Gout symptoms treatment

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

There are four stages of gout (asymptomatic, acute, intercritical and chronic).

In the asymptomatic stage, serum urate levels rise in the blood, but there are no symptoms

In the acute stage, attacks of gout occur. Symptoms usually last five to 10 days. Acute attacks are characterized by:

• sudden attack of severe joint pain
• swelling
• joints feel hot, tender and look dusky red or bruised

The next phase is the intercritical stage. Patients remain symptom-free between gout episodes. Most people have a second attack from six months to two years, while others are symptom-free for five to 10 years.

The final stage is the chronic stage. This is characterized by:

• persistently painful joints with large urate deposits in the cartilage, tendons and soft tissues
• skin over the deposits ulcerates and releases a white chalky pasty discharge which is loaded with uric acid crystals.
• joint stiffness
• limited joint motion

Evidence of reduced kidney function may be evident. Other co-morbid conditions such as hypertension and elevated cholesterol might be present.

The diagnosis of gout is based on symptoms, blood tests showing high levels of uric acid, and the finding of urate crystals in joint fluid. In chronic gout, x-rays show damage to the cartilage and bones.

Currently, there is no cure for gout, but with a proper diet, a healthy lifestyle and medications, the symptoms of gout can be relieved and further episodes eliminated.

The proper diet for a patient with gout consists of the following:

•Avoidance of foods high in purines (substances that produce uric acid when metabolized by the body). These foods include: sardines, anchovies, brains, liver, kidneys, tripe, sweetbreads, tongue, shellfish (mussels and oysters), fish roe, scallops, peas, lentils, beans and an excessive amount of red meat.
•Drinking 10 to 12 eight-ounce glasses of non-alcoholic fluids daily.

A healthy lifestyle should include:

• Reducing alcohol consumption
• Losing weight

Using medications for gout can be complicated, because the treatment needs to be tailored for each person and may need to be altered from time to time.

To relieve the pain and swelling of an acute attack, the doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, corticosteroid drugs, and/or adrenocorticotropic hormone (ACTH).

To prevent or treat the hyperuricemia that causes gout, probenecid, allopurinol, and febuxostat (Uloric) are recommended.

Older patients or patients with less than normal kidney function will not respond to probenecid. If they are started on allopurinol they will require a lower dosage and need to be watched carefully for evidence of allopurinol toxicity.

For patients with tophaceous gout, PEG-uricase (Krystexxa), a drug that converts uric acid to allantoin, a harmless metabolite that is excreted in the urine, is recommended.

To lower risk factors, consider:

• supervised weight-loss program with exercise (if the patient is overweight)
• avoiding a purine-rich diet
• avoiding alcohol consumption, especially binge drinking
• changing to another drug, if taking diuretics for hypertension. Diuretics raise serum uric acid levels.

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