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1/12/2020 Sophia Hogg

Gout

What is Gout?

Gout is a common and complicated form of arthritis which could affect anyone. It is characterized by unexpected, serious attacks of pain, inflammation, redness and tenderness in the joints, usually the joint at the bottom of the big toe.

An attack of gout could happen unexpectedly, usually waking you up in the middle of the night with the feeling that your big toe is on fire. The damaged joint is hot, inflamed and so tender that even the weight of the sheet on it might seem intolerable.

Gout symptoms might come and go, but there are ways to manage symptoms and stop flares.

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Gout Symptoms

The symptoms of gout almost always happen unexpectedly, and usually at night. They include:

  • Intense joint pain - Gout generally affects the large joint of your big toe, but it could happen in any joint. Other commonly affected joints involve the ankles, knees, elbows, wrists and fingers. The pain is likely to be most serious within the first 4 to 12 hours after it starts.

  • Lingering discomfort - After the most serious pain subsides, some joint discomfort might last from a few days to a few weeks. Later attacks are likely to last longer and damage more joints.

  • Inflammation and redness – The damaged joint or joints become inflamed, tender, warm and red.

  • Restricted range of motion - As gout progresses, you might not be able to move your joints normally.

Gout Causes

Gout happens when urate crystals amass in your joint, causing the swelling and intense pain of a gout attack. Urate crystals could form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purine substances which are found naturally or normally in your body.

Purines are also found in specific foods, like steak, organ meats and seafood. Other foods also promote higher levels of uric acid, like alcoholic beverages, particularly beer, and drinks sweetened with fruit sugar or fructose.

Generally, uric acid dissolves in your blood and passes through your kidneys into your urine. But at times either your body produces too much uric acid or your kidneys excrete too little uric acid. When this occurs, uric acid could build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue which cause pain, redness and swelling.

Gout Diagnosis

Tests to help diagnose gout might include:

  • Joint fluid test - Your primary care physician might use a syringe to draw fluid from your affected joint. Urate crystals might be visible when the fluid is inspected under a microscope.
  • Blood test - Your primary care physician might suggest a blood test to measure the levels of uric acid and creatinine in your blood. Blood test results could be misleading, though. Some individuals have elevated levels of uric acid, but never experience gout. And some people have signs and symptoms of gout, but do not have abnormal levels of uric acid in their blood.
  • X-ray imaging - Joint X-rays could be helpful to rule out other causes of joint swelling.
  • Ultrasound - Musculoskeletal ultrasound could detect urate crystals in a joint or in a tophus. This technology is more widespread in Europe than in the United States.
  • Dual energy CT scan - This type of imaging could discover the presence of urate crystals in a joint, even when it is not acutely swollen. This test is not used routinely in clinical practice due to the spending and is not widely available.

Gout Treatment

Treatment for gout generally involves medications. What medications you and your primary care physician choose will be based on your current health and your own preferences.

Gout medications could be used to treat acute attacks and stop future attacks. Medications could also lower your risk of problems from gout, like the development of tophi from urate crystal deposits.


Medications to treat gout attacks

Medications used to treat acute attacks and stop future attacks include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) - Non-steroidal anti-inflammatory drugs (NSAIDs) include over-the-counter alternatives like ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), as well as more-powerful prescription non-steroidal anti-inflammatory drugs (NSAIDs) like indomethacin (Indocin) or celecoxib (Celebrex).
    Your primary care physician might prescribe a higher dose to prevent an acute attack, followed by a lower daily dose to stop future attacks. Non-steroidal anti-inflammatory drugs (NSAIDs) carry risks of stomach pain, bleeding and ulcers.
  • Colchicine - Your primary care physician might suggest colchicine (Colcrys, Mitigare), a type of pain reliever which effectively lowers gout pain. The drug's effectiveness might be offset, although, by side effects like nausea, vomiting and diarrhea, particularly if taken in large doses. After an acute gout attack resolves, your primary care physician might prescribe a low daily dose of colchicine to stop future attacks.
  • Corticosteroids - Corticosteroid medications, like the drug prednisone, might control gout swelling and pain. Corticosteroids might be in pill form, or they could be administered into your joint. Corticosteroids are usually used only in people with gout who cannot take either non-steroidal anti-inflammatory drugs (NSAIDs) or colchicine. Side effects of corticosteroids might include mood changes, increased blood sugar levels and high blood pressure.

Medications to stop gout complications

If you experience many gout attacks each year, or if your gout attacks are less frequent but especially painful, your primary care physician might suggest medication to lower your risk of gout-related complications. If you already have proof of gout damage on joint X-rays, or you have tophi, chronic kidney disease or kidney stones, medications to lower your body's level of uric acid could be suggested. Alternatives include:

  • Medications which restrict uric acid production – Medications otherwise known as xanthine oxidase inhibitors (XOIs), including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), control the amount of uric acid your body produces. This might reduce your blood's uric acid level and lower your risk of gout. Side effects of allopurinol involve a rash and low blood counts.
    Febuxostat side effects involve rash, nausea, reduced liver function and an increased risk of heart-related death.
  • Medication which improves uric acid removal - These medications, known as uricosurics, include probenecid (Probalan) and lesinurad (Zurampic). Uricosuric medication improves your kidneys ability to remove uric acid from your body. This might reduce your uric acid levels and lower your chance of gout, but the level of uric acid in your urine is elevated. Side effects involve a rash, stomach pain and kidney stones. Lesinurad could be taken only along with an XOI.

If you or anyone you know is suffering from gout, the expert providers at Specialty Care Live will take care of your health and help you recover.

Call 469-805-4561 to book a telehealth appointment for an at-home check-up. You can request a callback from us too.