What Is Gout And How To Treat – Here’s what to expect at each stage of the disease and how to prevent gout from getting worse in the first place.
Gout is a type of inflammatory arthritis that occurs when levels of uric acid — a normal byproduct of metabolic reactions in your body — become too high. When uric acid levels become so high that your body cannot easily dissolve and excrete it (through urine), uric acid crystals begin to form. Uric acid crystals accumulate in the joints where they cause severe inflammation. The big toe is a well-known site of gout attack, but gout can affect various joints throughout the body.
What Is Gout And How To Treat
Gout is one of the oldest recorded diseases, with records dating back to ancient Egypt. This incredibly painful arthritis affects millions of American adults today, as it did in historical times, as memorably described by Dr. Thomas Sydenham in the 17th century:
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“The victim goes to bed and sleeps soundly. Around 2 p.m., he awoke with a sharp pain in his thumb; rarely in ankles, ankles, or feet… The pain, which was moderate at first, becomes more severe… Meanwhile, the sensation of the affected part is so delicate and vivid that it cannot bear the weight of a person’s bed sheet or across a room. Can tolerate walking.”
Fortunately, gout is one of the most treatable forms of arthritis today — some rheumatologists say it can be cured. But for many patients with gout, the disease goes untreated or untreated. For example, in a recent study, only 37 percent of people with gout took the uric acid-lowering drug allopurinol; Among gout patients with frequent flare-ups, only half received it.
If gout is not treated properly, the disease can become more progressive. Over time, gout can affect more joints throughout the body, causing problems like gouty tophi and permanent bone loss.
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Learn more about how gout develops, how gout progresses through the different stages, and how to treat gout to prevent symptoms, lower uric acid levels, and prevent long-term gout complications.
Also called asymptomatic hyperuricemia, in this early stage of gout, uric acid builds up in the blood and usually begins to form crystals around the joints of the feet.
Uric acid is formed when your body breaks down substances called purines, which are produced in your body and also found in some foods and drinks. Although eating purine-rich foods may contribute to high uric acid levels, many experts believe that the role of diet in the development of gout is overestimated. Chronically high levels of uric acid occur when your kidneys are unable to efficiently get rid of uric acid, which can happen for a number of reasons, including:
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“In this early stage of gout, the person has no joint pain, no red or swollen joints, just an elevated uric acid blood test,” says Theodore R. Fields, MD, FACP, is a rheumatologist at the hospital’s Department of Special Surgery. York City. “This is when uric acid or urate crystals collect in the joints and can later cause inflammation.”
But high uric acid alone is not enough to diagnose gout. “Most people with hyperuricemia never develop clinical gout,” says Alireza Mesami, FACR, FACP, MD, a rheumatologist at Henry Ford Health System in Michigan.
“It occurs when a person has pain, redness, and swelling in a joint, usually in the big toe, foot, ankle, or knee, but gout can also start in other joints,” says Dr. the field “This is when urate crystals are released into the joint fluid and trigger an inflammatory response, bringing in lots of white blood cells and releasing inflammatory chemicals that cause pain, redness and swelling.”
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If you think you’re having a gout attack, see your primary care physician or rheumatologist to start treating the disease. It is important to see a doctor during a gout attack, as your doctor may want to remove fluid from the affected joint and look at it under a microscope to check for the presence of uric acid crystals. Detecting uric acid crystals in the joint fluid helps confirm a gout diagnosis.
After a first gout attack, 75 percent of people will have a second one within a year; But some people can go years for another attack, Dr. the field The intermediate stage is “where a person has already had a gout attack, but does not currently have joint pain or swelling,” he says. “Almost all gout patients will go through this stage because the nature of gout is to flare up and then settle down for a while before the next flare-up.”
Although it may seem like nothing is wrong, this is the point at which patients should begin long-term treatment. Lowering uric acid levels with medication can prevent future gout attacks and long-term complications.
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This stage is also called “topfus gout” because uric acid can build up and form nodules called “toffees”, often on the tip of the big toe or on the elbow. But tophi can form anywhere on the body. “At this stage, a person almost always has joint pain from gout,” says Dr. the field “It usually takes many years of uncontrolled gout for a person to get to this stage.”
At this stage there is progressive damage to the joint, so gout patients should be treated before this starts to happen. “A delay in treatment can make gout worse,” says Dr. Maysami
As you become more familiar with the symptoms of gout, you may be able to sense that a gout attack is imminent. “Increased pain, swelling, redness and warmth in the affected joint during an attack are signs of the attack progressing,” says Dr. Maysami
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Also, the disease typically “progresses with repeated or more frequent gout attacks of longer duration, more joint involvement, and the appearance of tophi,” says Dr. Maysami
If you have multiple gout attacks each year, it’s important to take gout medication regularly, says Dr. the field
Without treatment, gout will usually progress. In addition, some factors can trigger gout attacks. “Anything that causes urate levels to go up or down suddenly can cause gout,” says Dr. the field
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This can include eating foods rich in purines, which break down into urates, such as red meat and shellfish. Foods rich in fructose can increase the body’s production of urate. Alcohol reduces the excretion of uric acid in the urine, which can lead to elevated uric acid levels. Specifically, “beer not only has an alcohol effect on urinary uric acid, but also contains protein that breaks down into purines and then urates, so it raises urates in two ways,” says Dr. the field
While you may want to limit high-purine foods to prevent flare-ups, both doctors we interviewed said diet alone isn’t enough to control gout. “Strict dietary restrictions on purines are rarely recommended, because they reduce serum [blood] urate levels by about 1 mg/dL, which is not enough for most patients,” says Dr. Mesemi.
Gout was once called the ‘disease of kings’, but it was mistakenly believed to be caused only by tempting foods and drinks. “Gout is a genetic disease — where your body puts too much urate in your urine or makes too much urate — and is not a nutritional disease,” says Dr. the field “Watching your diet can certainly help with gout attacks, but you almost always need medication to prevent a genetic predisposition to gout.”
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So if you find that certain foods trigger gout symptoms, avoid them. “Alcoholic beverages or rich foods can trigger gout attacks in some patients, and individual patients should avoid triggers that are known to trigger attacks,” says Dr. Mesemi.
However, one of the risk factors for gout is obesity. In fact, gout has become more common in recent times, possibly due to rising levels of obesity. “Those who are obese will have a greater urate-lowering effect than a purine-free diet when losing weight,” says Dr. Mesemi. To that end, a healthy diet and exercise can help you lose weight and reduce your chances of disease progression.
Stress can also trigger gout attacks. So there can be physical trauma to the foot (such as occurs while running), which can release some of the crystals and trigger an inflammatory response.
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“We don’t discourage people with gout from running or doing other exercises,” says Dr. the field “But if someone has a gout attack in the foot, ankle or knee, we recommend staying off the foot as much as possible because further trauma to the joint with a gout attack can prolong the flare.”
Starting a treatment regimen may inadvertently trigger a flare-up; But other drugs can be given to reduce this risk.
Fortunately, due in part to its long history, gout is one of the most well-understood and medically treatable forms of arthritis.
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