What is gout?
Gout is a health problem that causes inflamed, painful joints. The symptoms are caused by deposits of urate crystals at the joints. Gout used to be associated with kings who overindulged in rich food and wine. In truth, anyone can get gout. Gout affects more men than women. It is often linked with obesity, high blood pressure, high levels of lipids in the blood (hyperlipidemia), and diabetes.
What causes gout?
Gout is caused by monosodium urate crystal deposits in the joints. This is due to an excess of uric acid in the body. Too much uric acid may be caused by several things. It may be caused by the body making too much uric acid. Or the kidneys may not get rid of enough uric acid. It may also be caused by eating a lot of foods that are high in purines. Purines turn into uric acid in the body.
Foods high in purines include:
- Alcoholic drinks and sugary drinks high in fructose
- Certain meats, such as game meats, kidney, brains, and liver
- Dried beans and dried peas
- Seafood, such as anchovies, herring, scallops, sardines, and mackerel
Gout attacks may be triggered by any of the following:
- Drinking alcohol
- Eating a lot of protein-rich foods
- Emotional stress
- Minor surgery
Who is at risk for gout?
You are at higher risk for gout if you:
- Are a man
- Are a postmenopausal woman
- Have kidney disease
- Have high blood pressure, high cholesterol, or diabetes
- Have family members with gout
What are the symptoms of gout?
Gout causes sudden, recurrent attacks of symptoms that often occur without warning. Severe, chronic gout may lead to deformity. Symptoms can occur a bit differently in each person. Common symptoms include:
- General feeling of illness
- Hard lumps of urate crystal deposits under the skin (tophi)
- Severe, sudden pain in one or more joints, most often the joint in the big toe
- Skin that is red or purple, tight, and shiny over the joint
- Swollen joint(s)
- Warmth in the joint area
Some symptoms of gout can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.
How is gout diagnosed?
The process starts with a medical history and a physical exam. A fluid sample may be taken from the joint and checked for urate crystals.
How is gout treated?
Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. Treatment may include:
- Avoiding alcoholic drinks
- Colchicine, an oral or IV medicine to relieve pain and inflammation
- Corticosteroids to reduce inflammation
- Drinking more nonalcoholic fluids
- Eating less protein-rich foods
- Medicine to block production of uric acid in the body
- Medicine to lower the uric acid level in the blood
- Nonsteroidal anti-inflammatory medicines to relieve pain and inflammation
- Surgery to remove extremely large tophi
- Weight loss, if obesity is an issue
Talk with your healthcare provider about the risks, benefits, and possible side effects of all medicines.
What are the complications of gout?
People with gout have a higher risk for kidney stones, due to crystal deposits in the kidneys. They can also have kidney damage. Crystal deposits in the joints can cause some disability due to stiffness and pain.
Living with gout
You can reduce the risk of future flare-ups of gout and decrease their severity by taking medicine as prescribed. If you are given medicine to take when a flare-up occurs, it is best to start taking it at the first sign of symptoms. Or get medical attention at the first sign of symptoms. To help prevent episodes of gout:
- Talk with your healthcare provider before taking any new medicine, including over-the-counter medicines
- Drink plenty of water
- Don’t drink alcohol
- Exercise regularly
- Lose weight if needed
- Don’t eat foods that are high in purines
When should I call my health care provider?
If your symptoms get worse or you have new symptoms, let your healthcare provider know.
Key points about gout
- Gout causes inflamed, painful joints due to urate crystal deposits at the joints.
- Gout can also cause urate crystal deposits that cause lumps under the skin.
- Gout can be triggered by eating foods high in purines and drinking alcohol.
- Treatment of gout is aimed at reducing pain and the risk of future flare-ups.
- Gout can be managed with medicines and lifestyle changes.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
Stretching can keep your lower legs limber and your joints pain free. The following stretches involve the ankles and knee joints.
Keep these guidelines in mind when doing them:
- Check with your healthcare provider before beginning any exercise program, especially if you have had knee surgery.
- Begin each stretching session with 5 to 7 minutes of gentle aerobic exercise, such as walking or riding a stationary bicycle, to warm up your muscles.
- Start out slowly and build repetitions gradually.
- Stop any exercise that causes pain.
- Repeat each exercise 2 to 4 times, or as instructed.
Achilles tendon and calf muscles
Stand 2 or 3 feet from a wall. Lean forward with both hands touching the wall, 1 foot forward and the other 12 to 18 inches behind. Leave both feet flat on the floor during the stretch. Hold the stretch position for 15 to 30 seconds. Repeat for a total of 2 to 4 repetitions. Complete all repetitions on 1 side before changing sides.
Stand on a stair step with the toes of both feet near the edge. Position your heels below the level of the step, then rise on your toes. Hold the stretch and slowly return to the starting position.
Be careful. If you have small feet and a large body, overdoing calf raises could damage your foot. To avoid this, gradually increase the number and height of the raises.
Osteoarthritis, also called degenerative joint disease, happens when the cartilage in a joint breaks down. Cartilage allows the bones in a joint to glide over one another. When the cartilage breaks down, the bones rub together. This causes pain, swelling, and loss of motion. Osteoarthritis most often affects the hands, neck, lower back, knees, and hips.
Your healthcare provider can help you find ways to reduce pain, move better, and protect your joints from further injury. Changes in your daily activities can also help. These changes may include weight management, exercise, pain control, joint protection, and medication. If these don’t help, surgery may be an option.
Extra weight can put stress on your joints and increase pain. This happens most often in the weight-bearing joints, such as your hips, knees, and ankles.
Weight loss is not easy, but even losing a small amount of weight can help. Talk with your healthcare provider about ways to lose weight. Diet changes and exercise can help. A dietician or nutritionist can help you with eating healthy. In some cases, medication or weight loss surgery may help.
Exercise is a key part of arthritis care. Exercise strengthens the muscles that support your joints. It also lessens joint pain and stiffness. And, it helps to improve your overall health. You should try to do a variety of exercises to build strength and improve your lung and heart health. All exercises burn calories and can help you lose weight. It is critical to talk with your healthcare provider prior to starting an exercise routine. Your healthcare provider can help you determine what type of exercise routine and intensity level is best for you. Your healthcare provider may also be able to give you handouts on exercise techniques or refer you to a physical therapist to learn the optimal exercise routine for your needs.
|A man uses resistance band to strengthen his shoulders and arms.
The types of exercise are:
- Strengthening exercises. These can be done with exercise bands or resistance bands (inexpensive exercise aids), or with weights.
- Aerobic activities. These exercises keep your heart and lungs strong. Moderate aerobic activity for 30 minutes most days of the week is recommended. You can even break it up into three 10-minute increments. Activities such as swimming, walking, cycling are good choices.
- Range of motion/stretching activities. These can lessen pain and stiffness and help you move better.
- Balance exercises. These help you maintain balance and improve your daily living. Yoga and tai chi are excellent examples.
Start exercising slowly each time by gently moving your joints. Warm up for at least 5 to 10 minutes before any exercise. Talk with your healthcare provider:
- Before starting an exercise program or adding new exercises to your daily routine
- When a joint becomes painful or swollen
- About taking pain medication or using ice or heat before or after you exercise
To lessen pain and protect your joints from further damage you should:
- Balance rest with activity. It’s important to be active and to exercise every day. But, you should rest in between periods of activity.
- Take care of your joints. There are things you do every day that can make your joint symptoms worse. And, there are better ways of doing those same things. For example:
- Store heavy kitchen items at waist-height so that you can easily get to them.
- Use aids like long-handled graspers and jar-openers.
- Recognize pain. If your joints hurt more than usual, you may have done too much.
- Sleep. It’s important to get enough sleep each night. Sleep gives your energy to be active during the day. It also helps you to feel better overall. If you are having trouble sleeping, or don’t feel rested when you wake up, talk with your healthcare provider.
Over-the-counter and prescription medications can help reduce the pain and stiffness from osteoarthritis. They include:
- Pills, topical medication (rubbed on the skin), and injections into the joint
- Pain relievers, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen
It’s very important that you talk with your healthcare provider before taking any medication for arthritis. Even medications that are available without prescription can cause serious side effects. Some can make other medical problems worse and interfere with other medications.
Each person reacts differently to these medications. If one medication doesn’t work for you, your provider may prescribe a different one.
Although medications can help control most arthritis pain, you can also try:
- Relaxation techniques. Deep breathing, yoga, or easy stretching can help.
- Cold and heat. Applying ice packs, moist heat, or hot showers and baths can help lessen pain and stiffness. Ask your healthcare provider what he or she suggests.
- Other methods. Massage, acupuncture, transcutaneous electrical nerve stimulation or TENS (a small device that delivers light impulses to the nerves) can also help.
If other treatments don’t work for your arthritis, you may need surgery.
- Arthroscopic surgery. During arthroscopic surgery, the healthcare provider uses a special tool called an arthroscope to see and work inside your joint. It may be done to remove loose or damaged cartilage and bone. It can also be used to smooth or reposition bones.
- Joint replacement surgery. Joint replacement surgery is when the damaged joint is replaced with new man-made joints. The knee and hip joints are replaced most often.
Talk with your healthcare provider about the benefits and risks of these procedures.
There are many ways to handle the pain of osteoarthritis. Work with your healthcare provider to figure out what’s best for you.
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