Gout Symptoms and Diagnosis | Johns Hopkins Arthritis Center

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Arthritis / Acute Gout Attack

Gout is a form of arthritis, hence it causes pain and discomfort in the joints. A typical gout attack is characterized by the sudden onset of severe pain, swelling, warmth, and redness of a joint. The clinical presentation of acute gouty arthritis is not subtle with very few mimics other than a bacterial infection.

The joint most commonly involved in gout is the first metatarsophalangeal joint (the big toe), and is called podagra. Any joint may be involved in a gout attack (and it may be more than one) with the most frequent sites being in the feet, ankles, knees, and elbows.

An acute gout attack will generally reach its peak 12-24 hours after onset, and then will slowly begin to resolve even without treatment. Full recovery from a gout attack (without treatment) takes approximately 7-14 days.

An accurate and colorful discription of a gout attack was elegantly written in 1683 by Dr. Thomas Sydenham who was himself a sufferer of gout:

The victim goes to bed and sleeps in good health. About 2 o’clock in the morning, he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep. This pain is like that of a dislocation, and yet the parts feel as if cold water were poured over them. Then follows chills and shiver and a little fever. The pain which at first moderate becomes more intense. With its intensity the chills and shivers increase. After a time this comes to a full height, accommodating itself to the bones and ligaments of the tarsus and metatarsus. Now it is a violent stretching and tearing of the ligaments– now it is a gnawing pain and now a pressure and tightening. So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of a person walking in the room.

Chronic Tophaceous Gout

Some patients only experience acute gout attacks which may be limited to 1-2 times per year (or even 1-2 times in lifetime). However, for some patients, gout can be a chronic, relapsing problem with multiple severe attacks that occur at short intervals and without complete resolution of inflammation between attacks. This form of gout, called chronic gout, can cause significant joint destruction and deformity and may be confused with other forms of chronic inflammatory arthritis such as rheumatoid arthritis. Frequently, uric acid tophi (hard, uric acid deposits under the skin) are present and contribute to bone and cartilage destruction. Tophi are diagnostic for chronic tophaceous gout. Tophi can be found around joints, in the olecranon bursa, or at the pinna of the ear. With treatment, tophi can be dissolved and will completely disappear over time.

Tophi at helix of ear.Large tophaceous deposits surrounding joints.

Asymptomatic Hyperuricemia

It is important to recognize that although almost uniformly all patients with gout have hyperuricemia (high levels of uric acid in the blood)…all patients with hyperuricemia do not have gout. Although most patients will have elevated levels of uric acid in the blood for many years before having their first gout attack, there is no current recommendation for treatment during this period in the absence of clinical signs or symptoms of gout. This is termed ‘asymptomatic hyperuricemia’. The risk of a gout attack increases with increasing uric acid levels, but many patients will have attacks with “normal” levels of uric acid and some will never have an attack despite very high levels of uric acid.

Diagnosis of Gout

A diagnosis of gout can be made with the documentation of the presence of uric acid crystals in synovial fluid or from a tophaceous deposit. In the setting of an acute gout attack, aspiration of joint fluid (by using a needle to draw fluid out of the swollen joint) and examination of the fluid under polarized light can yield the definitive diagnostic finding of needle shaped negatively-birefringent uric acid crystals (yellow when parallel to the axis of polarization). Intracellular crystals within a neutrophil are characteristic during an acute attack.

As the clincal features of acute gout and a septic joint (bacterial infection) can be very similar, arthrocentesis is important to rule out infection by sending the joint fluid for culture in these circumstances. Importantly, gout and infection can co-exist in the same joint (they are not mutually exclusive) and consideration should be made for sending joint fluid for culture even in a patient with an established history of gout if they are at risk for infection.

Tophi can be aspirated or the tophaceous material expressed and examined under polarize microscopy as well to confirm a diagnosis of chronic tophaceous gout.

Serum uric acid concentrations may be supportive of a diagnosis of gout, but alone the presence of hyperuricemia or normal uric acid concentrations do not confirm or rule out the diagnosis of gout as frequently uric acid levels may be normal during an acute gout attack.

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How long does gout last? What to know

Gout is a chronic condition. A flare-up of symptoms can last a few days if a person gets treatment and up to a couple of weeks if they do not.

Gout is an inflammatory disease that causes flare-ups of symptoms that come and go. The time between flare-ups varies depending on the person and their response to treatment.

There is currently no cure for gout. However, lifelong treatment and lifestyle adjustments, such as dietary changes, can help people manage the condition.

In this article, we look at how long gout flare-ups typically last and explain how to treat and prevent them.

Gout is a form of inflammatory arthritis. The condition involves flare-ups of symptoms, which are periods during which the symptoms emerge or worsen. There is no cure for gout, and the condition can worsen over time without proper treatment.

Treatments focus on reducing symptom severity during a flare-up and preventing future flare-ups. Doctors typically aim to reduce the amount of uric acid in the blood, which contributes to gout symptoms.

According to Johns Hopkins Arthritis Center, a gout flare-up typically reaches its peak within 12–24 hours of the initial onset. However, this period will vary depending on the person’s response to treatment and their general health.

Treatment should lead the symptoms to return to normal within a few days of the flare-up.

As treatment shortens the duration of flare-ups, they typically last for about 7–14 days without it.

Treatment can also reduce symptom severity. A 2014 review of colchicine found that people using this treatment were 25% more likely to report a 50% reduction in pain during a flare-up than those receiving a placebo. However, colchicine can cause side effects, such as nausea, vomiting, and diarrhea.

Common symptoms during a gout flare-up include:

• intense joint pain with a sudden onset
• pain in one joint at a time, which may increase as the disease progresses
• painful, discolored, and swollen joints

The Centers for Disease Control and Prevention (CDC) note that gout is most common in the big toe but that it also frequently affects other joints, such as the knee, ankle, and other toes.

Treatment can reduce the severity and duration of a flare-up, but people can also take steps at home to manage the symptoms.

A person can manage a flare-up when it occurs and take steps to prevent future flare-ups.

During a flare-up, the American College of Rheumatology suggests treatments that include:

• Colchicine: Doctors commonly prescribe this medication at an early stage of the condition, but it can cause side effects, such as nausea and vomiting.
• Nonsteroidal anti‐inflammatory drugs (NSAIDs): These drugs, which include ibuprofen, reduce inflammation and pain.
• Corticosteroids: Doctors may offer these drugs to people who are unable to take NSAIDs.
• Anakinra (Kineret): Anakinra is a new biologic drug for gout.

A person should work with their doctor to determine the best medications for their situation. They should make the doctor aware of how well the medications are working and whether there are any side effects.

The Arthritis Foundation provides several tips for managing a flare-up, including:

• using ice on the joint
• drinking plenty of water
• avoiding alcoholic beverages
• using a cane
• reducing stress
• elevating the affected foot or limb
• avoiding high purine foods, such as red meat, sweetbreads, and shellfish

Learn what foods to eat on a low purine diet.

To avoid flare-ups in the future, the CDC recommends:

• protecting the joints as much as possible
• eating a balanced, healthy diet that avoids high purine foods
• staying physically active
• maintaining a moderate weight
• working with a doctor to determine the best treatments and create a management plan

Diet can affect the symptoms of gout.

The CDC, the Arthritis Foundation, and the American College of Rheumatology recommend eating a diet low in purines. This means avoiding:

• red meat
• organs
• certain types of seafood
• alcohol

The DASH diet and Mediterranean diet are both good options for avoiding high purine foods.

The DASH diet primarily involves fruits, vegetables, whole grains, and lean meats, while the Mediterranean diet is rich in vegetables, whole grains, fish, and unsaturated fats.

Anyone who experiences an episode of gout symptoms for the first time should speak with a doctor. The doctor can help the person determine the best course of treatment, which is likely to include dietary changes and home remedies.

It is worth contacting a doctor if the recommended treatments are causing side effects or not working. In these cases, doctors can adjust the treatment plan accordingly.

A person with gout should also talk with their doctor if their gout flare-up is lasting longer than usual or the symptoms are worsening.

Gout flare-ups are painful episodes that can last for 1–2 weeks. Timely treatment can reduce the duration of a flare-up and the severity of the symptoms.

People with gout can take steps to prevent flare-ups, such as avoiding foods that are high in purine. Doctors can work with a person to determine an effective treatment plan that allows them to manage the disease over time with medications and lifestyle adjustments.

What is a gout attack? – Podagrapro | All about gout: causes, symptoms, treatment

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Gout attack

What is a gout attack?

The first attack of gout often occurs at night and is often triggered by a sudden rise in uric acid levels, for example, as a result of the consumption of large amounts of meat or beer. Gout is manifested by severe pain. Pain occurs due to inflammation and swelling of the affected areas. Attacks of gout can last for hours or days and are accompanied by severe pain.

The patient wakes up with unbearable pain in one joint (usually the joint of the big toe). If left untreated, a gout attack can last for days or even weeks. Inflammation can even be seen from the outside in the form of redness and swelling of the surrounding tissue.

Signs of damage to the joint during an attack of gout:

• Severe pain in the area of ​​the affected joint;
• The affected joint may be red, swollen and hot;
• The affected joint is very sensitive to touch. Other symptoms may develop, including fever, headache, tachycardia, and nausea.

How long can a gout attack last?

If left untreated, an attack may last 7 to 14 days until the inflammation subsides and the pain subsides. Usually there is itching and peeling of the skin over the affected joint.

Which organs can be affected by a gout attack?

Gout can affect various parts of the body. In the early stages of gout, the following joints are affected:

The disease also affects the soft tissues, as well as the kidneys and other organs, including the heart and intestines.

What to do if a gout attack develops?

If you think you have an attack or symptoms of gout, see your doctor. Your doctor will prescribe you medication to relieve pain and control the disease. Since gout attacks often develop at night and are accompanied by very severe pain, you can go to the emergency medical service.

What should I do if I have a gout attack with severe pain?

Attacks of gout usually come on suddenly and are very painful. They can be caused by consumption of foods high in purines (meat, seafood), alcoholic beverages (beer and spirits), physical exertion, or infectious disease, injury, and hypothermia. If you wake up at night or early in the morning from pain in a joint and see that the joint is swollen and sensitive to touch, you need to act quickly. Below are steps you can take to help relieve pain.

Pain relief: what can be done?

Consult a doctor!

It is important to start treatment within the first 24 hours after an attack develops (the sooner the better). Early treatment can reduce the severity and duration of an attack.

If you have already been diagnosed with gout and your doctor has recommended drugs to treat a gout attack that causes severe pain, start treatment immediately.

Continue with your prescribed treatment,

, including during a new attack, and inform your doctor about the attack as soon as possible.

Cool the affected area

Place a cool pack wrapped in a towel over the affected joint to reduce pain and inflammation. Repeat this cooling procedure for 20 to 30 minutes several times a day.

Try to rest and use walking aids

If the foot is affected, raise the foot (above chest level) with pillows. This will help reduce swelling.

Using a cane or walking support during an acute attack of gout will relieve pressure on the affected joint.

Drink plenty of fluids

Staying hydrated can improve the excretion of uric acid (a cause of joint pain) and prevent kidney stones. You should try to drink 2 liters of fluid daily, at least half of which should be water. Check with your doctor if you have any restrictions on such a drinking regimen!

Change your diet

Eliminate high purine foods such as shellfish, red meat, sweet breads and sauces.

Avoid alcohol, especially beer

It is important to avoid alcohol, especially beer, which is high in purines. In addition, alcohol prevents the excretion of uric acid from the body.

Try to relax

Stress can make gout worse, so try to stay calm and relax: watch a movie, talk to a friend, read a book, listen to music, or try meditation.

Gout. Symptoms, treatment – Health Clinic 365 Yekaterinburg

What is gout?

Gout is a form of arthritis that often presents with sudden, severe attacks of pain, tenderness, redness, swelling (inflammation) in some joints that may be hot to the touch. The diagnosis and treatment of gout is done by a rheumatologist. With gout, the joint of the big toe is more often affected, but other joints of the legs (knee, ankle) can also be affected by gout. Less commonly, gout develops in the joints of the hands (wrist and elbow), and almost never in the joints of the spine.

Symptoms of gout.

• Sudden intense pain in a joint that often first occurs in the morning;
• Swelling of the joint, hyperemia of the skin in the area of ​​the joint.

What causes gout?

Previously, gout was considered a disease of the rich and famous who could afford too much fatty foods and wine. It is now known that fatty foods and excessive alcohol consumption can contribute to the development of gout, but they are not the determining causes of the disease.
It is now known that gout develops as a result of pathological deposition of crystals (sodium urate) around the articular cartilage, and in later stages in the joint fluid. This process leads to inflammation, accompanied by pain. Urate crystals can also be deposited in the kidneys, resulting in the formation of “urate” stones in the kidneys. Scientists believe that this is due to excess production of uric acid in the body, or as a result of a decrease in the body’s ability to remove uric acid from the blood through the kidneys. Normally, uric acid dissolved in the blood easily passes through the kidneys and is excreted from the body in the urine. The cause of the so-called primary gout is probably the presence of an abnormal X chromosome, which is inherited.

Eating certain foods high in uric acid also contributes to the development of gout in some cases. These foods especially include red meat and internal organs (such as liver and kidneys), as well as shellfish and anchovies.
Blood uric acid levels may vary depending on:

• How efficient your kidneys are at removing uric acid;
• What do you eat;
• Your general health;
• How much alcohol do you drink;
• What medications do you take;
• What comorbidities do you suffer from?

It is not yet clear to science why gout does not develop in every person with high uric acid levels. It is only known that the ability of the kidneys to excrete uric acid from the body is partly determined by heredity. However, this does not mean that if someone in the family suffers from gout, then all family members will get gout. Heredity, along with the risk factors mentioned above (which affect the level of uric acid in the blood), as well as male gender and age, increase the risk of developing gout.

How often do gout flare-ups occur?

Attacks of gout may recur from time to time in the same or different joints. The first “attack” can last from a few days to two weeks if treatment is not started.
Over time, attacks of gout may become more frequent, other joints may be involved, symptoms may become more severe, and attacks may last longer. Repeated attacks can damage the joint. In some patients, gout manifests itself only once, but this is rather an exception. According to statistics, about 90 percent of patients who have had one attack of gout will at least have a second attack, although it may occur up to several years after the first attack. In some patients, gout flares may occur every two, three, or more weeks.

Who suffers from gout?

The following groups of people are more likely to suffer from gout:

• Men (usually over 40) and menopausal women;
• Overweight people;
• Alcohol abusers;
• People who frequently use diuretics to lower blood pressure or treat chronic heart failure.

Gout can also occur in young patients, provided they take certain medications for a long period of time, abuse alcoholic beverages, or have certain genetic disorders.

How is gout diagnosed?

Gout cannot be diagnosed by blood tests (uric acid levels) alone, as many people have elevated blood uric acid levels but never develop gout. In addition to a medical examination and study of the medical history, one of the methods for diagnosing gout is a puncture of the inflamed joint with the collection of intra-articular fluid for examination. The resulting liquid is examined under a microscope in order to detect sodium urate crystals.
In addition to diagnosis, puncture with the removal of fluid from the inflamed joint, in some cases, has a curative, albeit palliative, effect. This happens due to a decrease in fluid pressure in the joint bag, which leads to a decrease in the intensity of pain. The above diagnostic method is simple, but unfortunately not always objective. The fact is that with gout, crystals may be absent in the intra-articular fluid. Sometimes crystals are not detected the first time, but can be detected during diagnostic punctures of the joint during subsequent exacerbations.
Since gout can cause chronic joint pain and involve other joints, it is extremely important to get an accurate diagnosis and start specific treatment as soon as possible.

How to treat gout?

Gout belongs to the group of chronic diseases, it is impossible to get rid of it, but at the same time, it is possible to choose a treatment aimed at preventing relapses (exacerbations). With proper treatment, symptoms of gout can often be resolved within 24 hours of starting therapy.

The goal of treatment for gout is:

• to reduce or eliminate pain and inflammation;
• Prevent future gout flare-ups that can lead to joint damage.

The therapy prescribed by the doctor will depend on several factors, including the patient’s age, medications taken (for other conditions), general health, medical history, and the severity of the gout attacks.
The following groups of drugs are used in the treatment of gout:

1. Anti-inflammatory drugs. Anti-inflammatory drugs reduce pain and swelling of the joint during an exacerbation. As a rule, they are prescribed until the symptoms of gout completely stop. Given that anti-inflammatory drugs have side effects, your doctor will discuss them with you and, if they occur, you may be prescribed another drug. Anti-inflammatory drugs used for gout include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) are usually prescribed to treat sudden and severe attacks of gout. NSAIDs usually reduce inflammation and pain within a few hours;
• Corticosteroids may be given to patients who cannot take NSAIDs. Corticosteroids, like NSAIDs, reduce inflammation and reduce pain. Corticosteroids may be given as a tablet or injected into the affected joint;
• Colchicine. Sometimes used in low doses over a long period of time to reduce the risk of gout relapses. The drug has anti-inflammatory and anti-gout action.

2. Medicines that affect the level of uric acid in the blood. Some patients may require the appointment of drugs in this group. Unlike anti-inflammatory drugs, they do not reduce inflammation and pain, but they can reduce the level of uric acid in the blood. Examples of such drugs include: allopurinol; probenecid and Febuxostat, also called Uloric. These drugs are recommended for patients with high uric acid levels, repeated relapses of gout, and patients with uric acid kidney stones. The goal of treatment is to lower blood uric acid levels to less than 6 mg/dL.
As mentioned above, drugs in this group do not relieve symptoms during an exacerbation, but a decrease in the level of uric acid over time prevents the development of relapses. A sudden drop in uric acid levels can trigger an acute attack of gout. For the relief of acute attacks of gout in patients taking allopurinol or similar drugs, additional colchicine or NSAIDs are prescribed until the symptoms disappear.

Side effects of drugs.

Side effects of drugs do not develop in everyone and their manifestation varies from patient to patient. The occurrence of side effects depends on the dose, type of drug, concomitant diseases, or combination with other drugs that the patient is taking.
If a rash or itching develops while taking allopurinol, you must stop taking the drug and tell your doctor.

Can gout be treated with a certain diet?

Exclusion from the diet of certain foods, for most patients, does not play a decisive role in maintaining the required level of uric acid.