HEALTH: GOUT - PREVENTION (JOINT - INFLAMMATION) GOUT - TREATMENT Bursitis>>
What is Gout?
Gout, a painful and potentially debilitating form of arthritis. Today it affects the health of roughly five million Americans. This disorder develops after tiny, needle-like crystals of uric acid (a biological waste product) accumulate in joints, causing swelling and extreme sensitivity, sometimes to the point where even the slight touch of a sheet is unbearable. When crystals form in the joints it causes recurring attacks of joint inflammation (arthritis). Chronic gout can also lead to deposits of hard lumps of uric acid in and around the joints and may cause joint destruction, decreased kidney function, and kidney stones, if they accumulate in the kidneys.
Gout usually affects one joint at a time, most often the big toe, but sometimes a knee, ankle, wrist, foot, or finger. If gout persists for many years, uric acid crystals may collect in the joints or tendons and under the skin, forming whitish deposits known as tophi. About 90 percent of people with gout are men older than 40, and the health of African American men are twice as likely as Caucasian men to be affected. Gout tends not to occur in women until at least 10 years after menopause.
Gout has the unique distinction of being
one of the most frequently recorded medical illnesses throughout history. It is
often related to an inherited abnormality in the body's ability to process uric
acid. Uric acid is a breakdown product of purines that are part of many foods we
eat. An abnormality in handling uric acid can cause attacks of painful arthritis
(gout attack), kidney stones, and blockage of the kidney-filtering tubules with
uric acid crystals, leading to kidney failure, reducing the quality of health.
The term gout refers the disease that is caused by an overload of uric acid in the body, resulting in painful arthritic attacks and deposits of lumps of uric acid crystals in body tissues.
Gout (arthritis)
is typically an extremely painful attack with a rapid onset of joint
inflammation. The joint inflammation is precipitated by deposits of uric acid
crystals in the joint fluid (synovial fluid) and joint lining (synovial lining).
Intense joint inflammation occurs as white blood cells engulf the uric acid
crystals and chemical messengers of inflammation are released, causing pain,
heat, and redness of the joint tissues.
Health: Risk Factors of Gout (Joint - Inflammation)
You're more likely to develop gout if you have high levels of uric acid
in your body.
Risk factors for developing gout include:
- Excessive alcohol use. Generally more than two drinks a day for men and more than one for women — increases the health risk of gout.
- Obesity. Excessive weight gain (especially in youth).
- Medical conditions. Certain diseases and conditions make it more likely that you'll develop gout. These include untreated high blood pressure (hypertension) abnormal kidney function, and chronic conditions, such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
- Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin niacin, cyclosporine, tuberculosis medications and others can also increase uric acid levels in the blood and lead to gout. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
- Low thyroid hormone levels. a recent study demonstrated an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.
- Family history of gout. If other members of your family have had gout, you're more likely to develop this health issue.
- Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop symptoms after menopause.
Health: Causes of Gout (Joint - Inflammation)
Gout occurs when urate crystals accumulate around your joint, causing
the inflammation and intense pain of a gout attack. Urate crystals can
form when you have high levels of uric acid in your blood. Your body
produces uric acid when it breaks down purines, substances that are
found naturally in your body, as well as in certain foods.
For many people's health, gout develops after a combination of factors
contributes to the buildup of excessive levels of uric acid in the
body. Abnormally high levels of uric acid may result from a diet that
is rich in purines, chemicals that are broken down into uric acid by
the body.
Purines can be found in anchovies, nuts, and organ foods such as liver, kidney, and sweetbreads. Also, herring, asparagus and mushrooms. Sometimes, for unknown reasons, the body will produce too much uric acid regardless of diet. Sometimes, for unknown reasons, the body will produce too much uric acid regardless of diet.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
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Also see: ARTHRITIS OSTEOARTHRITIS RHEUMATOID ARTHRITIS BURSITIS TENDONITIS
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Health: Symptoms of Gout (Joint - Inflammation)
Symptoms develop suddenly and usually involve
only one or a few joints. The big toe, knee, or ankle joints are most
often affected. The pain frequently starts during the night and is often described
as throbbing, crushing, or excruciating.
The attacks of painful joints may go away in several days, but may return from time to time. Additional attacks usually last long. Some people may progress to chronic gouty arthritis, while others may have no further attacks.
The small joint at the base of the big toe is the most common site of
an acute gout attack of arthritis. Other
joints that are commonly affected include the ankles, knees, wrists,
fingers, and elbows. Acute gout attacks are characterized by a rapid
onset of pain in the affected joint followed by warmth, swelling,
reddish discoloration, and marked tenderness. Tenderness can be intense
so that even a blanket touching the skin over the affected joint can be
unbearable. Patients can develop fever with the acute gout attacks.
These painful attacks usually subside in hours to days, with or without
medication. In rare instances, an attack can last for weeks. Most
patients with gout will experience repeated attacks of arthritis over
the years, affecting their quality of health.
Uric acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. These urate crystals can incite inflammation in the bursae, leading to pain and swelling around the joints (a condition called bursitis). In rare instances, gout leads to a more chronic type of joint inflammation that mimics rheumatoid arthritis.
In chronic (tophaceous) gout, nodular masses of uric acid crystals (tophi) deposit in different soft-tissue areas of the body. Even though they are most commonly found as hard nodules around the fingers, at the tips of the elbows, in the ears, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the vocal cords or (rarely) even around the spinal cord.
Specific gout symptoms include:
- Fever (sometimes)
- Joint pain HOW TO PREVENT GOUT NATURALLY
- Joint inflammation of the affected joints
- Joint stiffness
- Joint redness and purple skin around the affected joints
- Skin lump which may drain chalky material
- often, an initial episode that occurs at night
- extreme tenderness around the joint
Health: Diagnosis of Gout ((Joint - Inflammation)
To reach a diagnosis, your doctor will ask you about your diet, your
medication use, your alcohol consumption, and whether you have a family health
history of gout. During a physical health exam, your doctor will inspect your
inflamed joint and look for tophi on your skin. Your doctor may also
use a needle to withdraw a small fluid sample from your affected joint.
This fluid will be examined under a microscope to determine whether
uric acid crystals are present. Your doctor may also order a blood test
to determine your uric acid level, but this test is not definitive
because — for a variety of different reasons — many people without gout
experience elevated uric acid levels, and even in people with gout, the
results may be normal.
Gout is suspected when a patient reports a history of attacks of painful arthritis, particularly at the base of the toes. Ankles and knees are the next most commonly involved joints in gout. Gout usually attacks one joint at a time, while other arthritis conditions, such as systemic lupus and rheumatoid arthritis, usually attack multiple joints simultaneously.
The most reliable test for gout is finding uric acid crystals in a sample of the joint fluid obtained by joint aspiration (arthrocentesis). Arthrocentesis is a common office procedure performed under local anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the inflamed joint using a syringe and needle. The joint fluid is then analyzed for uric acid crystals and for infection.
Sometimes patients with a classic history and symptoms of gout can be
successfully treated and presumed to have gout without undergoing
arthrocentesis. However, establishing a firm diagnosis is still
preferable since other conditions can mimic gout. X-rays can sometimes be helpful and may show tophi-crystal deposits and
bone damage as a result of repeated inflammation. X-rays can also be
helpful for monitoring the health effects of chronic gout on the joints.
Health: Conventional Treatment of Gout (Joint - Inflammation)
Gout is usually treated with a two-prong medication strategy: The first goal is to ease attacks of joint pain and inflammation, while the second, longer-term goal is to decrease blood uric acid level and prevent further attacks.
Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences. Medications for gout include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may control inflammation and pain in people with gout. NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), as well as more powerful prescription NSAIDs. NSAIDs carry risks of stomach pain, bleeding and ulcers.
- Colchicine. Colchicine controls gout effectively, but may cause uncomfortable side effects, such as nausea, vomiting and diarrhea. If you're unable to take NSAIDs, your doctor may recommend colchicine.
- Steroids. Steroid medications, such as the drug prednisone may control gout inflammation and pain. Steroids may be administered in pill form, or they can be injected into your joint. Side effects of steroids may include thinning bones, poor wound healing and a decreased ability to fight infection. Steroids may be reserved for people who can't take either NSAIDs or colchicine.
In addition to medications for acute gout attacks, other drugs can be taken over prolonged periods to lower blood uric acid levels. Lowering blood uric acid levels reduces the risk of recurrent attacks of arthritis, kidney stones, and kidney disease, and also slowly dissolves hard tophi deposits.
Health Medicines used to lower blood uric acid level work either by increasing the kidney's excretion of uric acid or by decreasing the body's production of uric acid from the purines in foods. These medicines are generally not started until after the inflammation from acute gouty arthritis has subsided because they can worsen the attack. If they are already being taken prior to the attack, they are continued and only adjusted after the attack has resolved.
The health treatment of an acute attack of gout arthritis involves measures and medications that reduce inflammation. Preventing future acute gout attacks is equally as important as treating the acute arthritis. Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption, and medications to lower the uric acid level in the blood (reduce hyperuricemia).
Maintaining adequate fluid intake helps prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney stone formation in patients with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism to cause hyperuricemia. Therefore, alcohol has two major effects that worsen gout by impeding (slowing down) the excretion of uric acid from the kidneys as well as by causing dehydration, both of which contribute to the precipitation of uric acid crystals in the joints.
Dietary health changes can help reduce uric acid levels in the blood. Since purine chemicals are converted by the body into uric acid, purine-rich foods are avoided. Examples of foods rich in purines include shellfish and organ meats such as liver, brains, kidneys, and sweetbreads. Researchers have reported, in general, that meat or seafood consumption increases the risk of gout attacks, while dairy food consumption seemed to reduce the risk. Protein intake or purine-rich vegetable consumption was not associated with an increased risk of gout. Total alcohol intake was strongly associated with an increased risk of gout (beer and liquor were particularly strong factors). Fructose in soft drinks also increases the risk of gout.
Weight reduction can be helpful in lowering the risk of recurrent attacks of gout. This is best accomplished by reducing dietary fat and calorie intake, combined with a regular aerobic health exercise program.
Home health remedies which can alleviate the symptoms of acute gout include resting and elevating the inflamed joint. Ice-pack applications can be helpful to reduce pain and decrease inflammation. Patients should avoid aspirin-containing medications, when possible, because aspirin prevents kidney excretion of uric acid.
People with gout can develop more-severe health conditions, such as:
- Recurrent gout. Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Health medications may help prevent gout attacks in people with recurrent gout.
- Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fi). Tophi usually aren't painful, but they can become swollen and tender during gout attacks.
- Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the health risk of kidney stones.
Health: Practical Prevention of Gout (Joint - Inflammation)
Health Medications
If you experience several gout attacks each year or if your gout
attacks are less frequent but particularly painful, your doctor may
recommend medication to reduce your risk of future gout attacks. You
usually begin taking preventive medications once your acute gout attack
has subsided. Options include:
- Medication that blocks uric acid production. Allopurinol (Zyloprim, Aloprim) limits the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout. Side effects include a rash and low blood counts.
- Medication that improves uric acid removal. Probenecid improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.
Gout health diet
No specific dietary health changes are proved to reduce your health risk of gout.
However, it may make sense to eat foods that contain fewer purines. If
you want to try a gout diet, try to:
- Cut back on the amount of red meat and seafood you eat.
- Avoid alcoholic beverages.
- Eat more low-fat dairy products.
- Eat more complex carbohydrates, such as whole-grain breads.
Choose portions that allow you to maintain a healthy weight. Losing
weight may decrease uric acid levels in your body. But avoid fasting or
rapid weight loss, since doing so may temporarily raise uric acid
levels.
Take care of your body during a gout attack. While you're waiting for your medications to take effect, you may find it easier to cope with pain and inflammation if you:
- Reduce the amount of animal protein you eat. Government guidelines advise eating no more than 5 to 6 ounces of lean meat, poultry or fish a day for nearly everyone — especially people who have gout, because high-protein foods increase the blood level of uric acid. Organ meats (liver, brains, kidney and sweetbreads), anchovies, herring and mackerel are particularly high in purines.
- Avoid alcohol. Alcohol can inhibit the excretion of uric acid. If you're having a gout attack, it's best to avoid alcohol completely.
- Drink plenty of liquids. Fluids help dilute uric acid in your blood and urine, so be sure you get enough water and other fluids every single day to preserve the quality of your health.
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Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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