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Gout: Manage Your Symptoms

Kidney Disease (4)0

I have two dear friends who suffer from gout. I have seen their pain.  Sometimes it occurs as a result of eating foods that trigger the inflammatory process. Often flare-ups seem to occur for no particular reason. One thing is certain — their suffering is real!

What is Gout

Gout is loosely considered another type of arthritis. It is an inflammatory disease that mainly affects the joints. The initial complaint seems to be the pain of an unknown origin usually in the great toe. As the disease progresses it affects other joints and seems to increase in severity.

Persons who suffer from gout have a build-up of uric acid in their blood. Uric acid is produced when certain foods are metabolized by the body. It happens in people with too much uric acid accumulated in the blood. Uric acid is a chemical that is produced when the body breaks down certain foods.

The uric acid crystals usually remain between the joints where they form sharp needle-like crystals. These crystals are the cause of much pain. Uric acid crystals can also form on the inside of your ureters (the tubes that carry urine from the kidneys to the bladder). These crystals can sometimes evolve into kidney stones and may remain in the ureters, blocking them and stopping the flow of urine. 

Patients have described the pain of kidney stones as similar to “giving birth”. I have seen both men and women double over in agony from the pain of kidney stones as well as gout.

What are the symptoms of gout? 

People complain of sudden “flares” or attacks of severe pain, most often in the area of the big toe, ankle, or knee. Sometimes the joint becomes red and swollen. Only one joint is generally affected at any given time,  though some people can present with pain in multiple joints simultaneously.

Gout flares tend to happen more often during the night.

The pain from gout can be extreme. The pain and swelling are worst at the beginning of a gout flare. The symptoms then get better within a few days to weeks. It is not clear how the body “turns off” a gout flare.

A woman sitting with her hand on her right knee as if in pain
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Is there a test for gout?

Yes. To be tested for gout, your doctor or nurse will take a sample of fluid from the affected joint. If he or she finds typical gout crystals in the fluid, then you are diagnosed with gout. A simple blood test can also confirm the presence of gout.

The doctor may suspect gout:

● If you have had pain and swelling in one joint, especially the joint at the base of the big toe

●If your symptoms completely go away between flares, at least when you first start having them

●If your blood tests show high levels of uric acid

How is gout treated?

There are a few medicines that can reduce the pain and swelling caused by gout. When you find one that works for you, make sure to keep it on hand at all times. That way you can take it as soon as you feel a flare-up coming on. The medicines work best if you take them as soon as symptoms start.

A woman lying curled up in a fetal position suggesting she is in pain
Photo by Yuris Alhumaydy on Unsplash

Medicines used for Gout

NSAIDs Non-Steroidal Anti-Inflammatory Drugs — This group of medicines are anti-inflammatory medicines but do not contain steroids.  Examples are ibuprofen aka Advil, Motrin, and indomethacin aka  Indocin. NSAIDs may not be safe for those with kidney or liver disease or have bleeding problems.

Colchicine – This medicine helps with gout but it can also cause diarrhea, nausea, vomiting, and stomach pain.

Steroids –Steroids are by nature anti-inflammatory but long-term use can have unpleasant side effects, like weight gain, increasing blood glucose, etc. They reduce swelling and pain and may be taken as pills or injectables.

Medications for gout management

Yes, there are medicines that can reduce the chances of having future gout flares. Most people who have repeated or severe flares of gout need to take these medicines. In general, they all work by reducing the amount of uric acid in the blood. Examples of these medicines include allopurinol aka Aloprim, Zyloprim, febuxostat or Uloric, and probenecid.

Those with severe gout may also be prescribed a medicine called pegloticase, which is administered intravenously. If you are currently taking one of the medicines due to gout, your doctor will need to check that your uric acid levels are low enough to dissolve the gout crystals.

A word of caution!

Allopurinol, febuxostat, and probenecid can actually increase gout flares when you initially begin taking them. To prevent this, your healthcare provider may suggest that you take low doses of colchicine when you initiate these medicines. This will give the gout crystals time to dissolve and should help to stop the new flare-ups over time.

You may prevent gout flares by:

  1. Losing weight.
  2. Be mindful of foods that contain uric acid.
  3. Avoid alcohol and sugars.
  4. Keep hydrated.

I cannot stress the importance of staying hydrated, Being properly hydrated will keep a steady stream of urine production while preventing new crystals from forming.

A dinner plate with medium rare steak and vegetables
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Avoid high purine foods such as:

  • Red meats, hamburgers, beef.
  • Organ meats, eg: liver, kidneys, tripe.
  • Wild meat, eg; rabbit, venison.
  • Bacon, anchovies, sardines.
  • Seafood and shellfish.
  • Alcohol including wine.
  • Beans and peas.
  • Few vegetables, eg: spinach, asparagus, mushrooms.

Avoid foods high in sugar such as sweet drinks and juices, foods with added fructose or corn syrup. Also foods such as sodas, enriched fruit drinks, cereals, ice creams, and candy.

Left unchecked Gout could lead to:

  • Kidney stones and other kidney problems
  • Long-lasting joint problem
  • Ongoing very bad pain

What steps you can take.

  • Keep a healthy weight. Lose weight slowly. Rapid weight loss may actually initiate an attack.
  • Avoid beer, wine, and mixed drinks (alcohol).
  • Tell your doctor if you are taking drugs for heart and kidney problems. Tell your doctor about all the drugs, vitamins, herbal supplements, and any over-the-counter drugs you are taking.
  • If you need to stop taking your prescribed medications, speak to your medical provider first.
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Tips to manage your disease

Some of the factors that influence an increase of uric acid levels in your body may include:

  • Diet. If you consume a diet rich in meats, seafood, alcohol, high fructose beverages you are at an increased risk for high uric acid. 
  • Obesity. With an increased body mass index (BMI), your kidneys are working harder and your body produces an increased amount of uric acid. So losing weight will help lower the risk factor.
  • Medical conditions. High blood pressure, diabetes, metabolic syndrome, and heart and kidney diseases influence the production and elimination of uric crystals.
  • Certain medications. Thiazide diuretics used for high blood pressure, a low-dose aspirin may also increase your uric acid levels. 
  • Your genetics. If your immediate family members have suffered from gout, you’re at an increased risk for the disease. 
  • Age and sex. Males are more susceptible to gout. Women generally produce lower levels of uric acid until after menopause, then their levels compare to those of males. primarily because women tend to have lower uric acid levels. 
  • Recent trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing a gout attack.
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Managing your disease at home

There are some simple and effective home remedies for a gout flare-up. Along with your prescribed medications, you may try:

  • Resting the affected joint
  • Elevating the limb to allow for venous return thereby reducing swelling and pain.
  • Use an ice pack to reduce swelling, (never use ice on one area for greater than 20 mins any one time).
  • Try consuming vitamin C products, e.g., cherry juice

Cherry juice is high in vitamin C, which aids the excretion of uric acid in the urine, but the effect is mild compared to some of the available medicines for gout attacks. Cherry juice may also increase the risk of kidney stones, so do not use this if you are predisposed to stones.

A woman with red cherries in her hand
Photo by Jacek Dylag on Unsplash

Conclusion:

Gout is an inflammatory arthritic disease. It is chronic in nature and requires stringent management to be at your optimum. There are several proven ways you can manage your disease. Follow the advice of your medical provider and make every effort to lose weight and avoid “gout-triggering” foods. 

While some home remedies help to relieve gout pain. Do not rely solely on this if you are not experiencing relief as the longer you wait the longer it will take for your symptoms to get better. If you record no significant improvement within 24 hours of using your home remedies, consult with your doctor.

As much as possible, try to consume a healthy diet, exercise, stay hydrated by utilizing water, and reducing the consumption of mild diuretics such as sodas, teas, and coffee. A healthy diet includes plenty of fruits, vegetables, whole grains, and low-fat dairy products. 

Know what purine-rich foods are and how to avoid them. Remember in everything moderation is key. 

Be safe and be well!