Gout why

Doctors who specialize in gout and other forms of arthritis are called rheumatologists. To find a provider near you, visit the database of rheumatologists external 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.

Gout can be effectively treated and managed with medical treatment and self-management strategies. Your health care provider may recommend a medical treatment plan to. In addition to medical treatment, you can manage your gout with self-management strategies. Self-management is what you do day to day to manage your condition and stay healthy, like making healthy lifestyle choices.

The self-management strategies described below are proven to reduce pain and disability, so you can pursue the activities important to you. Gout affects many aspects of daily living, including work and leisure activities.

Fortunately, there are many low-cost self-management strategies that are proven to improve the quality of life of people with gout. Excessive uric acid levels are typically due to the overproduction of uric acid or issues with the kidneys in excreting this substance adequately. Without treatment, an acute gout attack will be at its worst between 12 and 24 hours after it began.

A person can expect to recover within 1—2 weeks without treatment, but there may be significant pain during this period. Gout can often be challenging to diagnose, as its symptoms are similar to those of other conditions. While hyperuricemia occurs in most people who develop gout, it may not be present during a flare-up.

As a result, a person does not need to have hyperuricemia for a diagnosis. To assess this, a rheumatologist will carry out a blood test and may also extract fluid from an affected joint for analysis. In addition, they can search for urate crystals around joints or within growths using an ultrasound scan. X-rays cannot detect gout, but healthcare professionals may use them to rule out other causes. As joint infections can also cause similar symptoms to gout, doctors can look for bacteria when carrying out a joint fluid test to rule out a bacterial cause.

A person can have elevated uric acid levels without any outward symptoms. While individuals do not need treatment at this stage, high uric acid levels in the blood can cause silent tissue damage. As a result, a doctor may advise a person with high uric acid levels to address factors possibly contributing to its buildup. This stage occurs when urate crystals in a joint suddenly cause acute inflammation and intense pain.

Stressful live events and excessive alcohol consumption could be contributors to flare-ups. This stage is the period in between attacks of acute gout. Between these periods, urate crystals may continue to build up in tissue. Chronic tophaceous gout is the most debilitating type of gout and may result in permanent damage to the joints and the kidneys.

At this stage, people can have chronic arthritis and develop tophi in cooler areas of the body, such as the joints of the fingers. Chronic tophaceous gout typically occurs after many years of acute gout attacks. If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.

Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:. The treatment helps you to manage your symptoms when an attack happens. But your preference is also taken into consideration — many people with gout quickly learn what works best for them.

Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.

To reduce the risk of this happening and to protect your stomach, your doctor will also prescribe a proton pump inhibitor. As with NSAIDs, colchicine tablets should be taken as soon as you notice an attack coming on, or it may not work as well.

Your doctor will probably recommend keeping a supply at home. Colchicine can interact with several other drugs, including statins taken for high cholesterol. However, they can also be taken as an injection into a muscle or joint affected by gout. This can be particularly helpful if gout is affecting only one joint. 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 or ULTs for short.

It can take a few months or years for the drugs to completely clear your body of urate crystals. You could actually have more attacks within the first six months of starting them. As the drugs start dissolving the crystals, they become smaller and are more likely to get into the joint cavity, triggering an attack. ULTs are usually life-long treatments and require yearly check-ups to monitor your urate levels.

Try not to miss or skip any of your doses, especially in the first year or two of starting treatment. This could cause your urate levels to go up and down, which could trigger an attack. Allopurinol is the most commonly used ULT.

Allopurinol is broken down and removed from the body through your kidneys, so if you have a problem with your kidneys, it may not be suitable for you. Your doctor might decide to start you on an even lower dose and increase slowly, or suggest that you try febuxostat instead. Febuxostat is a newer drug that reduces the amount of urate made in the body in the same way that allopurinol does. Febuxostat is more likely to trigger gout attacks than allopurinol when you first start treatment.

Uricosuric drugs, which include sulfinpyrazone, benzbromarone and probenecid, work by flushing out more urate than normal through your kidneys. This is because, by encouraging your kidneys to filter more urate, they also increase the risk of developing kidney stones. Uricosuric drugs are usually used on their own. If your gout has caused damage to your joints, then the treatments available will be the same as those used for osteoarthritis.

They include:. Visit our osteoarthritis page to find out more about treatments available for joint damage. This will then decrease the chances of you having attacks of gout.

Exercise is extremely important, not only to reduce the chances of an attack, but also for your general health and wellbeing. Exercises that get you out of breath are particularly good for burning calories. You could try dancing, walking in hilly countryside or doubles tennis.

It helps to find a sport or exercise which you enjoy and will keep doing. Some people find joining a leisure centre or sports club to be really fun and motivational. You should avoid exercising during a flare up of gout, as it could make your pain worse. You should try to have a well-balanced diet that is low in fats and added sugars, but high in vegetables and fibre.

Extreme weight loss or starvation diets increase cell breakdown in your body, which can raise urate levels. However, you should be OK to do some daytime fasting - for example, during Ramadan. Some of the more promising include anakinra, rilonacept, canakinumab, BCX and arhalofenate. Gout is a common disease and appears to be becoming more common over time. We are fortunate to have a strong armamentarium against this condition, with newer agents in development.

In view of the effectiveness of our treatments, it is important for a correct diagnosis to be made as early as possible, and therapy begun quickly, when appropriate. Other conditions for example, pseudogout which can mimic gout, should be definitively ruled out through crystal identification in joint fluid whenever possible. Non-medication treatments for gout are important, such as staying off the foot when it is inflamed and attending to diet both to reduce purine intake and to lose weight when indicated.

For acute attacks of gout, a key is treating as quickly as possible and choosing a medication least likely to cause side-effects, with special attention to individual co-morbidities. For chronic prevention of gout, the essential message is that present treatments work in a huge majority of patients, and are generally well-tolerated. It is important for patients to understand the four stages of gout See Figure 1 since the treatment of each is different.

It is also important for patients with gout to be carefully counseled to communicate any changes in the frequency of gout attacks to their practitioner. A primary care practitioner can often manage gout without a consultation with a rheumatologist, but consultation should be considered if the diagnosis is unclear, there is uncertainty as to whether or not to start uric acid-lowering medication, attacks continue to occur despite treatment, or possible medication side-effects are making treatment difficult.

He receives no compensation related to sales or prescription of any medications. Gout: Risk Factors, Diagnosis and Treatment. By Theodore R. What is gout? What causes gout? Who gets gout? Which joints are involved in gouty arthritis? What does a gout attack look and feel like? How is gout diagnosed? How can an attack of gout be treated? How can a gout attack be prevented? When is surgery considered for gout? What are future possible treatments of gout? Summary Disclosures More information.

The four stages of gout Gout is best understood by seeing it as having four phases or stages See Figure 1: Stages of Gout : Stage 1: High uric acid Elevated uric acid without gout or kidney stone, this stage has no symptoms and is generally not treated.

Stage 2: Acute flares This stage is marked by acute gout attacks causing pain and inflammation in one or more joints. Stage 3: Intercritical periods These are periods of time between acute attacks, during which a person feels normal but is at risk for recurrence of acute attacks. Schneiter J. Reachment Publications; In addition to comprehensive lists of foods lower, relatively high, and highest in purines, this book offers nearly low-purine recipes.

Reachment Publications: More recipes from the same author. This book is useful since people often find the recommendations about low purine diets confusing and difficult to follow. Lavoisier Booksellers, Cachan Cedex, France, A detailed review of the various types of crystal-induced arthritis, targeted at a professional audience.

Oxford University Press, London: A kidney specialist with special interest in gout explains the condition in detail for a lay audience. Icon Health Publications, A source covering a wide variety of sources of information about gout, including a glossary and research summaries.

Yale University Press, A socio-medical history of gout, including the famous figures who suffered from it, such as Benjamin Franklin and Thomas Jefferson. Wortmann RL. Effective management of gout: an analogy.

Am J Med. Modified from Wallace, SL, et al: Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. Baker et al: Serum uric acid and cardiovascular disease: Recent developments, and where do they leave us? Am J Med, , A review article concluding that uric acid is an independent risk factor for coronary disease.

Shoji et al: A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum, 51 3 , This is one among a group of studies demonstrating the benefit of keeping uric acid below 6.

Choi HK et al: Purine-rich foods, dairy and protein intake, and the risk of gout in men. New Engl J Med, 11 , This article emphasizes the finding that red meat and shellfish increase gout risk while low-fat dairy intake seems to decrease it.

Choi HK et al: Alcohol intake and risk of incident gout in men: a prospective study. Lancet, , This article pinpoints beer as being a particular risk factor for gout.

Arthritis Res Ther 8 Suppl 1:S2, This article reviews lifestyle modifications that can influence gout risk, including weight loss, alcohol and diet. N Engl J Med , A review of a recently recognized pathway by which colchicine inhibits the inflammatory process of gout.

Arthritis Rheum , This article stresses the importance of kidney abnormality as a risk factor in allopurinol hypersensitivity, and the importance of reducing allopurinol dose in patients with kidney dysfunction and of making sure that only patients who meet appropriate criteria get treated with allopurinol. Dalbeth N and Stamp L. Seminars in Dialysis , , This review emphasizes that it has not been proven that severe allopurinol allergic reactions relate to dose or that they are more common in patients with kidney problems.

The authors also stress that keeping doses of allopurinol too low often leads to inadequate control of uric acid levels. Arthritis Rheumatol.

Demonstration of effectiveness of lesinurad, in combination with allopurinol, in getting patients to their uric acid goal. Arthritis Rheum , , Early data that anakinra was effective in gout flares. Terkeltaub R et al: The interleukin 1 inhibitor rilonacept in treatment of chronic gouty arthritis: results of a placebo-controlled, monosequence crossover, non-randomised, single-blind pilot study.

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