Gout treatment symptoms

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

Gout occurs in four reasonably defined stages (asymptomatic, acute, intercritical and chronic).

In the asymptomatic stage, serum uric acid levels are elevated but there are no symptoms

In the acute stage, attacks of gout occur suddenly, sometimes overnight. 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 perhaps five to 10 years or longer.

The final stage is the chronic stage. This 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 motion of affected joints

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:

•Restricted intake 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.
•Having a patient drink 10 to 12 eight-ounce glasses of water daily.

Using medications for gout can be difficult, because the treatment needs to be individualized for each person and may need to be changed.

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).

Sometimes injections of corticosteroids into the affected joints are needed.

To prevent or treat chronic gout, probenecid, allopurinol, and febuxostat (Uloric) are recommended. Probenecid is not recommended for older patients or patients with reduced kidney function. If patients with reduced kidney function are started on allopurinol, they will require a lower dosage and need to be watched carefully for evidence of allopurinol toxicity.

PEG-uricase (Krystexxa), is a drug that converts uric acid to allantoin, a relatively harmless metabolite.It is administered intravenosuly and is used for patients with tophaceous gout or who whave failed other gout drugs.

To lower risk factors, consider:

• weight-loss program with exercise
• 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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