Recent Posts

Archive

Tags

I have the gout.

When patients ask me about gout, I ask them why do you ask about gout?

Patient: I was diagnosed with gout.

Me: How were your diagnosed?

Patient 1: By blood tests.

Patient 2: My foot hurt after working.

Patient 3: I ate a lot of crabs and then my toe started to hurt.

Me: Did it start all of the sudden, like you woke up with the pain?

Patient 1: No. It was over several days and has been getting worse since.

Patient 2: I felt it when I put on my work boots and got worse as the day went on because I was standing a lot.

Patient 3: Yes. It woke me up in the morning.

WHAT IS GOUT?

Gout usually is an "all of a sudden severe to extreme" pain in a joint, classically, but not exclusively the big toe. It can be described as throbbing, aching, burning, or stabbing pain. The affected joint usually is red, hot, swollen and extremely tender to touch. (See Picture)

HOW TO DIAGNOSE GOUT?

Diagnosis, therefore, is mostly clinical. Introducing a needle into the joint to extract fluid is the best diagnostic method and is the gold standard, however, it may be painful and there may not be enough joint fluid to extract and analyze. Subsequent injection of the joint with steroids mixed with lidocaine will help alleviate symptoms the fastest with least amount of systemic side effects.

Ultrasound examination can diagnose gout when a "double contour sign" is seen. It appears like another white line that is somewhat parallel to the joint. (See below image)

Contrary to popular belief, the blood test for gout, called uric acid, will likely be normal or low during an acute flare of gout, so it should not be used to rule out gout.

ACUTE GOUT TREATMENT

Treatment of gout in the acute setting usually involved Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as indomethacin, ibuprofen, or naproxen, to name a few. In patients with coronary artery disease, chronic kidney disease (CKD), or on non-Aspirin blood thinners, such as Coumadin, NSAIDs should not be used.

Colchicine tablets or capsules are used primarily in patients that do not have moderate to severe CKD. Colchicine, unfortunately is very expensive now, so may not be affordable even with health insurance.

Prednisone tablets are also used with the limitation of uncontrolled or brittle diabetes mellitus.

MAINTENANCE GOUT TREATMENT

If you have more than 2 flares of gout per year, then you should be on maintenance treatment or preventative treatment to prevent you from having any future attacks. It is like taking blood pressure medications. You may not feel your elevated blood pressure just like you have may not feel the gout is building up in your system until you have severe headaches or chest pains from high blood pressure or a gouty attack of your joint. There is no reason to play catch up when you can prevent it from doing any damage in the first place.

The maintenance medications are allopurinol and febuoxstat and in patients that continue to have flares or have large gout collections called tophi, there is an every two week infusion called Krystexxa (pegloticase) that works well.

DOES DIET MODIFICATION HELP?

Low protein and alcohol diet helps minimally, so I do not encourage diet modification. If you are the right treatment regimen, you should be able to eat without restrictions, unless you need a low salt, cholesterol, or diabetic diet due to other health reasons.

WHAT TO DO IF YOU HAVE AN ATTACK

1) Contact your treating physician

2) If more than two flares, ask about maintenance therapy

3) Continue your medications even if you have no flares

4) Do not stop your maintenance medication if you have a flare

5) If you are hospitalized for another reason, make sure your doctor continues your maintenance medication to prevent a flare, which may likely happen

  • Facebook Social Icon

©2017 by Rheumatology On Demand, LLC. Proudly created with Wix.com