Signs & Sy motoring

When gout first shows up, it usually affects only one joint, most often the big toe. It may also appear in a knee, ankle, wrist, foot, or finger.

The affected joint becomes red, swollen, painful, and very sensitive to the touch. Even light contact between a bed sheet and the joint can cause severe pain.

• The inflammation can be intense enough to cause fever, muscle aches, and other flu- like symptoms.
• First episodes of gout often come on suddenly, and usually occur at night.
• If you don't treat gout, the pain and inflammation can last several days. The first day or 2 of an attack are usually the most severe.
• More than half of people have repeat flare-ups, sometimes months or years after having no symptoms.
• The episodes can get progressively more serious. Over time, more joints may be affected, and the episodes may last longer.

Without treatment, gout can also cause long-term arthritis, with chronic swelling and permanent joint damage. Uric acid crystals can build up, producing large lumps under the skin called tophi. Crystals may also be deposited in the kidneys, causing kidney stones.

How Gout is Diagnosed

To determine whether you may have gout, your doctor will:

• Ask you about your symptoms
• Take a family history
• Examine your painful joints
• Look for tophi

If your symptoms don't point to a definitive diagnosis, your doctor will likely conduct the following tests:

• Perform blood tests to measure your uric acid levels and to test your kidney function.
• Use a needle to take a small amount of fluid from the inflamed joint. If you have gout, the fluid will contain white blood cells and uric acid crystals, which can be seen through a special microscope.
• Test a sample of your urine.

Sometimes, it can be hard to tell if a person's joint pain is caused by gout, another type of arthritis, or other conditions. There is even a condition that mimics gout and is commonly known as "pseudogout." Pseudogout is caused by calcium pyrophosphate crystals (not uric acid crystals) building up in joints and other tissues.

Management

Unfortunately, there is no cure for gout. The pain and inflammation can he treated, however, and there are a number of things you can do to prevent future attacks and to prevent the long-term effects of untreated gout, such as serious joint damage, tophi, and kidney disease. The goal of long-term management of gout is to lower uric acid to healthy levels. The target level is less than 6 mg/dl.

The pain and in animation of gout can be treated,and there are a number of things you can do to prevent future attacks.

Treating 1 pain Inflammation
If you see your doctor for painful, swollen joints, he or she may start you on a medication to ease your symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs), for example, work well for these purposes.

They are especially effective if they are started as soon as possible after the start of an attack, and if they are used at the maximum recommended dose.

NSAIDs include:
• Indomethacin • Ibuprofen • Naproxen Aspirin should not be taken by people with gout because it can raise the level of uric acid in your blood. Other options include corticosteroids, adrenocorticotropic hormone, and colchicine.

Preventive Drugs

Preventive medication can help people who have:

• Frequent attacks of Elevated uric acid levels
  - Attacks that don't respond promptly to treatment
  - Attacks that affect more than 1 joint at the time
• A history of kidney stones and previous gout Tophi

Preventive medications include allopurinol, febuxostat, probenecid, and sulfinpyrazone.

Allopurinol and febuxostat work by making your body produce less uric acid.

Probenecid and sulfinpyrazone work by making the kidneys release more uric acid.

These drugs work well in 70% to 80% of people with gout. Although these drugs can be used in those with mild to moderate kidney disease, they should not be taken by people who have severe kidney disease or who have had a kidney stone. These preventive medications usually need to be taken daily to be effective.

When you first start taking a medication to lower your uric acid levels, you may experience a gout flare-up. This happens because as uric acid level is lowered, crystals begin to dissolve in your joints. Your doctor may give you a medication to help prevent this attack. A low dose of colchicine or a low dose of an NSAID may be used for this purpose.

Whenever you start a new medication, remind your doctor

Diet ez Lifestyle

Here are some tips for the long-term management of gout:

• Keep well-hydrated
  - Lose excess weight(being overweight increases the risk of gout)
• Exercise Avoid foods that seem

any other drugs you take and any other conditions you have.

• Ask your doctor if there are medications you are taking (especially diuretics) that can cause uric acid buildup, and see if you can switch to something else
• Limit alcohol intake. For many people, attacks of gout come on after drinking alcohol. Alcohol has a high purine content, and the body breaks down purines into uric acid.
• Your doctor may also prescribe medicine to help treat the attack and also medicine to lower uric acid.

Gout:Not Just for the Rich

One common myth about gout is that it only affects the 'well-to-do.' This idea is false, though it has been around for a long time.

Descriptions of gout date hack as far as the 5th century BC. Throughout the ages, gout was called the "King of Diseases" and "Disease of Kings." Why?

Gout attacks seemed to follow banquets during which participants drank excessive amounts of alcohol. Eating large amounts of caviar and organ meats (such as pancreas or liver) may also have played a role in triggering gout attacks, because these foods are rich in the proteins that are broken down into uric acid. For those less able to afford large quantities of this food and drink, gout may have been less common.

The mistaken notion that gout only occurs in the wealthy developed in the same way that medical myths often develop: When 2 things occur together (gout and wealth), 1 is assumed to cause the other.