Gout

By Bryan Downs PT

What Causes Gout and How do you Treat It?

Gout is a disease that can be very painful. It is caused by a deposition of crystals in a joint due to high levels of uric acid. Gout is more prevalent in males over the age of 65 but can affect females and those under the age of 65 as well. This common disease affects greater than 3 million people in the United States each year.

Gout Gouty Arthritis Foot Pain JOI REHAB

Image of Gout

Signs and Symptoms of Gout

The signs and symptoms of gout are vary from one person to the next.  However, here are the most common symptoms of gout:

  • Joint pain – Usually a single joint, most commonly the great toe. However, gout can affect other joints such as the ankles, knees, elbows, wrists, and fingers.
  • Inflammation or Swelling
  • Redness or the area is warm to touch.
  • If you have a fever with intense joint pain, you should call your doctor right away.
  • Reduced range of motion in the affected joint
  • Acute CPPD (calcium pyrophosphate dihydrate) arthritis can affect larger joints such as the knee

If you are having these symptoms, you should contact your doctor immediately to see if medical intervention is necessary.

2 Types of Gout:

1. Gout

Result of a deposition of crystals in or around a joint secondary to an increase in uric acid levels that cannot excrete. In addition, This triggers an inflammatory response which can be very painful. The acute inflammatory reaction lasts about 2 weeks and may resolve without intervention. If acute attacks continue then chronic gout may develop. Chronic gout can have detrimental effects to the joints leading to damage and injuries to the soft tissue surrounding the joint. If it is left untreated loss of function of the joint may occur.

2. Pseudo Gout (aka Acute CPPD Arthritis)

This is caused by calcium deposits has a similar presentation as gout hence the name pseudo gout. During a pseudo attack, CPPD (calcium pyrophosphate dihydrate) is the type of crystal deposited. Often, CPPD arthritis and gout can only be differentiated from each other with a fluid analysis lab test. Acute CPPD also affects older individuals, however, it tends to affect the larger joints unlike gout.

How is it Diagnosed

The standard for diagnosis is a synovial fluid test.  This is an aspiration of the joint which is painful.  This testing of the fluid obtained from the joint would be either positive or negative for gout.  Other ways Gout can be diagnosed include:

  • Blood test
  • Imaging
  • Ultrasound
  • Physical exam

Risk factors:

  • Non-modifiable risk factors: Greater than 65 years of age, male gender, a family history of Gout.
  • Modifiable risk factors (things you can change/avoid):  Eating foods that are high in uric acid and being overweight.

Treatment for Gout

Treatment for Gout may include pharmacological intervention. The primary focus will be on symptom reduction and management. In addition to, lifestyle changes to prevent future acute attacks. Treatment for this condition and similar arthritis may include:

  • Colchicine – an anti-inflammatory medication to reduce pain related to gout
  • Corticosteroids – reduce inflammation that may occur
  • Allopurinol – reduce concentrations of uric acid
  • Lifestyle changes, such as exercise and diet modification, to reduce the recurrence of flare ups
  • Avoid foods that are high in uric acid: Shellfish, red meats, organ meats, alcohol, and vegetables that are high in purines (cauliflower, asparagus, spinach, and mushrooms)
  • NSAIDS (nonsteroidal anti-inflammatory drugs)

All treatment should be monitored and prescribed by a qualified medical professional.

Gout arthritis Gouty Arthritis

Image of Gout arthritis

Management

Long term management of gout is important to limit the development of a chronic condition. A chronic condition can have long lasting impairments of the affected joints and soft tissue. Management is primarily accomplished with lifestyle changes such as diet modification, weight loss, and proper exercise. This is a natural prescription to reduce the effects of arthritis on the joints.

  • Foods to limit or avoid: Shellfish, red meats, organ meats, alcohol, and vegetables that are high in purines (cauliflower, asparagus, spinach, and mushrooms).
  • Weight loss can reduce the stress on weight bearing joints and lessen forces occurring at the joint.
  • Choosing the correct exercises that reduce impact on the joints along with using the correct form can improve overall strength while avoiding inflammation of joints.

Written By: Bryan Downs PT

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