Gout

In this blog post, we will delve into everything you need to know about gout, including its causes, symptoms, and diagnosis. We will also provide a detailed overview of the most effective treatment options available, including medications, dietary and lifestyle changes, and natural remedies. Whether you are experiencing gout symptoms for the first time or have been living with the condition for years, our guide is designed to give you the tools and information you need to take control of your health and start feeling better.

Gout- What causes gout Pain?

Gout is one of the most common causes of intense joint pain. This intense pain is caused by a build-up of more uric acid crystals in the joint and surrounding tissues. These crystals cause inflammation in one or more joints, which leads to intense pain.

A gout flare can occur over several hours, where a person may suffer from redness, swelling, pain, and warmth over any of their affected joints. Uric acid crystals can also form hard lumpy deposits in the skin called tophi.

Untreated gout can affect any joint. However, the small joints of the feet and hands are affected more often. Gouty form of arthritis can present with painful form swelling in the joints, most often in the feet, and most commonly affects the big toe.

What is uric acid? Why is it measured in gout?

Uric acid is a substance produced during the digestion of certain foods and drinks. People with gout might have high levels of uric acid. However, it is interesting to remember that many people with high uric acid levels do not develop gout. If you have gout, your body has increased uric acid levels in the blood and the uric acid may deposit as urate crystals in and around your joints over time. These crystals can cause inflammation of the joint leading to severe and painful gout attacks or chronic forms of arthritis.

Who is more prone to gout? What can increase your risk?

Anyone can get gout. However, the following are some of the risk factors that increase the chances of someone getting it.

A healthy diet with high quantities of red meat, seafood, shellfish, red meat, and organ meats such as liver is high in purines.
Consumption of sugary drinks and eating foods high in fructose increases uric acid levels in our bodies, making us prone to gout.
Excessive alcohol intake also has a very significant role in the risk of developing gout.
People with obesity and high blood pressure have a higher rate of gout than the average population.
Chronic kidney disease increases the risk of developing gout as the kidneys do not function properly and are not efficient in getting rid of enough uric acid from the body.
Certain medications like diuretics, especially thiazide diuretics, increase uric acid levels in our body, leading to gout.
Men are more likely to have gout than women.

When to seek medical advice? How does a doctor diagnose gout?

Most gout gets diagnosed when people visit their doctor after suffering from joint pain. Thus, you must see your doctor immediately if you have joint pain. Your doctor will ask you about your history of joint pain, examine your joints, and ask if you have current medication plans.

Your doctor may withdraw fluid from an affected joint using a needle and syringe and study the joint fluid under a microscope, looking for urate crystals. Gout is diagnosed if the doctor detects uric acid-based crystals in the affected joint. Uric-based crystals also can be found in deposits (called tophi) that can appear under the skin. Tophi occur when you have advanced gout.

Your doctor can also order blood tests to ascertain your uric acid levels. High uric acid levels with joint pain could indicate gout. Interestingly, blood uric acid levels may be normal to low during gout attacks. It should be noted that some people who do not have gout can also have increased uric acid levels. X-rays and ultrasounds are imaging studies that help assess the severity of gout.

How is gout treated?

There is no cure for gout, but treatment for it does exist. Your doctor will tailor your treatment plan based on the number of joints involved, the nature and frequency of gout attack (flare) kidney functions, and/or other health conditions.

What do you do in case of a gout flare?

If you have a gout flare, your doctor can prescribe anti-inflammatory medications, including colchicine and Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen or oral steroids depending on the number of joints and severity of the illness and coexisting medical history conditions and certain medications. These anti-inflammatory medications are effective if they are taken early during a gout attack and help to relieve pain and swelling. They are usually taken for several days to a few weeks until the gout flare has subsided.

Colchicine has been used to treat gout for many years and is very effective. However, some people can not tolerate it due to its side effects, such as nausea, vomiting, or diarrhea. Your doctor can decrease your colchicine dosage if you have side effects or have pre-existing kidney or liver disease.

For any joint inflammation, it is highly recommended to rest the affected joint and apply ice packs or cold compression to alleviate the pain.

What to do after a gout flare? Diagnosing Gout attacks.

After your gout flares have subsided, your doctor can prescribe you medications that can lower uric acid levels over time. This is particularly helpful in preventing or lessening gout attacks/flares. The target uric acid level in gout treatment is 6 mg/ dL or lower to dissolve or prevent crystals.

Your doctors may recommend taking medications to decrease uric acid levels in the body, especially those with repeated gout flares, high blood uric acid levels, or kidney stones. These medications, however, do not help the painful flares of acute gout, so gout patients should start taking them only after the acute attacks subside.

Allopurinol, followed by febuxostat (Uloric), is the most commonly used drug to reduce uric acid’s blood levels to normal. These drugs act by blocking the production of uric acid. Your doctor may choose an alternate medication regimen for you with a drug called Probenecid that utilizes the kidneys to remove uric acid from the body. It is usually prescribed for patients with good kidney functions. There are many other drugs on the market that your doctor can prescribe to treat gout. These drugs are to be taken for the long term (ranging from months to years).

When to see a rheumatologist? Medical conditions?

Gout treatment can be complex when someone has comorbidities like kidney or liver problems and is prescribed other medications. Your primary care physician can treat most instances of gout. However, your primary care physician may refer you to a rheumatologist if you have persistent gout or a medical condition like heart disease or kidney disease that limits you from taking certain gout medications. A rheumatologist can work with you, explore your medication choices, and help manage your gout flare to maintain normal uric acid levels, which will eventually help you prevent joint damage.

Medication and lifestyle changes to prevent further gout attacks

Since gout affects your quality of life, you will benefit from undertaking lifestyle changes to get your gout under control to prevent gout attacks and chronic joint pain. Here are some steps that can help you control your gout.

Take medication as prescribed and adhere to the treatment plan.
Work on losing weight if you are overweight or obese.
Limit or cut down on alcoholic drinks.
Remain hydrated. Make sure you are drinking an adequate amount of water.
Avoid or decrease intake of certain food such as red meat, seafood, and sugary drinks.