Do I Need To Stop Eating Meat If I Have Gout
No, but practice moderation, Dr. Burg reiterates. Avoid organ meats such as liver because they have higher levels of purines, which can cause flare-ups. Moderate intake of lean meats such as chicken and turkey should not affect your condition. Seafood such as shrimp and lobster tends to be higher in purines, though, so dont make it a regular part of your diet.
If You Have Rheumatoid Arthritis Avoid Soda And Other Sugary Beverages
Add rheumatoid arthritis to the long list of conditions that are made more difficult to manage by eating a diet high in added sugar. In a 2018 study published in Arthritis Care & Research, researchers polled 217 individuals with RA about the ways 20 common foods affected their RA symptoms. Sugar-sweetened soda was the most troublesome food, with 12.7 percent of respondents saying it worsened their symptoms. Desserts came in as a close second, with 12.4 percent of respondents linking sweet treats to RA flare-ups.
Another study, published in 2014 in The American Journal of Clinical Nutrition, tried to determine if drinking sugar-sweetened soda increased risk for developing RA in women. They followed nearly 187,000 women for an average of 18 years. The researchers found that women who consumed one or more sugary sodas a day had a 63 percent increased risk for developing seropositive RA. This is the most common type of RA, in which a blood test detects antibodies the immune system produces against body tissue . Soda consumption appeared to have no impact on potential for developing seronegative RA, the other main form of RA in which antibodies cant be detected but an individual still has RA symptoms.
What Does A Gout Attack Look And Feel Like What Would A Foot Or Toe With Gout Look Like
When gout occurs, the joint tends to be extremely painful and is warm, red and swollen . The inflammation that is part of a gout attack is systemic, so that fever and chills, fatigue and malaise are not uncommonly part of the picture of a gout attack.
Figure 6: Toe with Acute Attack of Gout
Gout attacks can occur in joints that look normal, or in joints that have easily visible deposits of uric acid. These deposits are called tophi and can be in numerous locations, but especially on the feet and elbows. In Figure 9, the little finger of the right hand is bandaged since fluid was just removed from it, which demonstrated innumerable uric acid crystals.
Figure 7a: Tophi on Foot
Figure 7b: Tophus Over Achillesâ Tendon
Figure 8: Tophus on Elbow
Figure 9: Tophi on Hands
Figure 10: Large Tophus of Finger
While some gout attacks will solve quickly by themselves, the majority will go on for a week, several weeks, or even longer if not treated. Since gout attacks are usually quite painful and often make walking difficult, most gout sufferers will request specific treatment for their painful condition.
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Which Foods Should You Avoid When You Have Gout
Purines are compounds that are found in specific food and drink and they change to uric acid in the body. Most meat and seafood are high in purine and can increase uric acid levels in the body. These therefore should be limited during episodes of a gout attack and portion size should be reduced. Common examples of foods high in purine include anchovies, sardines, offal foods such as liver, kidney, sweetbreads, game, goose, minced meat, mussels, partridge, roe, scallops, herring, gravies, stock cubes and meat and yeast extracts.
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Common Symptoms Of Gout
Pain that migrates: Gout usually affects the big toe, but it can also occur in the ankles, knees, elbows, wrists, and fingers. The symptoms are rarely symmetrical, and the location varies from flare to flare. For example, an attack in the left big toe might be followed by an attack in the right toe, and the next gout attack might strike one of the knees or wrists.
Fever: People with RA do sometimes experience a fever, but its much more commonly seen in those with gout, says Dr. Portnoff: The burden of inflammation in a gout flare and the bodys robust response to it can be so great that it causes a fever.
Tophi: Over time, people with chronic gout can develop tiny, hard lumps in the affected joints. These lumps, called tophi, are concentrations of uric acid crystals. They can also form in the kidneys and lead to kidney stones.
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Is It Gout Or Something Else
The pain and redness of gout can look like an infection or other conditions.
- Pseudogout is another form arthritis. The crystals formed in this condition are made of calcium pyrophospate, not uric acid. But like regular gout, the attack comes on all of a sudden. Joints become swollen, warm, painful, and stiff.
- Reactive arthritis is a reaction to infection that has similar signs.
- Psoriatic arthritis and infectious arthritis can look like gout, too.
The Four Stages Of Gout
Gout is best understood by seeing it as having four phases or stages :
Stage 1: High uric acid
Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.
Stage 2: Acute flares
This stage is marked by acute gout attacks causing pain and inflammation in one or more joints.
Stage 3: Intercritical periods
These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks.
Stage 4: Advanced gout
This is a stage of chronic gouty arthritis, in which there are lumps of uric acid, or tophi , frequent attacks of acute gout, and often a degree of pain even between attacks .
Figure 1: Stages of Gout
Figure 2: Illustration of Toe Joint with Gouty Tophus. normal toe joint Urate crystals, shown in white, at the “bunion joint,” represent a gouty tophus.)
Figure 3: Progression of Gout
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The Sharp Pain During A Gout Flare Can Usually Help Distinguish The Two
At first glance, it might seem like gout and rheumatoid arthritis arent so different. Both cause pain, swelling, and stiffness of the joints that can limit your range of motion. However, the cause differs. RA is an autoimmune disease, which means the bodys own immune system attacks the joints, whereas the pain of gout is due to elevated levels of uric acid in the blood. But despite some similarities in symptoms, rheumatologists usually dont have much trouble telling the two conditions apart.
Cases of gout are often clear-cut because the flash of pain patients experience during a flare is so dramatic, says Kelly A. Portnoff, MD, a rheumatologist at The Portland Clinic in Portland, Oregon. It feels like a hot poker in their joint. Whereas if you have RA, the pain kind of creeps up on you.
A patients age also provides clues. While rheumatoid arthritis can affect almost anyone, it most often first appears in women in their reproductive years. Gout tends to arise in one of two life stages: the late twenties/early thirties and the seventies and eighties.
When gout strikes earlier, its often due to lifestyle factors that promote high levels of uric acid, such as meat-heavy diet and excessive alcohol intake, Dr. Portnoff says. When gout appears later in life, its more likely the result of kidney damage or health conditions that increase the risk of gout, such as high blood pressure, diabetes, and heart disease.
How Can I Self
The methods of managing an acute attack of gout differ from the ongoing methods for managing gout. If youve been diagnosed with gout, youll benefit in the long term from making healthy changes to your lifestyle, such as:
- maintaining a healthy body weight. If you do need to lose weight, make sure your weight loss is gradual as crash diets can increase uric acid levels
- drinking alcohol in moderation and avoiding binge drinking
- drinking plenty of water, and staying hydrated
- avoiding, or eating in moderation, foods that are high in purines. Talk with a dietitian for tips and advice
- exercising regularly aim to complete at least 30 minutes of physical activity most days of the week
- working closely with your GP to prevent further attacks and actively manage your condition.
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How Is It Diagnosed
The only way to diagnose gout with certainty is by your doctor finding urate crystals in fluid taken from your joint. Uric acid levels can be measured by blood tests, however these are not always accurate. Uric acid levels may be normal or even lowered during an attack of gout. Blood tests are most useful in ruling out other causes for your symptoms, such as joint infections or other forms of arthritis. X-rays are often normal in the early stages so are not very useful in diagnosing gout.
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Rheumatoid Arthritis Vs Gout: Causes And Risk Factors
Rheumatoid arthritis is an autoimmune disease, meaning, the bodys immune system attacks the joints wrongfully, setting off the symptoms associated with rheumatoid arthritis. Inflammation causes the synovium to thicken, which over time destroys the cartilage, allowing bones to rub together.
Risk factors for rheumatoid arthritis include being a female, being over the age of 40, having a family history of RA, smoking, being exposed to environmental pollutants, and being obese.
Gout is a result of crystallized uric acid, which occurs when a person has high levels of uric acid in their blood. Uric acid results from the breakdown of purines found in some foods like red meat and alcohol.
Normally, uric acid passes through our systems and is released through our urine, but with excessively high levels, the uric acid can build up and crystallize in joints and surrounding tissues, causing discomforting symptoms.
Risk factors for gout include eating a diet high in uric acid-promoting purines, being overweight or obese, having an untreated medical condition like hypertension, taking certain medications, having a family history of gout, being male over the age of 40, and recovering from a recent surgery or trauma.
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Treatments For Gout And Psoriatic Arthritis Differ
Treatment for joint pain depends on the underlying disease. If its gout, the first step in treating a flare is medication: over-the-counter nonsteroidal anti-inflammatory drugs , such as ibuprofen, aspirin, or naproxen sodium prescription steroids or a prescription anti-inflammatory called colchicine, which influences the bodys reaction to uric acid crystals.
For ongoing management of gout, the American College of Rheumatology’s 2020 guidelines recommend the drug Zyloprim , which reduces the production of uric acid in the body, along with a three- to six-month course of nonsteroidal anti-inflammatory drugs . Corticosteroids, taken orally or injected directly into the affected joint, may also be used as an initial treatment.
For mild cases of psoriatic arthritis, NSAIDs such as aspirin or ibuprofen usually help. If your symptoms are severe, your rheumatologist may recommend disease-modifying anti-rheumatic drugs or biologics.
Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in one or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the complications of gout.
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The Role Of Diet In Gout Prevention
Dietary control may be sufficient in a patient with mildly elevated uric acid, for example, 7.0 mg/dL
For those with a higher level, for example, 10.0 mg/dL, diet alone will not usually prevent gout. For the latter, even a very strict diet only reduces the blood uric acid by about 1 mg/dL- not enough, in general, to keep uric acid from precipitating in the joints. The cutoff where patients with gout seem to dramatically reduce their number of attacks is when their uric acid level is taken below 6.0 mg/dL.4
What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
References
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Differences Between Ra And Gout
Both diseases cause redness, swelling, and pain in the joints. Both can cause serious disability and disrupt your quality of life.
However, a close look at initial signs and which joints are involved will clearly differentiate these two diseases. The best way to know whether you have RA or gout is to make an appointment with your doctor for a diagnosis.
Specific signs that distinguish the diseases:
Arthritis / Acute Gout Attack
Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.
The joint most commonly involved in gout is the first metatarsophalangeal joint , and is called podagra. Any joint may be involved in a gout attack with the most frequent sites being in the feet, ankles, knees, and elbows.
An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack takes approximately 7-14 days.
An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of gout:
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What Types Of Doctors Treat Gout
Rheumatologists traditionally have expertise in diagnosing and treating gout, especially complicated situations. Other specialists such as internists, general practitioners, family medicine doctors, and orthopedists can manage straightforward cases of gout. Nephrologists may treat patients with uric-acid-lowering medications such as allopurinol in order to prevent damage to the kidneys, which can occur with elevated uric acid levels .
What Is The Latest Research On Gout
Research is being done on using medications that block a chemical signal known as interleukin-1 to treat gout flares in patients who do not respond to other therapies. Anakinra and canakinumab are two medications that block interleukin-1. They are currently used for other conditions and are under investigation for use in gout flare-ups.
There is ongoing research in using a specialized CT scan known as a dual energy CT scan to diagnose gout. There is also a great deal of research investigating the various uric acid transporter genes that are responsible for uric acid metabolism.
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Getting The Right Diagnosis
If you experience joint issues, receiving a timely, accurate diagnosis from a rheumatologist is essential. You want to be sure you receive proper treatment and prevent long-term damage or complications.
We will use all the tools we have to get an accurate diagnosis, says Zhanna Mikulik, MD, a rheumatologist at the Ohio State Wexner Medical Center in Columbus. Your rheumatologist will look at what joints are affected, what the pattern is, and how it started.
How Is Gout Diagnosed
In a clear-cut case, a primary care physician can make the diagnosis of gout with a high level of confidence. However, often there are two or more possible causes for an inflamed toe or other joint, which mimics some of the symptoms of gout, so tests to identify the presence of uric acid is performed.
Since the treatment for gout is lifelong, its very important to make a definitive diagnosis. Ideally, the diagnosis is made by identifying uric acid crystals in joint fluid or in a mass of uric acid . These can be seen by putting a drop of fluid on a slide and examining it using a polarizing microscope, which takes advantage of the way uric acid crystals bend light. A non-rheumatologist, when possible, can remove fluid from the joint by aspirating it with a small needle and send it to a lab for analysis. A rheumatologist is likely to have a polarizing attachment on their microscope at their office. Gout crystals have a needle-like shape, and are either yellow or blue, depending on how they are arranged on the slide .
Figure 11: Uric Acid Crystals Under Polarizing Light Microscopy
There are many circumstances where, however ideal it would be, no fluid or other specimen is available to examine, but a diagnosis of gout needs to be made. A set of criteria has been established to help make the diagnosis of gout in this setting .2
Table 1: Diagnosing gout when no crystal identification is possible
Ideally, 6 of 10 features will be present of the following:
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