For years, this condition was mistakenly thought of as a 'rich man's disease'. But gout doesn't check your bank statement before it strikes. Potent medicines and lifestyle changes can now end the excruciating pain and get you back on your feet.
LIKELY FIRST STEPS
Often a painful gout attack first strikes the big toe when uric acid crystallines in the joint fluid.
Treatments
Medications
When acute gout strikes, you need relief--fast. The first choice is the prescription nonsteroidal anti-inflammatory drug (NSAID) indomethacin (Indocin), in doses of up to 200 mg a day. It knocks down inflammation and swelling caused by the immune reaction to the uric acid crystals, normally starting to work within 24 hours, and often much sooner. For severe pain, your doctor may need to prescribe more powerful painkillers, such as codeine or pethidine. A prescription-strength version of a familiar NSAID such as ibuprofen (Brufen) may help, or your doctor may prescribe one of the newer COX-2 inhibitors, such as celecoxib (Celebrex) , rofecoxib (Vioxx) or meloxicam (Mobic), especially if you have a history of gastrointestinal side effects with NSAIDs. Another option, if the preferred drugs are ineffective or can't be tolerated, is corticosteroids, such as methyl prednisolone (administered by injection) and predisone (taken orally).
To decrease your immune responsiveness, your doctor may prescribe the potent antigout drug colcincine (Colgout) derived from the autumn crocus and used for centuries to combat gout. It's very effective, and usually taken every hour initially until the pain subsides (for severe attacks it can be injected). By the tenth dose, most people experience improvment. But because colchicine comes with a slew of nasty side effects (nausea, vomiting, diarrhoea, abdominal cramps), most of which are dehydrating, the dose is usually reduced to just twice a day.
After the acute attack has passed, your doctor may prescribe other antigout drugs. Most often used for long-term treatment, allopurinol (Allohexal Progout, Zy loprim) slows production of uric acid and helps prevent recurrences. Some doctors prescribe small doses of colchicine along with the allopurinol, such as probenecid (Pro-Cid). Some doctors prescribe probenecid and alloourinol together.
IT'S THE CHERRIES
A good serving of cherries a day keeps the gout away. Or so goes the folk wisdom. While hard scientific evidence is lacking, lots of anecdottal evidence suggests (and many gout sufferers agree) that dark cherries can help prevent gout attacks.
Cherries are loaded with flavonoids, potent antioxidants known to have anit-inflammatory properties. Flavonoids help reduce uric acid levels and block the inflammation-causing substances that are released in the joint when crystals start building up.
If you want to give cherries a try, eat 250 g of fresh or canned cherries a day. Or drink about 2 cups of real cherry juice. Cherry fruit extract capsules are avaiable from online suppliers of vitamins and supplements. For relief for a gout attack, try taking 2000 mg (usually two capsules) three times a day. To help prevent future attacks, take 1000 mg (or one capsule) daily.
Lifestyle changes
You can't prevent your first gout attack, but you can decrease the risk of recurrence. Here are a few of the most effective strategies:
There are several good choices for grout in Mother Nature's storehouse. Bromelain, an enzyme found in pineapple, is believed to pack anti-inflammatory properties that can help cut a gout attack short. Take a bromelain supplement once every three hours to relieve pain, and then twice a day to help prevent future attacks. Quercetin, a flavonoid found in plants, is believed to help lower uric acid levels, and is better absorbed when taken with bromelain.
Whether fish oil helps relieve gout pain is debatable, but it is an effective anti-inflammatory. And vitamin C, if taken in small doses throughout the day, is thought to help release uric acid from body tissues and speed it out of the body. Never take one large dose of this vitamin: it can increase the risk of freeing up too much uric acid all at once, which could cause a kidney stone.
What is happening
An acute gout attack feels like shards of broken glass have been jammed into one of your joints, most often your big toe. The 'shards' are actually uric acid crystals, and the question is, how did they get so painfully into your toe (instep, ankle, knee, finger)? It all starts with purines, chemcial compounds in your DNA. Humans are the only mammals that lack an enzyme to break down purines, so when they're metabolised by the body, they become uric acid. This seemingly useless substances is produced by the liver and released into the blood. Usually it passes through the kidneys to be excreted.
For unknown reasons, some people accumulate uric acid---either by producing too much or excreting too little. Genetic seems to play some role (up to 20 percent of people with gout have a family history of it), as do such lifestyle factors as obesity, eating lots of animal protein and overimbibing alcohol. When too much uric acid builds up, it eventually spills over into the fluid that cushions the spaces around your joints. Most of the time it stays harmlessly in this solution. Trouble starts when you get dedhyrated for some reason. Your body then pulls fluids from everywhere, including the joint fluid; this causes the uric acid to crystallise into monosodium urate inside certain joints. Your immune system then leaps into action, inflaming the affected joint in an effort to expel the 'foreign' crystals from your body.
Gout attacks usually occur in men over age 40 (it takes years for uric acid levels to build up). Less than 5 percent of gout patients are women; it's thought oestrogen helps move the uric acid through the kidneys and out of the body. (This may be why women who get gout are usually postmenopausal.) About half the time gout strikes the big toe, often late at night or early in the morning; it causes inflammation and swelling---even the weight of a bedsheet can be extruding. Untreated, an attack will usually peak one to two days after symptoms first appear, and subside within a week, although it may last longer.
An acute gout attack feels like shards of broken glass have been jammed into one of your joints, most often your big toe. The 'shards' are actually uric acid crystals, and the question is, how did they get so painfully into your toe (instep, ankle, knee, finger)? It all starts with purines, chemcial compounds in your DNA. Humans are the only mammals that lack an enzyme to break down purines, so when they're metabolised by the body, they become uric acid. This seemingly useless substances is produced by the liver and released into the blood. Usually it passes through the kidneys to be excreted.
For unknown reasons, some people accumulate uric acid---either by producing too much or excreting too little. Genetic seems to play some role (up to 20 percent of people with gout have a family history of it), as do such lifestyle factors as obesity, eating lots of animal protein and overimbibing alcohol. When too much uric acid builds up, it eventually spills over into the fluid that cushions the spaces around your joints. Most of the time it stays harmlessly in this solution. Trouble starts when you get dedhyrated for some reason. Your body then pulls fluids from everywhere, including the joint fluid; this causes the uric acid to crystallise into monosodium urate inside certain joints. Your immune system then leaps into action, inflaming the affected joint in an effort to expel the 'foreign' crystals from your body.
Gout attacks usually occur in men over age 40 (it takes years for uric acid levels to build up). Less than 5 percent of gout patients are women; it's thought oestrogen helps move the uric acid through the kidneys and out of the body. (This may be why women who get gout are usually postmenopausal.) About half the time gout strikes the big toe, often late at night or early in the morning; it causes inflammation and swelling---even the weight of a bedsheet can be extruding. Untreated, an attack will usually peak one to two days after symptoms first appear, and subside within a week, although it may last longer.
- Drink lots of water immediately to lessen symptoms; keep drinking long term to help flush out the uric acid.
- Take NSAIDs such as Indocin to relieve inflammation.
- Use colchicine to reduce your immune reaction.
- Abstain from alcohol. It dehydrates you, making a gout attack more likely.
QUESTIONS TO ASK
- Do I need a blood test to determine if I have gout?
- Could other medications I'm taking make my gout worse?
- Does being overweight contribute to m gout attacks?
Often a painful gout attack first strikes the big toe when uric acid crystallines in the joint fluid.
Treatments
To treat a gout attack, you must stop the immune reaction that is causing such pain, and you need to dissolve the uric crystals by rehdyrating your joint fluid. This means your essential first step is to drink copious amounts of water. Then you'll need to reduce the inflammation around your joints with medication. After a gout
Treatment Options
MEDICATIONS
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Indocin Reduces inflammation and swelling.
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Painkillers Prescription NSAIDs, codeine, as needed.
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Corticosteroids If other drugs aren't tolerated.
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Colcincine Slows initial immune reaction.
--------------------------------------------------------------------------------------------------------------------------------------------
Antigout drugs Affect uric acid production and excretion.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Stay hydrated Essential for forestalling acute attacks.
----------------------------------------------------------------------------------------------------------------------------------------------
Dietary measures Avoid purine-rich foods and alcohol.
----------------------------------------------------------------------------------------------------------------------------------------------
Weight loss Choose a low-protein diet.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Supplements Bromelain, quercetin, fish oil, vitamin C.
attack, you may be lulled into a false sense of security when your joints go back to working just fine. But one study found that 62 percent of patients with gout had another attack within a year, and 78 percent within two years. After 10 years, nearly 93 percent suffered a recurrence.
Untreated, gout can develop into a chronic disease with the formation of large, solid deposits of uric acid crystals called tophi that settle around the joints and other areas. A build-up of uric acid can also cause painful kidney stones. But with proper treatment, gout rarely becomes chronic. Medications can blunt an acute attack and help prevent recurrences. And lifestyle changes, from losing weight to watching what you eat and drink, can make a big difference.
TAKING CONTROL
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Indocin Reduces inflammation and swelling.
------------------------------------------------------------------------------------------------------------------------------------------
Painkillers Prescription NSAIDs, codeine, as needed.
-------------------------------------------------------------------------------------------------------------------------------------------
Corticosteroids If other drugs aren't tolerated.
-------------------------------------------------------------------------------------------------------------------------------------------
Colcincine Slows initial immune reaction.
--------------------------------------------------------------------------------------------------------------------------------------------
Antigout drugs Affect uric acid production and excretion.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Stay hydrated Essential for forestalling acute attacks.
----------------------------------------------------------------------------------------------------------------------------------------------
Dietary measures Avoid purine-rich foods and alcohol.
----------------------------------------------------------------------------------------------------------------------------------------------
Weight loss Choose a low-protein diet.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Supplements Bromelain, quercetin, fish oil, vitamin C.
attack, you may be lulled into a false sense of security when your joints go back to working just fine. But one study found that 62 percent of patients with gout had another attack within a year, and 78 percent within two years. After 10 years, nearly 93 percent suffered a recurrence.
Untreated, gout can develop into a chronic disease with the formation of large, solid deposits of uric acid crystals called tophi that settle around the joints and other areas. A build-up of uric acid can also cause painful kidney stones. But with proper treatment, gout rarely becomes chronic. Medications can blunt an acute attack and help prevent recurrences. And lifestyle changes, from losing weight to watching what you eat and drink, can make a big difference.
TAKING CONTROL
- Be a smart drinker. If you want to have a beer, a glass of wine or other alcohol, just be sure to compensate by dowing lots of water before you go to bed. This will keep you hydrated, which helps to prevent a gout attack.
- Try some fruit. Although cherries are widely acclaimed as the most effective fruit for gout (see above), strawberries and blueberries also seem to help keep it at bay. Interestigly, celery (and celery seed extract) have a similar effect.
- Take care with diluretics. If you're on a diruretic drug for high blood pressure or a heart problem, be aware it could worsen your gout becuase the drug is designed to make you excrete excess fluid. Check with your doctor.
- Plan a gout-free vacation. Travel can throw off your eating and drinking patterns. Before you go, talk to your doctor about preventive measures. Your doctor may prescribe medication just in case a gout attack strikes while you're away.
Medications
When acute gout strikes, you need relief--fast. The first choice is the prescription nonsteroidal anti-inflammatory drug (NSAID) indomethacin (Indocin), in doses of up to 200 mg a day. It knocks down inflammation and swelling caused by the immune reaction to the uric acid crystals, normally starting to work within 24 hours, and often much sooner. For severe pain, your doctor may need to prescribe more powerful painkillers, such as codeine or pethidine. A prescription-strength version of a familiar NSAID such as ibuprofen (Brufen) may help, or your doctor may prescribe one of the newer COX-2 inhibitors, such as celecoxib (Celebrex) , rofecoxib (Vioxx) or meloxicam (Mobic), especially if you have a history of gastrointestinal side effects with NSAIDs. Another option, if the preferred drugs are ineffective or can't be tolerated, is corticosteroids, such as methyl prednisolone (administered by injection) and predisone (taken orally).
To decrease your immune responsiveness, your doctor may prescribe the potent antigout drug colcincine (Colgout) derived from the autumn crocus and used for centuries to combat gout. It's very effective, and usually taken every hour initially until the pain subsides (for severe attacks it can be injected). By the tenth dose, most people experience improvment. But because colchicine comes with a slew of nasty side effects (nausea, vomiting, diarrhoea, abdominal cramps), most of which are dehydrating, the dose is usually reduced to just twice a day.
After the acute attack has passed, your doctor may prescribe other antigout drugs. Most often used for long-term treatment, allopurinol (Allohexal Progout, Zy loprim) slows production of uric acid and helps prevent recurrences. Some doctors prescribe small doses of colchicine along with the allopurinol, such as probenecid (Pro-Cid). Some doctors prescribe probenecid and alloourinol together.
IT'S THE CHERRIES
A good serving of cherries a day keeps the gout away. Or so goes the folk wisdom. While hard scientific evidence is lacking, lots of anecdottal evidence suggests (and many gout sufferers agree) that dark cherries can help prevent gout attacks.
Cherries are loaded with flavonoids, potent antioxidants known to have anit-inflammatory properties. Flavonoids help reduce uric acid levels and block the inflammation-causing substances that are released in the joint when crystals start building up.
If you want to give cherries a try, eat 250 g of fresh or canned cherries a day. Or drink about 2 cups of real cherry juice. Cherry fruit extract capsules are avaiable from online suppliers of vitamins and supplements. For relief for a gout attack, try taking 2000 mg (usually two capsules) three times a day. To help prevent future attacks, take 1000 mg (or one capsule) daily.
Lifestyle changes
You can't prevent your first gout attack, but you can decrease the risk of recurrence. Here are a few of the most effective strategies:
- Don't get dehydrated. This is yet one more reason to drink at least eight glasses of liquids a day. Doing so helps keep your joint fluid intact and also flushes uric acid out of your system.
- Avoid purine-rich foods. Watch out for organ meats (liver, kidneys, sweetbreads), anchovies, shrimp, sardines, fish roe, yeast, herring and mackerel. And there are even vegetables that are high in purines: mushrooms, asparagus, cauliflower and spinach.
- Lose weight the smart way. Obesity is a strong risk factor for gout, especially in men. If you want to loose weight, avoid a high-protein plan (Atkins, the Zone, Sugar Busters). Increasing your animal protein intake boosts puriness and makes your grout worse.
- Avoid alcohol. First, it makes you wee and can dehydrate you, and second, it inhibits the excertion of uric acid as it boosts uric acid production. So drink lots of water and limit yourself to two drinks a day if you're a man, one drink if you're a woman. One study found alcohol to be the only significant risk factor for women with gout.
There are several good choices for grout in Mother Nature's storehouse. Bromelain, an enzyme found in pineapple, is believed to pack anti-inflammatory properties that can help cut a gout attack short. Take a bromelain supplement once every three hours to relieve pain, and then twice a day to help prevent future attacks. Quercetin, a flavonoid found in plants, is believed to help lower uric acid levels, and is better absorbed when taken with bromelain.
Whether fish oil helps relieve gout pain is debatable, but it is an effective anti-inflammatory. And vitamin C, if taken in small doses throughout the day, is thought to help release uric acid from body tissues and speed it out of the body. Never take one large dose of this vitamin: it can increase the risk of freeing up too much uric acid all at once, which could cause a kidney stone.
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