Acute Attack Pain Management
Home remedies. Reducing inflammation during an acute gout attack will provide pain relief.
- Ice. Apply ice to the affected area to reduce swelling. Do not apply ice directly to the skin. Use an ice pack or wrap a towel around the ice. Apply ice for about 20 minutes at a time.
- Elevate. Frequently raise and keep the affected area above the level of the heart.
- Rest. Move the affected area as little as possible while symptoms are present.
- Over-the-counter non-steroidal anti-inflammatory medicines. If the gout attack is mild, anti-inflammatory drugs available without a prescription may relieve pain. Because there are serious side effect of using non-steroidal anti-inflammatory drugs even the over-the-counter strength be sure to check with your doctor before taking them.
Prescription medications. Your doctor may recommend a prescription-strength non-steroidal anti-inflammatory medicine such as indomethacin.
Colchicine is also given to reduce inflammation during an acute gout attack. This drug has recently been approved by the Federal Drug Administration for treatment of gout. Like all medications, colchicine has side effects that you will need to discuss with your doctor.
Your doctor may also prescribe corticosteroids for acute gout attacks. These are strong anti-inflammatory medications that can be taken either in pill form, intravenously, or injected into the painful joint. Cortisone may improve the severe inflammation very quickly.
Which Joints Are Involved In Gouty Arthritis And Why Is It Most Common In The Foot
As with all other known types of arthritis, Gout has particular joints it tends to attack, and the foot is its most common location. Gout especially favors the bunion joint, known as the first metatarsophalangeal joint , but the ankle, midfoot and knee are also common locations, as is the bursa that overlies the elbow.
The bunion joint is the first joint involved in 75% of patients and is ultimately involved in over 90% of those with this condition. . It is thought that this joint is especially involved in gout because it is the joint that receives the highest pounds per square inch of pressure when walking or running.
Late in gout, if untreated, multiple joints can be involved, including the fingers and wrists. The shoulder joint is very rarely involved by gout and the same is true of the hip.
Figure 5: Location of Gout Attacks
Whats The Outlook For People With Gout
Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.
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Blood Test For Uric Acid Level
A blood test may be done to measure uric acid level in the blood. Since uric acid can fall during an attack, the uric acid may not be elevated at that time. Some doctors may wait until several days after the attack to order a blood test. Nearly all people with gout have elevated uric acid in this case, although not all people with elevated uric acid have gout. Therefore the blood uric acid is only one part of making the diagnosis.
Comorbid Conditions And Gout
Having gout increases the risk of developing diabetes, heart disease and other conditions.
In gout, uric acid builds up and forms painful crystals around joints, often affecting the big toe. Health problem linked to gout go beyond the joints, however. Excess uric acid can also damage kidneys, blood vessels, and other organs, and gout raises the risk for several disorders. These include kidney and cardiovascular disease, as well as diabetes, depression and sleep apnea.
Understanding your vulnerability to gouts linked conditions means you can make lifestyle changes, such as adopting a healthier diet, moving more, and losing weight, that lower risks and improve symptoms. At the same time, your doctor can watch for developing problems and intervene with treatments that limit damage.
The first attack of gout should be a wake-up call, says Eswar Krishnan, MD, a rheumatologist in Newbury Park, California. It should prompt a complete health and health risk evaluation, lifestyle reassessment and, in the case of men and women younger than fifty, a complete renal assessment.
If you have gout, speak with your doctor about:
Chronic Kidney Disease and Kidney Stones
Women with gout are 71% more likely to develop type 2 diabetes in men, gout increases the risk for diabetes by 22%, according to a 2016 Annals of the Rheumatic Diseases study.
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Examination Of Synovial Fluid
Synovial fluid examination is the most accurate method for diagnosing gout. The synovial fluid is the lubricating liquid that fills the joint space . This is the membrane that surrounds a joint and creates a protective sac. The fluid cushions joints and supplies nutrients and oxygen to the cartilage surface that coats the bones. This exam also helps detect gout between attacks.
A procedure called arthrocentesis is performed. The health care provider uses a needle attached to a syringe to draw out fluid from the affected joint. This is called aspiration. The fluid sample is sent to a laboratory. If crystals of uric acid, also called monosodium urate are found, this makes the diagnosis of gout. These crystals are very distinctive under the microscope using special polarizing filters. Aspiration sometimes eases symptoms by reducing swelling and pressure on the tissue surrounding the joint.
Synovial fluid analysis is a method to look at the fluid that cushions a joint. It is done to help diagnose and treat joint-related problems such as gout.
Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
Themostcommon drugtreatments for attacks of gout are:
Some people will be better suited to NSAIDS, while for others NSAIDs cannot be used. But your preference is also taken into consideration.Many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treatedwith NSAID tablets, which can help with pain andreduce some of your inflammation. Naproxen, diclofenac,and etoricoxibare three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on.Your doctor may let you keep a supply soyou can start taking them at the first signsof an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicineisnt apainkiller.Butcan be very effective at reducing theinflammation caused by urate crystals.
You should avoid taking colchicine if you have chronic kidney disease.
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Do Gout And Ra Have The Same Symptoms
Both gout and RA can cause pain and stiffness in multiple joints. But otherwise the two tend to follow different patterns.
Rheumatoid arthritis. This condition usually starts in smaller joints like your hands and feet. Theyâll feel tender, swollen, and warm to the touch. Then it usually moves to other, larger joints like your wrists, elbows, shoulders, ankles, knees, and hips. Itâs rare, but you might also have fatigue and loss of appetite or a fever, though thatâs less likely.
Most people have similar symptoms on both sides of the body. That means if one shoulder hurts, the other one probably does, too.
RA can make your joints feel stiff when you wake up in the morning. The pain may get better with activity over the course of the day.
Gout. Unlike RA, it usually starts with a sudden attack of pain. The pain can be severe. It isnât unusual for a person with gout to feel like their joint is on fire. It might feel like thereâs a hot poker in the joint.
Gout usually affects only one joint. The big toe is a common spot, but gout also can affect ankles, knees, elbows, or wrists.
The affected joint also might look red and swollen. It may be warm to the touch. Sometimes a gout attack can cause a fever.
How Will It Affect Me
Attacks can vary from person to person.Some people only have an attack everyfew years, while othersmayhaveattacksevery few months.
Without medication,attacks tend to happen moreoften,andother joints can become affected. Having high urate levels and gout for a long time can lead to other health problems, including:
- narrowing of thearteries- whichcan leadto anincreased risk of stroke, heartattacks or other heart problems
- osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage
- an increased risk of developing kidney disease or worsening of the condition if you already have it
- an increased risk of somecancers, especially prostate cancer
- mental health problems, including depression
- underactive thyroid
- erectile dysfunction.
Mostof the damage and complications caused by gout can be stopped if you take medication to lower your urate levels and have a healthy diet andlifestyle.
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Do Ra And Gout Have The Same Cause
Rheumatoid arthritis and gout both are types of arthritis, but the underlying causes are completely different. RA is an autoimmune condition. It happens when your bodyâs immune system attacks the tissue that lines your joints. This attack causes painful swelling, inflammation, and joint deformity. Since RA is an immune system disease , it can affect other parts of the body, too, including the skin, eyes, and heart.
Gout affects people with too much uric acid in their blood. Your body creates this type of acid when it breaks down certain foods, including meat. Your kidneys normally get rid of it when you pee. But when thereâs too much of it in your system, the uric acid can form crystals. These needle shaped crystals build up in joints and surrounding tissue where they can cause pain and inflammation.
Do Doctors Treat Ra And Gout The Same Way
Neither RA nor gout is curable. But there are treatments to help manage your symptoms. Some are the same for either condition:
- Pain treatments. Over-the-counter pain relievers like ibuprofen and naproxen can help with either condition. A medication called colchicine can also ease gout pain.
- Inflammation treatments. Corticosteroids like prednisone can help with inflammation and the pain it causes.
When it comes to treating the underlying disease, doctors focus their efforts on treating the cause. RA treatment may include drugs that suppress the immune system.
Gout treatment usually includes medications that prevent the buildup of uric acid crystals.
What you eat can also affect the levels of uric acid in your blood. If you have gout, take these steps to prevent an attack of gout:
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How Can An Attack Of Gout Be Treated
The management of an acute attack of gout is very different from the prevention of subsequent attacks.
Treatments used for prevention, such as allopurinol can actually make things worse if given during an attack, and so need to be held back until the attack has resolved for several weeks.
There are a number of measures that can help resolve an attack of gout. See Table 2 for summary of treatment strategies for acute gout. One principle is that treatment for an attack of gout should be instituted quickly, since quick treatment can often be rewarded with a quick improvement.
If an attack of gout is allowed to last more than a day or so before treatment is started, the response to treatment may be much slower.
Table 2: Medications to treat acute attacks of gout
How Can I Prevent Gout
If gout runs in your family, men in particular should limit alcohol, fats, and foods that are more likely to increase uric acid level in the body. Those include meat, sardines, bacon, mussels, and yeast. Beer, especially, can also bring on a gout attack. Drinking plenty of liquids may help minimize the risk of kidney stones. Your doctor can do blood and urine tests to figure out your potential risk of a gout attack. Itâs also a good idea for men who are at greater risk to keep an eye on their weight.
Medications can also help prevent gout attacks if you have them often. These drugs decrease the production of uric acid or increase the amount of uric acid you get rid of in urine. These medicines include allopurinol , colchicine , pegloticase , probenecid , and rasburicase .
If these medications arenât effective, your doctor may prescribe . If you have heart issues, be very cautious taking febuxostat.
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Preventing An Attack During Travel
Travel may increase the risk for gout attacks. Travel not only increases stress but eating and drinking patterns may change. Before traveling, patients should discuss preventive measures with their health care provider. The doctor may prescribe taking a corticosteroid at the first sign of a gout attack. In most cases, this stops the attack.
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
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What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
Treatments To Prevent Gout Attacks
There are drugs available that can lower urate levels, prevent new crystals from forming and dissolve away the crystals in your joints. They are called urate lowering therapies .
Treatment with ULTs is generally started after an attack of gout has completely gone.
Theres no single fixed dose of a ULT, and different people need different doses to get to the right blood urate level.
It can takea few months or yearsfor the drugs to completely clear your body of urate crystals. But once theyre gone,you will no longer have attacks of gout,tophior risk of joint damagedue to gout.
Its important torememberthatULTswont stop attacks of gout straight away.Youmighthavemore attacks within the first six months of startingthem.
Dont stop taking yourULTs if this happens to you, as this isactually asign that the drugs areworking. As the drugs start dissolving the crystals,they become smaller and are more likely to get into the joint cavity,triggeringan attack.
Your doctor might suggest taking a low dose of colchicine orNSAIDas a precautionagainst attacks during the first six months of starting ULTs.
ULTs are usually life-long treatments and require yearly check-ups to monitor your urate levels.If your symptoms arent getting under control,talk to your doctor about your urate level,as you might need to be on a higher dose.
Allopurinol is themost commonly usedULT. Its a very effective treatment for most people with gout.
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Who Should Diagnose And Treat Gout
The disease should be diagnosed and treated by a doctor or a team of doctors who specialize in care of gout patients. This is important because the signs and symptoms of gout are not specific and can look like signs and symptoms of other inflammatory diseases. Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologistsexternal icon on the American College of Rheumatology website. Once a rheumatologist has diagnosed and effectively treated your gout, a primary care provider can usually track your condition and help you manage your gout.