Bay Area Medical Information
Gout
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About Gout

One of the most painful forms of arthritis, an attack of gout occurs when too much uric acid builds up in the body. For many people, the first attack of gout occurs in the big toe. Often, the pain wakes a person from sleep. The toe is very sore, red, warm, and swollen. A gout attack can be brought on by stressful events, alcohol or drugs, or another illness.

Treatment

Early attacks usually get better within 3 to 10 days, even without treatment. However, an acute attack of gout should be treated with medications which will relieve the pain, swelling, redness, and warmth of the affected joint(s). Also measures are begun to eliminate any underlying causes and prevent future attacks. The next attack may not occur for months or even years.

To reduce the symptoms of an acute gout attack:

  1. Rest the affected joint(s)
  2. Take one or more of the following medications at the first sign of a gout attack, as prescribed by your health professional.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin. Avoid aspirin because it may abruptly change uric acid levels in the blood and may make symptoms worse.
    • Colchicine
    • Corticosteroids
    • ACTH
Medications that help prevent recurrent attacks:

Medications that reduce uric acid levels in the blood, can reduce the risk of future attacks. Most health professionals will wait 2 to 4 weeks after a gout attack is over to begin medication to lower the high uric acid levels. These medications can cause uric acid stored elsewhere in the body to begin moving through the bloodstream and could make symptoms worse if treatment begins during a gout attack.

  1. Probenecid: uricosuric agent that increases elimination of uric acid by the kidneys.
  2. Allopurinol (Zyloprim) decreases production of uric acid by the body.
  3. Colchicine an antiinflammatory agent used specifically for gout is often prescribed to prevent flare-ups during the first months that you are taking uric acid-lowering medications.
What you can do to reduce the risk of future attacks:
  1. Maintain a healthy body weight. Ask your doctor about how to lose weight safely. Fast or extreme weight loss can increase uric acid levels in the blood.
  2. Follow a regular exercise program.
  3. Avoid drinking alcohol. Beer, in particular, is rich in purines and appears to be worse than some other beverages that contain alcohol.
  4. Avoid diets high in meat and seafood. These high-purine foods can raise uric acid levels.
  5. Maintain a healthy balanced diet
  6. Drink plenty of water
  7. Avoid certain medications such as diuretics (water pills), niacin, cyclosporine, levodopa and regular use of low-dose aspirin.
  8. Follow-up with your doctor as planned and to each visit bring a list of all medications, vitamins, nutritional supplements, herbs, and over-the-counter products that you take.
Long-term treatment

If you have previously had a gout attack, you are likely to have another, especially if you are not managing the disease with medications or other treatment. Most people with gout will need to take medications that lower uric acid levels throughout their lives. However, in a few cases some people may be able to reduce their uric acid levels to normal by controlling their weight, not drinking alcohol, and avoiding certain medications.

When high blood uric acid levels are not causing any symptoms, treatment is rarely needed in healthy individuals. However, people with extremely elevated levels may need regular testing for signs of kidney damage, and they may need long-term treatment to lower their uric acid levels. Your blood uric acid level may be monitored by your health professional until it is lowered to normal levels.

People who have endured gouty symptoms off and on without treatment for more than 10 years, may develop chronic changes in the joint(s). Uric acid crystals may have accumulated in the joints to form gritty, chalklike nodules called tophi. Treatment of gout that has advanced to this stage involves medication (Allopurinol) or possibly even surgery to eliminate tophi which can cause deformity.

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References
1) What is gout? from the National Institute of Arthritis and Musculoskeletal and Skin Diseases
 

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