What is gout? Causes and remedies.
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I suffer from gout and it hurts like heck. Most of the pain is centered on my big toes. I will try to explain certain things you can do to reduce the pain and eventually get rid of that nasty pain.
According to Wikipedia:
A gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint. Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours. The joint at the base of the big toe is affected in about half of the cases.
Gout is a common and complex form of arthritis that can affect anyone. It’s characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, often the joint at the base of the big toe.
An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.
Gout symptoms may come and go, but there are ways to manage symptoms and prevent flares.
The signs and symptoms of gout almost always occur suddenly, and often at night. They include:
- Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in any joint. Other commonly affected joints include the ankles, knees, elbows, wrists, and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins.
- Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
- Inflammation and redness. The affected joint or joints become swollen, tender, warm, and red.
- Limited range of motion. As gout progresses, you may not be able to move your joints normally.
Gout is arthritis that happens when you have too much uric acid in your blood and it forms sharp crystals in one of your joints.
Your big toe is the most common place for it to happen. Flare-ups can last up to 10 days. The first 36 hours are the most painful. It usually affects only one joint at a time, but if it’s not treated, you might end up with it in your knee, ankle, foot, hand, wrist, or elbow.
Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.
Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.
Purines are also found in certain foods, such as steak, organ meats, and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation, and swelling.
You’re more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:
- Diet. Eating a diet rich in meat and seafood and drinking beverages sweetened with fruit sugar (fructose) increases levels of uric acid, which increases your risk of gout. Alcohol consumption, especially beer, also increases the risk of gout.
- Obesity. If you’re overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid.
- Medical conditions. Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
- Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
- Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
- Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
- Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing a gout attack.
People with gout can develop more severe conditions, such as:
- Recurrent gout. Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.
- Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas such as your fingers, hands, feet, elbows, or Achilles tendons along the backs of your ankles. Tophi are not usually painful, but they can become swollen and tender during gout attacks.
- Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.
During symptom-free periods, these dietary guidelines may help protect against future gout attacks:
- Drink plenty of fluids. Stay well-hydrated, including plenty of water. Limit how many sweetened beverages you drink, especially those sweetened with high-fructose corn syrup.
- Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
- Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
- Limit your intake of meat, fish, and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
- Maintain desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.
Gout frequently involves joints in the lower extremities. The classic location for gout to occur is the big toe (first metatarsophalangeal joint). Podagra is the medical term for inflammation at the base of the big toe. Gout can also affect the foot, knee, ankle, elbow, wrist, hands, or nearly any joint in the body. When gout is more severe or longstanding, multiple joints may be affected at the same time. This causes pain and joint stiffness in multiple joints.
Another sign of gout is the presence of tophi. A tophus is a hard nodule of uric acid that deposits under the skin. Tophi can be found in various locations in the body, commonly on the elbows, upper ear cartilage, and on the surface of other joints. When a tophus is present, it indicates that the body is substantially overloaded with uric acid. When tophi is present, the uric acid level in the bloodstream typically has been high for years. The presence of tophi indicates tophaceous gout and treatment with medications is necessary.
Longstanding untreated gout can lead to joint damage and physical deformity.
Kidney stones may be a sign of gout as uric acid crystals can deposit in the kidney and cause kidney stones.
What increases your chances of gout?
The following makes it more likely that you will develop hyperuricemia, which causes gout:
- Being male.
- Being obese.
- Having certain health conditions, including:
- Using certain medications, such as diuretics (water pills).
- Drinking alcohol. The risk of gout is greater as alcohol intake goes up.
- Eating or drinking food and drinks high in fructose (a type of sugar).
- Having a diet high in purines, which the body breaks down into uric acid. Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna.
You’re more likely to get gout if you:
- are a middle-aged man or postmenopausal woman
- have parents, siblings, or other family members with gout
- eat too much purine-rich food, such as red meats, organ meats, and certain fish
- drink alcohol
- Take medications such as diuretics and cyclosporine
- have a condition like high blood pressure, kidney disease, thyroid disease, diabetes, or sleep apnea
Gout home remedies
Some gout-relief methods don’t come in a bottle from your pharmacy. Evidence from studies suggests that these natural remedies may help lower uric acid levels and prevent gout attacks:
- tart cherries
- apple cider vinegar
- nettle tea
- milk thistle seeds
But simply eating these foods may not be enough to tame gout. Learn how much of them to take for the greatest impact on your symptoms. Gout surgery
Gout can typically be treated without surgery. But after many years, this condition can damage the joints, tear the tendons, and cause infections in the skin over the joints.
Hard deposits, called tophi, can build up on your joints and in other places, like your ear. These lumps may be painful and swollen, and they can permanently damage your joints.
Three surgical procedures treat tophi:
- tophi removal surgery
- joint fusion surgery
- joint replacement surgery
Which one of these surgeries your doctor recommends depends on the extent of the damage, where the tophi are located, and your personal preferences. Learn how surgery can help stabilize joints that have been weakened by gout.
Certain foods, medicines, and conditions can set off gout symptoms. You may need to avoid or limit foods and drinks like these, which are high in purines:
- red meat like pork and veal
- organ meats
- fish such as cod, scallops, mussels, and salmon
- fruit juice
Some medicines you take to manage other conditions increase the level of uric acid in your blood. Talk to your doctor if you take any of these drugs:
- diuretics, or water pills
- Blood pressure-lowering medicines such as beta-blockers and angiotensin II receptor blockers
Your health may also be a factor in flares. All of these conditions have been linked to gout:
- diabetes or prediabetes
- joint injury
- congestive heart failure
- high blood pressure
- kidney disease
Here are a few steps you can take to help prevent gout:
- Limit how much alcohol you drink.
- Limit how much purine-rich food, such as shellfish, lamb, beef, pork, and organ meat, you eat.
- Eat a low-fat, nondairy diet that’s rich in vegetables.
- Lose weight.
- Stop smoking.
- Stay hydrated.
If you have medical conditions or take medications that raise your risk of gout, ask your doctor how you can lower your risk of gout attacks.
Tests and diagnosis
Gout can be tricky to diagnose, as its symptoms when they do appear, are similar to those of other conditions. While hyperuricemia occurs in the majority of people who develop gout, it may not be present during a flare. On top of that, the majority of people with hyperuricemia do not develop gout.
One diagnostic test that doctors can carry out is the joint fluid test, where the fluid is extracted from the affected joint with a needle. The fluid is then examined to see if any urate crystals are present.
As joint infections can also cause similar symptoms to gout, a doctor can look for bacteria when carrying out a joint fluid test in order to rule out a bacterial cause. The fluid may need to be sent to a lab, where it can take several days to analyze.
Doctors can also do a blood test to measure the levels of uric acid in the blood, but, as mentioned, people with high uric acid levels do not always experience gout. Equally, some people can develop the symptoms of gout without having increased levels of uric acid in the blood.
Finally, doctors can search for urate crystals around joints or within a tophus using an ultrasound scan. X-rays cannot detect gout but may be used to rule out other causes.
There are various stages through which gout progresses, and these are sometimes referred to as different types of gout.
It is possible for a person to have elevated uric acid levels without any outward symptoms. At this stage, treatment is not required, though urate crystals may deposit in tissue and cause slight damage.
People with asymptomatic hyperuricemia may be advised to take steps to address any possible factors contributing to uric acid build-up.
This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain. This sudden attack is referred to as a “flare” and will normally subside within 3 to 10 days. Flares can sometimes be triggered by stressful events, alcohol, and drugs, as well as cold weather.
Interval or intercritical gout
This stage is the period between attacks of acute gout. Subsequent flares may not occur for months or years, though if not treated, over time, they can last longer and occur more frequently. During this interval, further urate crystals are being deposited in tissue.
Chronic tophaceous gout
Chronic tophaceous gout is the most debilitating type of gout. Permanent damage may have occurred in the joints and the kidneys. The patient can suffer from chronic arthritis and develop tophi, big lumps of urate crystals, in cooler areas of the body such as the joints of the fingers.
It takes a long time without treatment to reach the stage of chronic tophaceous gout – around 10 years. It is very unlikely that a patient receiving proper treatment would progress to this stage.
One condition that is easily confused with gout is pseudogout. The symptoms of pseudogout are very similar to those of gout, although the flare-ups are usually less severe.
The major difference between gout and pseudogout is that the joints are irritated by calcium pyrophosphate crystals rather than urate crystals. Pseudogout requires different treatments for gout.
In some cases, gout can develop into more serious conditions, such as:
- Kidney stones: If urate crystals collect in the urinary tract, they can become kidney stones.
- Recurrent gout: Some people only ever have one flare-up; others may have regular recurrences, causing gradual damage to the joints and surrounding tissue.
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Gout with tophus
When uric acid crystals build up in joints for a long time, they produce hard deposits called tophi under the skin. Without treatment, these tophi can damage bone and cartilage and leave the joints permanently disfigured.
Tophi are swollen lumps around the joints that look like knots on a tree trunk. You’ll see them in joints like your fingers, feet, and knees, as well as on your ears. Tophi themselves don’t hurt, but the inflammation they cause can be painful.
Essential oils are plant-based substances used in aromatherapy. Some oils are thought to have anti-inflammatory, pain-relieving, and antibacterial effects.
Some of the essential oils used to treat gout include:
- lemongrass oil
- celery seed oil
- yarrow oil extract
- olive leaf extract
- Chinese Cinnamon Essential
You can either breathe in these oils, rub the diluted oil on your skin, or make tea from the dried leaves of the plant. Just don’t put the oils themselves into your mouth. They’re not safe to ingest.
It’s always a good idea to check with your doctor before you use any alternative medicine, even one that’s generally considered safe, like essential oils. If you do use these oils, follow safety precautions to make sure you don’t have a reaction.
Is gout hereditary?
Gout is at least partly due to heredity. Researchers have found dozens of genes that increase people’s susceptibility to gout, including SLC2A9 and ABCG2. Genes associated with gout affect the amount of uric acid the body holds onto and releases.
Because of genetic factors, gout runs in families. People with a parent, sibling, or other close relatives who have gout are more likely to get this condition themselves.
It’s likely that genes only set the stage for gout. Environmental factors, such as diet, actually trigger the disease.
The prevalence of gout in the U.S. has risen over the last twenty years and now affects 8.3 million (4%) Americans. Gout is more common in men than in women and more prevalent in African-American men than white men. The chances of having gout rise with age, with a peak age of 75. In women, gout attacks usually occur after menopause. Among the U.S. population, about 21% have elevated blood uric acid levels, a condition known as hyperuricemia. However, only a small portion of those with hyperuricemia will actually develop gout. If your parents have gout, then you have a 20% chance of developing it.
Alcohol, like red meat and seafood, is high in purines. When your body breaks down purines, the process releases uric acid.
More uric acid increases your risk of having gout. Alcohol can also reduce the rate at which your body removes uric acid.
Not everyone who drinks will develop gout. However, high consumption of alcohol (more than 12 drinks per week) can increase the risk — especially in men. Beer is more likely than liquor to influence the risk.
In surveys, people have reported that drinking alcohol triggers their gout flares.
Natural remedies for gout
Cherries or tart cherry juice
According to a 2016 survey, cherries — whether sour, sweet, red, black, in extract form, as a juice, or raw — are a very popular and potentially successful home remedy for many.
One 2012 study and another that same year also suggest cherries may work to prevent gout attacks.
This research recommends three servings of any cherry over a two-day period, which was considered the most effective.
Magnesium is a dietary mineral. Some claim it’s good for gout because a deficiency of magnesium may worsen chronic inflammatory stress in the body, though no studies prove this.
Still, a 2015 study showed that adequate magnesium is associated with lower and healthier levels of uric acid, thus potentially lowering gout risk. This applied to men but not women within the study.
Try taking magnesium supplements, but read the label directions closely. Or, eat magnesium-rich foods daily. This may decrease gout risk or gout occurrence long term.
Ginger is a culinary food and herb prescribed for inflammatory conditions. Its ability to help gout is well-documented.
One study found topical ginger reduced pain related to uric acid in gout. Another study showed that in subjects with high levels of uric acid (hyperuricemia), their serum uric acid level was reduced by ginger. However, the subjects were rats, and ginger was taken internally rather than topically.
Make a ginger compress or paste by boiling water with 1 tablespoon of grated fresh ginger root. Soak a washcloth in the mixture. When cool, apply the washcloth to the area where you’re experiencing pain at least once per day for 15 to 30 minutes. Skin irritation is possible, so it’s best to do a test on a small patch of skin first.
Take ginger internally by boiling water and steeping 2 teaspoons of ginger root for 10 minutes. Enjoy 3 cups per day.
Interactions are possible. Let your doctor know first before you take large amounts of ginger.
Warm water with apple cider vinegar, lemon juice, and turmeric
Apple cider vinegar, lemon juice, and turmeric are each frequently recommended anecdotally for gout. Together, they make a pleasant beverage and remedy.
Mix juice from one squeezed half lemon into warm water. Combine with 2 teaspoons turmeric and 1 teaspoon apple cider vinegar. Adjust to taste. Drink two to three times per day.
Celery or celery seeds
Celery is a food traditionally used to treat urinary issues. For gout, extracts and seeds of the vegetables have become popular home remedies.
Experimental use is well-documented, though scientific research is scant. It’s thought that celery may reduce inflammation.
Adequate celery amounts for treating gout aren’t documented. Try eating celery many times per day, especially raw celery sticks, juice, extract, or seeds.
If purchasing an extract or supplement, follow label directions closely.
Stinging nettle (Urtica dioica) is an herbal remedy for gout that may reduce inflammation and pain.
Traditional use is frequently referred to in studies. There’s still no research directly proving it works. One study showed it protected the kidneys, but the subjects were male rabbits, and kidney injury was induced by the administration of gentamicin, an antibiotic.
To try this tea, brew a cup of boiling water. Steep 1 to 2 teaspoons of dried nettle per cup of water. Drink up to 3 cups per day.
Dandelion teas, extracts, and supplements are used to improve liver and kidney health.
They may lower uric acid levels in those at risk for kidney injury, as shown in a 2013 study and a 2016 study, but these were on rats. Dandelion is unproven to help gout.
You can use dandelion tea, an extract, or a supplement. Follow label directions closely.
Milk thistle is a herb used for liver health.
Follow dosing directions on a milk thistle supplement carefully or discuss it with your doctor.
Hibiscus is a garden flower, food, tea, and traditional herbal remedy.
It may be a folk remedy used to treat gout. One study showed that hibiscus might lower uric acid levels, though this study was performed on rats.
Use a supplement, tea, or extract. Follow label directions closely.
Topical cold or hot application
Applying cold or hot water to inflamed joints may also be effective.
Studies and opinions on this are mixed. Soaking in cold water is most often recommended and considered the most effective. Ice packs may also work.
Soaking in hot water is typically only recommended when inflammation isn’t as intense.
Alternating hot and cold applications may also be helpful.
Natural health sites may recommend apples as part of gout-reducing diets. The claim: Apples contain malic acid, which lowers uric acid.
However, there aren’t any studies supporting this for gout. Apples also contain fructose, which may trigger hyperuricemia, leading to gout flare-ups.
Eating one apple per day is good for overall health. It may be mildly beneficial for gout, but only if it doesn’t add to excessive daily sugar consumption.
Bananas are thought to be good for gout. They’re potassium-rich, which helps the tissue and organs in the body to function properly.
Bananas also contain sugars, including fructose, which can be a gout trigger. Many foods are higher in potassium and lower in sugar than bananas, such as dark leafy greens and avocados.
Eat one banana per day for benefit. No studies yet support any benefit from bananas for gout.
Some people recommend a bath of Epsom salts to prevent gout attacks.
The idea is that Epsom salts are rich in magnesium, which may lower gout risk. However, studies show magnesium can’t be adequately absorbed through the skin to confer any health benefits.
To give Epsom salts a try, mix 1 to 2 cups in your bath. Soak your entire body or only specific joints for symptom relief.
The bottom line
Plenty of options are available for helping or preventing gout attacks at home. Most are natural and have little to no side effects.
Always check with your doctor first before adding a supplement to your regimen. Interactions and side effects could be possible with herbal supplements.
Never replace your established, prescribed gout treatments with a home remedy without informing your doctor. None of the herbal supplements recommended are regulated by the U.S. Food and Drug Administration for what they contain or how well they work. Only purchase supplements from trusted companies for safety.
If your gout pain is considerable, sudden, or intense — or if home remedies cease to work — contact your doctor immediately.
Always Please See Your Doctor First For Guidance if You Suffer From Any Medical Condition.
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