Are you suffering from gout attacks? In this video you will get a complete A-Z overview
of gout . Coming up.
What is Gout?
Gout is a type of arthritis. It is caused by increased levels of uric acid in your blood.
Uric acid is formed when your body breaks down purines. Purines are substances found
in your animal and plant foods. When you have too much uric acid in your blood, your kidney
is not able to get rid of it. This condition is also called hyperuricemia. This causes
crystals of uric acid to form and build up in your joints. It usually tends to affect
your big toe joint. As the disease progresses, other joints can be involved. The accumulation
of these crystals causes pain and swelling in the affected joints.
If these crystals build up in the smaller tubes of your kidney, they can form kidney
stones and cause an obstruction in the flow of your urine.
What are typical gout symptoms?
You will experience pain, redness and swelling of the affected joint. These gout attacks
come on suddenly. Most often they start at nighttime or even in the early morning hours.
They can, however, start any time of the day. Classically, your big toe gets affected. Some
individuals can have several joints which are affected. Your pain can increase with
intensity and reaches its peak within 12-24 hours. In the next couple of days and sometimes
weeks your pain should improve. The reason you have pain is because your body
sees these crystals as foreign bodies and an inflammatory reaction is set off to get
rid of these foreign bodies. These chemical cascades release several substances causing
redness, pain and swelling in your joint or joints. Initially, if you have a gout attack
it only involves a single joint. Overtime, especially if your gout goes untreated multiple
joints can be involved. The joints affected can be your knees, toe joints and ankles.
Between the gout attacks you can have longer periods of no symptoms and these can last
weeks, months and even years. The problem that can arise is that if your gout goes untreated
over several years not only will the time between gout attacks shorten, however, several
joints can be involved. What happens if you have a longstanding history
of high uric acid? (Hyperuricemia) You develop a form of gout called tophaceous
gout. In this form of gout, uric acid crystals in masses also called “tophi” accumulate
in various areas of your body including in multiple joints, tissues, bones, cartilage
and even under the skin. Under the skin they look like nodules. Tophi can cause damage
to your bones and cartilage resulting in deformities of your joints.
What happens to your kidney if you have gout? You can have an accumulation of urate crystals
which build up in your kidney or even in the urinary tract. This leads to the formation
of kidney stones. This can lead to an obstruction of the ureter (which are the tubes which lead
from the kidney to the bladder). If you are interested in a video looking at kidney stones,
click on this link above.
What are the risk factors of gout? These include obesity
HTN Diabetes
Congestive heart failure Poor kidney function (chronic kidney disease)
Using medications such as water pills (HCTZ, LASIX)
Drinking alcohol regularly & excessively Having a diet high in purine rich foods. Here
you will see listed some of them and by no means is this list exhaustive.
Consuming large amounts high fructose syrup
in the form of drinks or food Prolonged fasting
Eating large amounts of meat and seafood (sardines, trout, tuna). These purine rich foods which
the body beaks down into uric acid
How is Gout diagnosed?
This requires a thorough history and physical examination by your health care provider including
a detailed look and you’re eating and drinking habits as well as studying your medication
list. Other tests which can be done are x-rays as
well as lab tests looking at uric acid levels. Having said that a uric acid level during
a gout flare up is difficult to interpret as the level during an acute attack can be
low, normal, or high. It is more diagnostic two or more weeks after a gout attack.
The most accurate diagnosis would be examining the fluid in your joint. Your health care
provider will remove small amount of fluid from inside your joint using a needle and
syringe under aseptic conditions. Urate crystals can be then examined under the microscope.
What is the fastest way to get rid of gout?
Choice of medication will depend on several factors including your previous history and
treatment of gout, your kidney function, bleeding history and history of stomach ulcers.
NSAIDS such as Ibuprofen, naproxen, indomethacin, or celecoxib are used as anti-inflammatory
medications to reduce the swelling of the joint. They are most effective the earlier
they are started during a gout attack. However, NSAIDS are generally not recommended in older
adults given the side effects of these medications. NSAIDS are also not recommended if one of
these applies to you: on blood thinners (like warfarin), bleeding history, stomach ulcers,
liver, or kidney disease. Here is a video looking at the question Is it safe to take
Ibuprofen every day?
Another medication which can be used instead is Colchicine. This medication should be started
within 24 hours of a gout attack. The dosing is different if you are using Colchicine for
an acute attack or for prophylaxis: During an acute attack your health care provider
can start you on 1.2mg followed by 0.6mg after one hour. Other health care providers prefer
to give the medication three times a day during an acute attack. The dosing would be 0.6mg
there times daily. The worst pain is on that first day and this can be followed on day
2 by reducing the dose to 0.6mg twice daily.
If you are using Colchicine prophylactically your dose is 0.6mg daily or twice daily. Usually,
the dose is kept lower to reduce the possibility of GI side effects. Colchicine is not intended
to be used long term as it serves more as a bridge before you are placed on a longer
term therapy .You stay on this medication for about 3-6 months until your urate level
have stabilized.
If you have kidney disease, your health care provider will adjust the dose of the medication.
The side effects of colchicine for some individuals are GI in nature: diarrhea, nausea, vomiting,
abdominal pain.
Another medication which can be used are steroids. The steroids (Prednisone, prednisolone, methylprednisolone)
can be given in form of pills. If other interventions are ineffective or contraindicated steroids
can be injected into a single joint.
Long term strategies with medications.
Here there are two choices Allopurinol(brand names are Alloprim, Zyloprim) and febuxostat
( brand names are Uloric, Adenuric). Allopurinol works by reducing the amount of urate produced
in your body. The usual recommendation is to continue with this medication indefinitely
as sometimes stopping the medication can lead to a recurrence of gout. The goal is for your
serum urate level to be less than 6.0 mg/dl and in patients who have tophi less than 5.0mg/dl.
If you have kidney problems the starting dose of Allopurinol will be adjusted by your health
care provider. The starting dose for febuxostat is 40mg daily, it can be increased to 80mg
daily if your goal urate levels are not reached.
Other medications (I am listing them to the side) which can be used are Probenecid, Lesinurad
and Pegloticase. All of them have urate lowering properties and have specific indications.
Fourteen Lifestyle changes to crush gout! Every single study associated with these tips
are listed in the description for further reading.
1) Weight loss is encouraged, as obesity is a risk factor. Just losing weight has shown
to lower uric acid levels 2) Cut out or limit intake of sugary drinks
3) Stop any medications which can provoke
gout like thiazide diuretics 4) Earlier in this video I mentioned if you
ingest purine rich foods you are at a risk for a gout attack. The advice will be to reduce
or avoid these foods. 5) The approach nowadays is to follow a healthier
diet, plant-based diet rich in vegetables and fruits, whole grains, reduced saturated
fat and lean source of meat such as chicken or turkey. Yes, there is research to show
that certain vegetables which are high in purines such as spinach or asparagus DO NOT increase
having gout attacks. 6) Encourage the intake of water
7) Intake of low-fat dairy products in the context of a DASH diet has been shown to be
helpful in lowering uric acid levels. 8) Studies have shown that Vitamin C lowered
uric acid levels. Vitamin rich foods such as citrus fruits, peppers, and strawberries.
9) Intake of cherries has been associated
with decreased gout attacks. 10) Intake of dietary and supplemental omega
3 polyunsaturated fatty acids have also shown to decrease uric acid levels.
11) Dietary fiber and folate , yes that helps too.
12) Following the DASH diet (dietary approach to stop hypertension) a diet rich in fruits
and vegetables and low fat diary products is also encouraged to manage your gout.
13) It goes without saying to avoid or minimize alcohol intake
14) There has been some research to suggest drinking coffee is beneficial in lowering
uric acid levels Please take in coffee in moderation.And don't drink coffee TOO late!
Have a good day and Think your Health.