with the sudden, burning joint pain that a gout attack can bring on most commonly in the big toe.
Gout a type ofarthritis is caused by too much uric acid in the blood. Usually, having an excess of uric acid isnt harmful. In fact, many people with high levels in their blood never get gout. But when uricacid levels in your blood are too high, the uric acid may form hard crystals in your joints.
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 You Can Do To Prevent Gout
Along with being painful and reducing your quality of life, untreated recurrences of gout can lead to complications, such as permanent damage to your toe joint. If youre at an increased risk of developing gout or have previously experienced an episode of gout, you can take the following preventative steps.
Treatment: Acute Gout Attack
Acute attacks of gout and long-term treatment of gout and hyperuricemia require different approaches. Treatment usually involves medication. After the first attack, some health care providers advise patients to keep a supply of medicines on hand to take at the first sign of symptoms of a second attack.
Treatments are prescribed for conditions associated with gout, including uric acid nephropathy and uric acid nephrolithiasis.
Supportive measures include applying ice and resting the affected joint.
Many patients do not require medication. Often lifestyle and dietary measures are enough to prevent attacks. Measures include not eating foods high in purines, not drinking alcohol, and maintaining a healthy weight.
Medicines for gout attacks are aimed at relieving pain and reducing inflammation. These include:
- Nonsteroidal anti-inflammatory drugs
These medicines may be combined to treat a gout attack.
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Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
Themostcommon drugtreatments for attacks of gout are:
Some people will be better suited to NSAIDS, while for others NSAIDs cannot be used. But your preference is also taken into consideration.Many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treatedwith NSAID tablets, which can help with pain andreduce some of your inflammation. Naproxen, diclofenac,and etoricoxibare three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on.Your doctor may let you keep a supply soyou can start taking them at the first signsof an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicineisnt apainkiller.Butcan be very effective at reducing theinflammation caused by urate crystals.
You should avoid taking colchicine if you have chronic kidney disease.
Why Have I Developed Gout
If youre suffering from gout, it means that needle-like crystals have formed in the affected joints, which have caused the joint to swell. As were sure you can imagine, this is extremely painful anytime that joint is moved especially when you take a step and your foot naturally bends up on your big toe like this:
The cause of the crystals is a high concentration of uric acid, known as hyperuricemia, in the blood. Uric acid builds up in two primary ways:
Not everyone with hyperuricemia will develop gout in fact, only approximately 10% of people will, and the reason why some people with high uric acid levels develop gout and others dont is not well understood. What is known is that 80-90% of people with gout have hyperuricemia.
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How Hyperuricemia And Gout Develop
Metabolism of Purines
The process leading to hyperuricemia and gout begins with the metabolism, or breakdown, of purines. Purines are compounds that are important for energy. They are part of the nucleic acids that are present in all cells of the body. Purines can be divided into two types:
- Endogenous purines are produced within human cells.
- Exogenous purines are obtained from food.
The process of breaking down purines results in the formation of uric acid in the body. Most mammals, except humans, have an enzyme called uricase. Uricase breaks down uric acid so it can be easily removed from the body. Because humans lack uricase, uric acid is not easily removed and can build up in body tissues.
Uric Acid and Hyperuricemia
Purines in the liver are converted to uric acid. The uric acid enters the bloodstream. Most of the uric acid goes through the kidneys and is excreted in urine. The remaining uric acid travels through the intestines where bacteria help break it down.
The enzyme responsible for production of uric acid from purines is xanthine oxidase. This enzyme is the target of urate-lowering treatments such as allopurinol.
Normally these processes keep the level of uric acid in the blood below 6.8 mg/dL. But sometimes the body produces too much uric acid or removes too little. In either case, the level of uric acid increases in the blood. This condition is known as hyperuricemia.
How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
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Information About Medicines For Gout
Starting medicines which lower uric acid can set off an attack of gout. You should work with your doctor to learn which medicines and dosages may cause gout flare-ups. In general, it is best to increase the dose slowly over many weeks. Also, you may need a medicine such as colchicine to prevent gout flares for the first several months after starting the urate-lowering medicine. Your uric acid should be lowered to less than 6.0 mg/dL, and sometimes less than 5.0 mg/dL. Gout medications may interact with other drugs. Most people with gout will need to take the urate-lowering medicine for the rest of their life.
Stigma And Mental Health
Gout has for centuries been associated with excess and is the butt of innumerable jokes. That stigma, along with fear of another painful flare, can increase stress and contribute to more inflammation in your body. Like other forms of arthritis, inflammation in gout is associated with a slightly increased chance of depression, especially in people who have frequent flares.
If you feel down or discouraged, dont be embarrassed to talk about gout to your friends and family. And keep in mind that regular exercise, restorative sleep and healthy food can go a long way toward improving your mood. The better your mood and outlook, the more able youll be to manage gout.
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How You Can Manage And Prevent Foot Gout
Regardless of whether you have ever suffered from gout, you should know that managing the condition is not as simple as taking medication during a flare-up. You should talk with your healthcare provider about your lifestyle, diet, and overall health.
You may need to make changes in your lifestyle to prevent recurrence. You should always keep personal records of gout attacks to discuss with your doctor.
Exercising, eating healthy, maintaining an average weight, and avoiding things that increase your uric acid levels are all essential to preventing and managing gout.
How Can I Manage My Gout And Improve My Quality Of Life
Gout affects many aspects of daily living, including work and leisure activities. Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout.
For gout in particular:
- Eat a healthy diet. Avoid foods that may trigger a gout flare, including foods high in purines , and limit alcohol intake .
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms. These can help with gout as well.
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How Is Foot Gout Diagnosed
If you are experiencing sudden bouts of intense pain in your joints, or if you feel you are experiencing the symptoms of foot gout, you should see your doctor immediately. Early detection can improve your chances of catching the gout during its early stages and successfully treating the condition.
Your doctor will perform a number of tests on you and ask questions about your family history, medical history, personal habits, and diet. He or she may also perform a joint fluid test. During this test, a needle is used to draw fluid from your affected joint for analysis. Your doctor may also order a blood test to measure your uric acid levels.
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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Medications For Gout Attacks
To treat gout attacks and to prevent future ones, you doctor may recommend these medications:
Nonsteroidal anti-inflammatory drugs
Colchicine is a medication that your doctor may prescribe based on its proven effectiveness in reducing heel gout pain.
If NSAIDs or colchicine arent appropriate for you, your doctor might recommend corticosteroid medications, either in pill form or via injection, to control inflammation and pain.
An example of this type of medication is prednisone.
Podiatry Care Helps You Manage Gout
If youre in the middle of a gout flare-up or have a history of gout, Dr. Rambacher can help you find solutions. He can help you reduce pain during a gout episode, manage secondary issues that arise from gout , and prevent future flare-ups.
Relieve the discomfort and pain gout causes, and make sure you never experience gout again by making an appointment with Podiatry Hotline Foot and Ankle in Mission Viejo, CA. You can schedule your appointment online or by calling the office.
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