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Out With Gout: Everything You Need To Know About Gout

Medically reviewed on Aug 23, 2017 by C. Fookes, BPharm

Gout - We Take It Seriously

A recent survey of gout sufferers revealed that over a third would trade a winning lottery ticket for an assurance of never suffering another bout of the disease again.

If you are someone with gout, then you don't need the results of a survey to tell you how painful the condition is. But to non-sufferers, this result gives some indication as to the degree of pain people with gout have to endure.

Gout is a type of arthritis that occurs in small joints of the body, most commonly the big toe. And unfortunately... it's a disease that's often not taken seriously.

Symptoms Include Excruciating Pain

The pain of gout is excruciating. So excruciating, in fact, that even the weight of a cotton bed sheet on a gout-inflicted toe is often too much to bear.

While gout is most common in the big toe, it can also occur in the feet, ankles, knees, hands and wrists. The affected joint or joints become swollen, tender and red, and look and feel "hot". Movement is usually difficult.

The pain tends to come on suddenly and reaches a peak in four to 12 hours. Although the first episode usually resolves in a few days, future gout attacks are likely to last longer and affect more joints.

Gout is Associated With Uric Acid

Gout was once thought of as a rich man's disease because it tended to only afflict those who had access to copious amounts of food and alcohol. You've probably heard it referred to as "The Disease of Kings".

But modern research shows gout has little to do with wealth. Doctors know that gout occurs when uric acid crystallizes in a joint. Uric acid is a waste product that is formed when purines - crucial substances found in protein and other foods - are broken down. Under normal conditions, uric acid dissolves in the blood, passes through the kidneys, and is excreted in the urine. Not so in people with gout.

Our Immune System Attacks Uric Acid Crystals

But while people with high levels of uric acid in their body are more likely to get gout, the relationship between uric acid and gout is not clear-cut. Gout doesn't affect everybody who has high uric acid levels and sometimes gout attacks occur when levels are low. Doctors are still trying to figure that one out!

But what they do know is that the pain of gout is due to crystals of uric acid forming inside the joint. Our body tries to fight these crystals, so it is our immune response which causes the swelling, redness and intense pain.

Who Is More Likely to Get Gout?

Well, not Kings these days!...Although it is a condition that is definitely more common in men.

Seven to nine times more common in fact, although women are more likely to suffer from it after menopause.

It is the most common type of arthritis in men over the age of 40, and overall is estimated to affect more than 5 million Americans every year.

Diet, Beverages, Diseases, Treatments and Medicines Can Bring On Attacks

Gout is more likely to occur after eating purine-rich foods - such as red meat; organ meats (such as kidneys, liver, or brains); and seafood (for example, herring, mussels, or sardines) - or after drinking alcohol, particularly beer and spirits.

Processed foods (for example chips, frozen dinners), refined carbohydrates (such as white bread and white rice) and beverages high in fructose or sucrose also contribute to gout.

Risk is increased in people with certain medical conditions including cancer and psoriasis, and with some medications (like aspirin or diuretics) or treatments (for example, chemotherapy or radiation).

When to See Your Doctor

If you experience sudden, intense pain in a joint, call your doctor for a diagnosis.

Gout that is not treated can cause irreversible joint damage, kidney stones and the formation of tophi.

Tophi are small chalky-colored stone-like deposits of uric acid that collect under the skin and are most frequently found in skin around the joints and on the outside of the ear.

Medications to Treat Gout Attacks

Gout treatment can be categorized into medicines used to treat an acute attack, and medicines used to prevent gout complications, such as tophi.

Medicines used to treat gout attacks relieve pain and inflammation and include:

Medicines to Prevent Gout Complications

Doctors may advise additional medication for people who experience several gout attacks each year or who have particularly painful episodes.

Medicines to prevent recurrences of gout either block the production of uric acid or improve its removal. Examples include:

Hard To Treat? Option Of Adding Zurampic

Ideally, doctors aim for a target uric acid level of less than 6.0mg/dL (360 ┬Ámol/L) for most people with hyperuricemia associated with gout.

If this target has not been reached within six months or so with a xanthine oxidase inhibitor (such as allopurinol or febuxostat), doctors now have the option of adding in lesinurad (Zurampic).

Zurampic is used in addition to other drugs such as allopurinol or febuxostat, and research shows it is effective at increasing the excretion and decreasing the production of uric acid. In trials, nearly twice as many people achieved their target serum uric acid levels compared to those treated just with allopurinol.

Zurampic should be taken in the morning at the same time as your other gout medication. There is a risk of kidney failure with the medicine, especially if it is taken alone or in people who become dehydrated. Drink at least two liters (68 oz) of liquids throughout the day when taking Zurampic to keep your kidneys functioning properly. Seek urgent medical advice if you develop shortness of breath, pain when urinating, urinate less often or not at all, or swelling occurs in your feet or ankles.

People with gout requiring both allopurinol and lesinurad may find it easier to take Duzallo, a combination medicine approved in August 2017 that contains both active ingredients in one tablet.

Your Gout: What You Can Do

Although medications are the most effective way to prevent and treat gout, a few lifestyle changes go a long way in reducing the risk of future attacks.

Avoid sweetened drinks containing fructose or sucrose, and alcoholic beverages such as beer and spirits. Drink plenty of water.

Limit your intake of purine-rich foods such as red meats, organ meats, and seafood. Eat mostly fresh vegetables and use low-fat dairy products as a protein source.

Exercise regularly and lose weight if you are overweight.

Finished: Out With Gout - Everything You Need To Know About Gout

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