Gout Diagnosis and Treatment: What Works Best

March 12, 2024

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Gout is a common and painful form of arthritis caused by excess uric acid buildup in the bloodstream, leading to urate crystal formation in the joints. An estimated 8.3 million Americans suffer from gout, with cases rising globally. Understanding the available gout treatment methods and lifestyle changes to lower uric acid levels is key to managing this condition.

What Causes Gout?

Gout occurs when high uric acid levels in the blood cause needle-like urate crystals to accumulate in the joints, tendons, or surrounding tissue. This leads to sudden and severe pain, swelling, redness, and tenderness in the affected area – often the big toe, ankle, or knee.

Uric acid production results from the breakdown of purines, which are natural substances found in some foods and human cells. Normally, uric acid dissolves in the blood and passes through the kidneys into the urine. But in people with gout, uric acid builds up and crystallizes.

Risk factors for developing gout include:

  • Obesity
  • High purine foods like red meat, seafood, and alcohol
  • Sweetened beverages
  • Certain medications like diuretics and aspirin
  • Family history
  • Age and gender – Men over 40 are more prone
  • High blood pressure, diabetes, kidney disease or metabolic syndrome

Repeated gout attacks can cause permanent joint damage and erosion of bone over time. Thus, it’s crucial to treat gout flares quickly and take preventive steps.

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Treating an Acute Gout Attack

When a gout flare occurs, the goals are to alleviate severe pain, reduce inflammation, and prevent further attacks. Common gout medications used include:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs like ibuprofen (Advil), naproxen (Aleve), or indomethacin provide effective pain relief by blocking enzymes that trigger swelling and inflammation. Over-the-counter NSAIDs may suffice for mild cases. Prescription-strength options treat more severe gout.

Colchicine

Colchicine works by reducing urate crystal deposition in joints to curb inflammation. It’s most effective when taken within 12 hours of gout pain starting. Side effects like nausea and abdominal pain can occur.

Corticosteroids

Corticosteroids like prednisone fight inflammation by suppressing the immune system. They can be given as oral medications or directly injected into the gout-affected joint for faster relief. Short term use is advised given their side effects.

In severe refractory cases, the above drugs may be combined. It’s vital to treat gout flares quickly for the best outcomes. Lifestyle changes also help alleviate symptoms.

Lifestyle Tips to Manage Gout Attacks

Making certain lifestyle adjustments during gout attacks can complement medical treatment:

  • Hydrating well by drinking fluids like water helps remove uric acid. Herbal teas, fruit/veg juices, and broths are other options.
  • Applying ice packs for 15-20 minutes constricts blood vessels to reduce swelling and pain.
  • Elevating the affected limb eases pain and limits swelling by improving drainage.
  • Avoiding high purine foods like meats, seafood, and alcohol that raise uric acid.
  • Losing weight if obese or overweight, which strains joints.
  • Reducing stress via yoga, meditation, massage, etc which can trigger flares.
  • Wearing loose, open footwear to limit pressure on the affected toe/ankle joint.
  • Using over-the-counter pain relievers like acetaminophen as needed for pain.

Such gout home remedies alongside medications provide symptom relief during sudden attacks. But long term treatment is vital to prevent recurrent episodes.

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Uric Acid Lowering Drugs for Gout Management

The mainstay of gout treatment involves taking daily medications for gout to reduce blood uric acid levels. This helps dissolve and eliminate urate crystals from joints to prevent recurrent flare ups.

Common urate-lowering drugs include:

Xanthine Oxidase Inhibitors

  • Allopurinol – Widely used first line gout medicine that blocks enzyme xanthine oxidase to hinder uric acid production. Dose is adjusted until optimal uric acid level reached.
  • Febuxostat – More potent xanthine oxidase inhibitor typically reserved for those intolerant to allopurinol or with kidney dysfunction.

Uricosurics

  • Probenecid – Increases uric acid excretion from the kidneys into urine to reduce blood levels. Less effective in kidney disease.
  • Lesinurad – Newer uricosuric for gout cases not responding to standard drugs when combined with a xanthine oxidase inhibitor.

Starting at a low dose and gradually increasing uric acid lowering medications minimizes side effects like rash, nausea or diarrhea. Particularly with more powerful drugs, dosage should be carefully monitored through blood testing 4-6 weeks later to avoid overdosing.

Can Diet Help Treat Gout?

Yes, diet plays an important supporting role in gout management. Foods naturally contain varying levels of substances called purines that get metabolized into uric acid. Consuming excess purines promotes uric acid overproduction.

Foods to avoid with gout include:

  • Organ meats like liver or kidneys
  • Game meats
  • Anchovies, sardines in oil
  • Mussels, scallops, trout, tuna
  • Meat extracts like Oxo and Bovril
  • Alcohol, especially beer due to its high purine content

Whereas foods that help lower gout risk include:

  • Low fat dairy like milk, yogurt and cheese
  • Whole grains like oatmeal, brown rice and quinoa
  • Fresh fruits like strawberries, blueberries, oranges and cherries
  • Vegetables like spinach, kale, bell peppers and potatoes
  • Legumes like beans, peas and lentils -Seeds and nuts like almonds, walnuts and flaxseed
  • Vegetable oils like olive oil and avocado oil
  • Coffee and vitamin C supplements

Avoiding crash diets and staying hydrated also supports gout care. Losing weight gradually if obese and limiting alcohol are likewise recommended. Consulting a registered dietitian helps craft an optimal anti-gout diet.

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Preventing Gout Flare Ups

Making certain lifestyle changes can significantly reduce recurring gout attacks, alongside uric acid lowering treatment. These include:

Maintaining Healthy Body Weight

Carrying excess pounds strains joints, causing tissue damage that triggers gout flares. Losing weight lowers uric acid levels.

Staying Well Hydrated

Drinking adequate fluids like water or herbal teas helps flush out uric acid through urine, reducing crystal deposits.

Limiting Alcohol Intake

Alcohol interferes with uric acid removal while beer is rich in purines. Moderating intake prevents flares.

Exercising Regularly

Low impact exercises like swimming, cycling and walking helps lower uric acid and maintains flexibility plus strength.

Quitting Smoking

Smoking worsens gout severity and flares. Its toxins hinder uric acid processing and excretion.

Managing Related Conditions

Having co-existing issues like obesity, high BP, high cholesterol and diabetes aggravates gout by raising uric acid levels further. Following respective treatment plans helps control gout.

Incorporating the above strategies reduces recurrent attacks substantially while supporting medical therapy. They help avoid permanent joint damage and disability.

Can Natural Remedies Help Relieve Gout?

Yes, certain complementary therapies and natural gout remedies offer pain relief and help lower uric acid levels when used alongside standard treatment:

  • Tart cherry juice – Has compounds that reduce inflammation and uric acid production. Shown to lower gout flare ups.
  • Apple cider vinegar – Acetic acid promotes uric acid excretion. Mixed with honey and water, few spoonfuls a day aids gout control.
  • Turmeric – Curcumin has anti-inflammatory effects that alleviates joint pain and swelling.
  • Ginger, celery seed tea, cilantro – Have antioxidative and cleansing properties that support gout treatment.
  • Epsom salt baths – Relax muscles while magnesium absorbs through skin to help flush out uric acid.
  • Massage – Improves circulation and drainage of tissues while promoting relaxation. Helps ease gout symptoms.
  • Mind-body therapies like tai chi, yoga and meditation help reduce pain perception while lowering stress.

Such complementary gout remedies can enhance quality of life when combined with conventional medical treatment and lifestyle modification.

Diagnosing Gout

Accurately diagnosing gout involves assessing symptoms and running appropriate tests to check for high uric acid levels.

Common diagnostic approaches include:

  • Physical exam – Joint tenderness, redness, warmth and swelling indicates gout likelihood. Family history and risk factors are reviewed.
  • Joint fluid test – Extracting fluid with a needle reveals urate crystals upon microscopy. This confirms gout diagnosis.
  • Blood test – Having a blood uric acid level above 6.8 mg/dL during a gout attack indicates a high probability of gout.
  • Imaging tests – Ultrasound, CT or MRI scans help visualize soft tissue and joint damage in chronic gout.

Early gout diagnosis is key, as recurrent flares can progressively harm joint structures in a short timeframe.

FAQs About Gout Treatment

What is the fastest way to get rid of gout?

Using NSAIDs or colchicine at the first sign of gout can provide fastest relief by rapidly reducing inflammation. Combining rest, ice application and drinking fluids also speeds recovery.

What foods should you avoid during gout attack?

High purine foods like red meat, seafood, alcohol and broths further raise uric acid, worsening gout pain. Sticking to low purine foods like dairy, eggs, pasta and rice helps minimize symptoms.

Can you permanently get rid of gout?

There is no permanent cure yet to eliminate gout entirely. But combining uric acid lowering treatment, lifestyle changes and diet helps prevent further gout attacks and significantly minimizes recurrence risk long term.

What happens if gout is left untreated?

Leaving gout unchecked allows urate crystals to increasingly accumulate in joints, causing painful flareups that become more frequent and severe. It can permanently harm joints and surrounding bone, causing disability.

What is the fastest home remedy for gout pain?

Applying ice packs to the affected joint for 15-20 minutes, keeping the area elevated, staying well hydrated, and taking anti-inflammatories like naproxen provides the fastest home pain relief during gout flares.

In summary, available gout medications target both relieving painful symptoms during sudden attacks, as well as preventing future episodes and joint damage long term. Combining uric acid lowering drugs, lifestyle and dietary modifications minimizes gout recurrence substantially. Seeking early treatment optimizes outcomes. Ongoing research also seeks more advanced gout therapies for hard-to-treat cases.

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