Home Remedy for Gout Attack

When to Cure Gout with Surgery?

gout

Gout is a serious condition that can be treated by surgery. But there are many things you should consider before your doctor agrees to do this.  Treatment should be applied before surgery is recommended. Always go first for natural remedies:

Home Remedies for Gout

Gout’s four stages

Gout disorder can be divided into four stages.

1. This is the first stage of gout, where the uric acids level rises. However, people with this condition rarely experience gout and its symptoms.

2. The second stage is the acute, where a person with high levels uric acid in their body starts to feel more severe joint pains than what was experienced in the asymptomatic phase. This stage can last months to years. Gout attacks are not frequent enough to cause gout symptoms. Normal cases will feel the second attack in the 6th month.

3. The second stage’s gout disorder was not treated in the third stage. The result is that the joint pains become more severe and can also be accompanied by bursitis, or inflammation of the bursa. The bursa is a sac that contains the lubricating fluids for the joints. This is also when the gout attacks that developed in the acute stage of gout start to migrate to other joints, causing severe pains. The multiple gout pains can cause fever and almost complete immobilization.

4. Tophi, which is a visible lump of uric acid on the skin of gout sufferers, will develop if the multiple pains in the joints continue. These are signs of joint degeneration. The tophi pressure and swelling in the area around the joints is constant. It can lead to total immobility and deformity. Tophi is a condition that restricts joint mobility and causes pain.

Gout can also lead to other serious conditions, such as hypertension, albuminuria, or albumin protein found in urine, which is indicative of kidney disease, and Urolithiasis, which is the presence of stones in the urinary system. Gout sufferers will need surgery to relieve their crippling pain.

There are very rare cases where a person’s physical condition and body does not respond to any medication or treatment. These cases could be due to people who only take medications to relieve gout pains, but maintain a healthy diet and lifestyle.

Gout Diet

When to consider surgery?

Tophaceous gout is a condition where the body develops tophus. This type of gout can be prevented by surgery. Before surgery is considered for these extreme cases, you will need to have certain medical qualifications:

1. Functional surgery is when the tophaceous condition of gout prevents the patient from wearing any type of footwear or pants.

2. The patient is completely immobilized.

3. To reduce or eliminate the pressure from the tophaceous stones, before any damage or deformities to the joint occurs. Gout surgery is not recommended for severe cases like tophaceous or severe cases.

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What are the Symptoms of Gout?

Symptoms of gout usually appear suddenly and severely. An attack of gout usually affects only one joint, most commonly the big toe joint. However, the attack may involve more than one joint. Symptoms often develop at night and worsen over the next 24 to 36 hours. Other affected joints include the knees, ankles, feet, wrists, hands, fingers, and elbows.

Gout often appears on the Hand: Gout Hand and other times in the Foot: Gout Foot

Symptoms in the affected joint usually include:

  • Severe pain
  • Extreme tenderness
  • Swelling
  • Redness
  • Warmth

Other symptoms may include:

  • Fever
  • Chills
  • General ill feeling

Symptoms are usually more severe in people who develop gout before age 30. Some people will only have one attack of gout. Most people with gout, however, will suffer a recurrence within two years of the first attack, and subsequent recurrences after that (if the condition is left untreated).

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Complications of Gout

Chronic arthritis can cause pain, deformity and limitation of joint movement. Inflammation may be exacerbated in some joints and decreased in others. Patients with gout may develop urolithiasis with uric acid or calcium oxalate stones.

Complications of gout include renal obstruction and infection, with secondary tubulointerstitial disease. Untreated progressive renal dysfunction, often related to hypertension, or, less frequently, to other causes of nephropathy, further affects urate excretion, accelerating the deposition of crystals in tissues.

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Other possible complications of gout include:

  • Accumulation of uric acid deposits (tophi).
  • Hard lumps under the skin near (or around) the joints.
  • Hard lumps at the edge of the ear.
  • Other parts of the body may be affected such as fingertips, cornea of the eye, aorta, spine, or around the brain
  • Permanent damage to affected joints
  • Carpal tunnel syndrome, a painful condition of the wrists
  • Kidney stones (if uric acid builds up in the kidneys)
  • Kidney damage

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Prognosis of Gout

When gout is diagnosed early, lifelong urate-lowering therapy allows most patients to live a normal life. In many patients with advanced disease, aggressive lowering of serum urate concentration can resolve tophi and improve joint function.

Gout is usually more severe in patients whose symptoms begin before age 30 and whose baseline serum uric acid value is > 9.0 mg/dL (> 0.5 mmol/L). The high prevalence of metabolic syndrome and cardiovascular disease increases mortality in patients with gout.

Some patients do not improve sufficiently with treatment. Common reasons include inadequate education provided to patients, lack of compliance, alcoholism and especially undertreatment of hyperuricemia by physicians.

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Can Gout be prevented?

Gout is a disorder caused by hyperuricemia (serum urate > 6.8 mg/dL [> 0.4 mmol/L]) leading to precipitation of monosodium urate crystals in and around the joints, most often causing acute or chronic recurrent arthritis. The initial attack (crisis) of gout is usually monoarticular and usually affects the first metatarsophalangeal joint .

Symptoms of gout include pain, acute pain on pressure, warmth, redness and swelling. Definitive diagnosis requires the identification of crystals in the synovial fluid. Treatment of acute exacerbations is with anti-inflammatory drugs. The frequency of attacks can be reduced by regular use of nonsteroidal anti-inflammatory drugs, colchicine, or both plus persistent lowering of the serum urate level below its saturation level (< 6.8 mg/dL [< 0.4 mmol/L) with allopurinol, febuxostat, or uricosuric drugs, such as probenecid.

Gout is more common in men than in women. It usually appears at middle age in men and after menopause in women. It is rare in young people, but in those who develop the disease before the age of 30, it is more severe. Gout usually occurs in family groups. Patients with metabolic syndrome are at increased risk for gout.

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Can Gout be prevented?

Unfortunately, gout cannot be prevented, many people who suffer from this disease need medication to control it.

To prevent future attacks, you can consider the following:

  • Drink water constantly
  • Follow the medical treatment according to your specialist’s indications.
  • Avoid consuming red meat
  • Avoid sugary drinks
  • Avoid alcohol consumption, especially beer.
  • Healthy diet rich in fruits, vegetables and whole grains
  • Do physical activity at least 30 minutes a day.

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What are the Causes?

The main cause of gout is hyperuricemia, that is, having high levels of uric acid in the blood. Other risk factors are obesity, high blood pressure, intake of certain foods (red meat) and alcohol abuse. Although it is not considered a direct cause, it may be associated with spring fingers.

A good Diet can help prevent Gout: Gout Diet

Symptoms and Signs of Gout

Acute gouty arthritis usually begins with acute (often nocturnal) pain. It most often affects the metatarsophalangeal joint of the big toe (called podagra), but also the instep, ankle, knee, wrist and elbow. Rarely affects the hip, shoulders, sacroiliac joint, sternoclavicular or cervical spine. The pain becomes increasingly intense in a few hours, and is often excruciating. There are signs of infection, such as swelling, warmth, redness and extreme sensitivity to pressure. The skin becomes tight, hot, shiny and reddish or purplish. There may be fever, tachycardia, chills and malaise.

The symptoms of the disease are sudden attacks of intense pain and swelling of a joint, leading to arthritis, with the base of the big toe being the most affected. Gout also presents other signs such as cold, chills and tachycardia.

Here you can learn more about the Symptoms of Gout: Gout Symptoms

Evolution

The first acute exacerbations usually affect a single joint and last only a few days. Later, several joints are affected simultaneously or sequentially and acute exacerbations persist for up to 3 weeks without treatment. Then attacks occur at shorter and shorter intervals. Finally, the patient suffers several acute exacerbations per year. If urate-lowering therapy is not initiated, patients may develop chronic deforming arthritis secondary to tophaceous gout due to continued urate deposition.

Treatment for Gout

After the detection of this condition, which can be given thanks to the studies included in certain Check Up, we proceed with the treatment. There are two types of Gout medications that focus on two different problems. The first helps to reduce the inflammation and pain associated with gout attacks.

The second to prevent complications of Gout by reducing the amount of uric acid in the blood. The type of medication will depend on the frequency and severity of your symptoms, along with other health problems you may have.

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What is Gout?

Gout is a type of arthritis and occurs when uric acid accumulates in the blood and causes inflammation in the joints. Sometimes, these crystals are deposited in the kidneys, causing Nephritic Colic or alterations in their function.

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Pathophysiology of Gout

The greater the degree and duration of hyperuricemia, the greater the probability of developing gout. The causes that produce an elevation of uric acid concentration are:

  • Decreased renal (most common) or gastrointestinal excretion.
  • Increased production (rare)
  • Increased purine intake (usually in combination with decreased excretion).
  • It is not known why some people with high serum uric acid (urate) concentration develop acute exacerbations of gout and others do not.

Decreased renal excretion: this is the most common cause of hyperuricemia. It can be hereditary (e.g., due to variations in the efficiency of the uric acid transporter), and is also observed in patients receiving diuretics and in those with diseases that decrease glomerular filtration. Ethanol increases purine catabolism in the liver and the formation of lactic acid, which blocks urate secretion in the renal tubules and can also stimulate hepatic urate synthesis. Lead poisoning and cyclosporine, in the higher doses used for transplant patients, alter renal tubular function, with urate retention.

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Increased urate production may be due to increased nucleoprotein turnover in hematologic diseases (e.g., lymphoma, leukemia, hemolytic anemia) and in those with increased rates of cell proliferation and cell death (e.g., psoriasis, cytotoxic cancer treatment, radiation therapy). Increased urate production may also manifest as a primary hereditary abnormality or with obesity, as urate production correlates with body surface area. In most cases, the cause of urate overproduction is unknown, although it is rarely attributed to enzymatic abnormalities; one possible cause is hypoxanthine-guanine phosphoribosyltransferase deficiency (Lesch-Nyhan syndrome is the complete deficiency) or overactivity of phosphoribosylpyrophosphate synthetase.

Increased intake: increased intake of purine-rich foods (e.g., liver, kidneys, anchovies, asparagus, broth, herring, meat sauce and broth, mushrooms, mussels, sardines, sweetbreads) may contribute to hyperuricemia. Beer, including non-alcoholic beer, is particularly rich in guanosine, a purine nucleoside. However, a strict low-purine diet decreases serum urate concentration by only 1 mg/dL (0.1 mmol/L) and therefore is rarely sufficient therapy for patients with gout.

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Urate precipitates as acicular monosodium urate crystals that form extracellular deposits in avascular tissues (e.g., cartilage) or in relatively avascular tissues (e.g., tendons, tendon sheaths, ligaments, bursa walls) and in the skin around joints and colder distal tissues (e.g., ears, finger pads). In cases of prolonged severe hyperuricemia, monosodium urate crystals may be deposited in large central joints and in the parenchyma of organs such as the kidney.

At the acidic pH of urine, urate precipitates readily as small, plaque-like or diamond-shaped uric acid crystals that may aggregate to form grit or stones, which can obstruct the flow of urine. Tophi are aggregates of monosodium urate crystals that develop in joints and skin tissues. They are usually enclosed in a granulomatous fibrous matrix, which prevents them from causing acute inflammation.

Acute gouty arthritis can be triggered by trauma, illness (e.g., pneumonia or other infection), surgery, use of thiazide diuretics or drugs with hypouricemic effects (e.g., allopurinol, febuxostat, probenecid, nitroglycerin), or by abuse of purine-rich foods or alcohol. Acute exacerbations are usually precipitated by a sharp rise or, more frequently, a sharp fall in serum urate levels. The reason why acute flares follow some of these precipitating conditions is unknown. Tophi in and around joints can limit movement and cause deformities, called chronic tophaceous gouty arthritis. Gout increases the risk of developing secondary osteoarthritis.

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