GoutTreatment.com
Gout Treatment
Gout is a kind of arthritis characterized by sudden and severe pain, swelling, redness, and tenderness in the joints. It often affects the joint at the base of the big toe. Gout is one of the most frequently recorded medical illnesses throughout history.
Causes of Gout
Gout is caused by a buildup of uric acid crystals in the joints leading to inflammation and intense pain. Uric acid crystals can form when the blood level of uric acid is high. Uric acid is a breakdown product of purines (found naturally in the body and certain foods).
Naturally, uric acid is excreted into the urine. However, abnormalities can occur, and the body produces too much, or the kidneys excrete too little. When this happens, uric acid crystals can buildup, forming sharp, needle-like crystals in the joint or surrounding tissue.
Prevalence of Gout
8.3 million (4%) Americans currently have gout. About 21% of the U.S. population have hyperuricemia (elevated blood uric acid levels), but only a small portion of them will develop gout.
Symptoms
Though gout commonly affects the small joint at the base of the big toe, it also affects other joints, including the ankles, knees, wrists, fingers, and elbows.
Inflammation and intense joint pain. The pain usually hits suddenly and at night. It is followed by warmth, swelling, and marked tenderness. The pain usually subsides in hours to days, with or without medication. In rare instances, an attack can last for weeks.
Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks.
Limited range of motion. As gout progresses, joint movement becomes more difficult.
Diagnosis
Though hyperuricemia occurs in most people who develop gout, it may not be present during an attack. Also, the majority of people with hyperuricemia do not develop gout.
- A Joint fluid test: fluid is extracted from the affected joint and examined for uric acid crystals and infection.
- A blood test to measure the levels of uric acid in the blood.
- An Ultrasound scan to search for uric acid crystals around joints or within tophi.
Risk factors of Gout
Several factors can increase the likelihood of hyperuricemia, and therefore gout.
Purine-rich Diet. Meat, seafood, and beverages sweetened with fructose increase the risk.
Alcohol: increase levels of uric acid, which increases gout risk.
Obesity: Here, there is more turnover of body tissue, resulting in more uric acid production. The kidneys also have a more difficult time eliminating uric acid.
Medical conditions such as untreated hypertension, diabetes, metabolic syndrome, and heart diseases. Kidney diseases also impair efficient waste removal, leading to elevated uric acid levels.
Certain medications. Diuretics, low-dose aspirin, anti-rejection drugs prescribed for people who have undergone an organ transplant can increase uric acid levels.
Genetics. An individual has a 20% chance of developing gout if their parent had it.
Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid level starts to increase. The risk of gout also increases with age.
Recent surgery or trauma has been associated with an increased risk of gout.
Chronic lead exposure has been linked to some cases of gout.
Complications of Gout
Gout can result in more severe conditions, such as:
Recurrent gout. Some people may never experience gout symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
Tophi/Advanced gout. Untreated gout may cause deposits of uric acid crystals to form under the skin in nodules called tophi. Tophi can develop in several areas such as the fingers, hands, feet, elbows, or Achilles tendons. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.
Kidney stones/failure. Uric acid crystals may collect in the urinary tract of people with gout, causing kidney stones and blockage of the kidney filtering tubules leading to kidney failure.
Management of Gout
The role of uric acid in gout has been clearly defined and understood. Based on this understanding and some available medications, gout can be controlled. Without treatment, an acute gout attack will ease between 12 and 24 hours and resolve within 1 to 2 weeks.
Drug Management
Medication can be used to treat gout attacks symptoms, prevent future flares, and reduce the risk of complications.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and Corticosteroids reduce pain and inflammation.
- Xanthine oxidase inhibitors such as allopurinol: minimizes the production of uric acid.
- Probenecid: improves the kidney’s ability to excrete uric acid.
- Febuxostat and lesinurad: decrease the level of uric acid in the blood and prevent the deposit of uric acid in joints, kidneys, and in tissue.
Dietary Management
Dietary changes can help reduce blood uric acid levels in the blood and prevent future attacks:
Increase fluid intake (around 2 to 4 liters a day). This helps prevent acute gout attacks and decreases the risk of kidney stone formation.
Eliminate diet triggers. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases and other studies, purine-rich foods such as red meat, organ meats, seafood, sugar, and alcohol are the most likely triggers. Avoiding triggers and keeping to a good gout diet is vital in gout management. Hence, the risk of gout flares can be reduced by limiting the intake of purine-rich foods.
Low-fat dairy products. Low-fat dairy products may have a protective effect against gout.
Limit alcohol consumption. Alcohol has diuretic effects that can contribute to dehydration, affect uric acid metabolism, lead to hyperuricemia, and slow down uric acid excretion from the kidneys. All these can precipitate acute gout attacks.
Weight management and exercise: The Arthritis Foundation emphasizes the importance of weight management for people with gout. This can help lower uric acid levels in the body, reduce pressure on painful joints, lower heart disease risk, and build up strength and flexibility.
DASH Diet: Dietary Approach to Stopping Hypertension (DASH) diet is associated with a lower risk of gout because it lowers uric acid levels.
Natural Remedies for Gout
Some natural remedies may help reduce uric acid levels.
Cherries: All cherry types in extract, juice, or raw form is a prevalent and potentially successful home remedy for gout. Studies also suggest cherries may work to prevent gout attacks.
Ginger: can relieve gout. One study found topical ginger reduced pain related to uric acid in gout. Another study showed that it reduced hyperuricemia.
Celery: traditionally used to treat urinary issues. Celery extract and seeds have become popular home remedies for gout. Research suggests that certain compounds in celery seed may have benefits in treating gout. However, high dosages of celery seed extracts and supplements may be dangerous in pregnant women. Some people are also allergic to a fungus that is commonly found in celery.
Nettle tea: may reduce inflammation and pain. Traditional use is frequently referred to in studies. Another study also shows its kidney-protection ability.
Dandelion teas, extracts, and supplements are used to improve l kidney health. They may lower uric acid levels in those at risk for kidney injury, as shown in studies.
Milk thistle seeds: A study suggested it may lower uric acid in conditions that can hurt the kidneys, and another study supports this finding.
Hibiscus: might help lower uric acid levels.
Apples: The claim: Apples contain malic acid, which lowers uric acid. Eating one apple per day is good for overall health. It may be mildly beneficial for gout, but only if it doesn’t add to excessive daily sugar consumption.
Natural remedies should NEVER replace prescribed gout treatments.
Other Management Options
Rest: minimize movement while joints are inflamed to avoid worsening the symptoms and duration.
Topical cold or hot water application: Studies on this are mixed. Soaking in cold water or using ice packs is most recommended and most effective. Soaking in hot water is only recommended when inflammation is not intense.
Future of Gout Management
Though there is currently no cure for gout, it can be treated with self-management strategies and medications. New drugs are being developed that may be more versatile and safe in treating the elevated uric acid levels in patients with chronic gout. These drugs have to undergo clinical trials and approval by regulatory authorities as safe and effective before being made available for public use. There are many active clinical trials ongoing in a variety of fields related to gout and hyperuricemia.
