The Facts on Osteoarthritis
Osteoarthritis (OA) is a joint disease that causes the cartilage to break down and bone to overgrow or form cysts. Cartilage is a smooth, shiny material that lines the joints - allowing them to glide easily as you move. It is a type of resilient connective tissue that covers and protects the ends of bones in joints. Although OA can affect any joint in the body, it most frequently affects the hips, knees, hands, feet, and spine.
Arthritis is among the leading causes of disability in Canada. OA is the most common form of arthritis. It affects 1 out of every 10 people in this country. Statistics show that men and women are affected in equal numbers. OA usually occurs after the age of 45, but it can occur earlier in life, and even be seen in the spines of teenagers. After menopause, women tend to get more severe and complicated problems.
Risk factors for developing OA include:
increasing age
having a family member with the condition
repeated injury to the joint through sports or work
being overweight
having another form of arthritis
There's no cure for OA, although research is beginning to unravel the mechanisms of the disease, which should lead to new treatments. Treatments currently focus on managing pain, reducing the load on the joints, and improving the strength of the muscles supporting the joints. Experimental therapies try to slow the progression of the disease and increase the mobility and flexibility of the joints.
Causes of Osteoarthritis
As you move or put pressure on a joint, cartilage allows bones to slide over one another and acts as a shock absorber. Cartilage itself does not have any nerve cells and therefore cannot sense pain. OA results when the cartilage becomes worn out, allowing the bones underneath to rub against each other and cause pain and swelling. It is not simple wear-and-tear but a process involving the cells and proteins of bone and cartilage.
As the condition progresses, the joint may become disfigured and small growths called osteophytes begin to grow inside the joints. Osteophytes are small, irregular, bony growths that are also called bone spurs. Bits of broken-off cartilage or bone are also found floating inside the joint. This causes even more pain, swelling, and immobility of the joint.
The exact cause of these changes is unknown. Scientists believe that the following factors play a role:
increasing age: The cartilage wears down with time. By age 65, 80% to 90% of people have OA, as shown on X-ray, though a much smaller percentage have symptoms.
family genes: Scientists believe that OA may be passed on through families, with the symptoms appearing in middle age.
being overweight: Excess weight puts stress on weight-bearing joints such as hips and knees, and increases the risk of cartilage breakdown. This is the most important risk factor for OA affecting hips, and leg and foot joints.
injury: Trauma to the joint, such as overuse, can damage the cartilage and lead to OA. This is often the cause of OA in younger people.
other types of arthritis: For example, rheumatoid arthritis can also damage joints and lead to OA.
How to cut your stroke risk.
Symptoms and Complications of Osteoarthritis
The following are symptoms of osteoarthritis (OA):
deep, aching joint pain, sometimes sharp, with activity; the pain can persist at rest
transient joint stiffness after a period of rest (such as getting up in the morning or after a long time spent sitting)
swelling and stiffness in one or more joints
enlarged middle- or end-joints of the fingers or the base of thumb
a crunching feeling or sound when moving joints
loss of joint flexibility
back and neck pain and stiffness
Weight-bearing joints such as hips, knees, and feet are more prone to OA. It is important to note that many people have OA but don't experience any symptoms. The symptoms of OA can be made worse by overusing the joints.
Diagnosing Osteoarthritis
Most doctors use a number of methods to diagnose OA including:
your description of signs and symptoms, when it started and how it is affecting your life
a physical examination of affected joints, including an assessment of flexibility, mobility, and deformity
analysis of X-rays of the joints to identify cartilage loss, bone damage, and the presence of osteophytes; in some cases, doctors may also request an MRI
analysis of fluid from the affected joint (joint aspiration)
blood tests to rule out other causes of joint problems
bony protrusions of the middle joints (called Bouchard's nodes) and the end joints (called Heberden's nodes) of the fingers
Can you balance MS and a busy life?
Treating and Preventing Osteoarthritis
Treatments include physical therapy to improve mobility and flexibility, medications to manage pain, and surgery.
Talk to your physiotherapist or occupational therapist about "aids of daily living" such as canes, walkers, and braces if you have OA.
Non-prescription medications may be sufficient to treat pain and swelling for milder symptoms, but prescription medications are needed for more severe symptoms. The following are commonly used medications to treat OA:
acetaminophen* reduces mild to moderate pain
NSAIDs such as ibuprofen or naproxen reduce both pain and swelling
topical medications such as diclofenac or capsaicin lotion may be used for very mild pain or in addition to other treatments
codeine may be considered to treat severe acute (short-term) pain
cortisone, which is injected directly into the joints, can relieve pain and swelling
hyaluronic acid injections into joints are used to relieve pain and improve mobility, but there is disagreement about their usefulness
chondroitin or glucosamine have been used with some success by people; although many significant studies have failed to show any value to their use
Surgery is an option if one joint is badly damaged or is causing severe symptoms. Different types of surgical options are available and include joint replacement, arthroscopy (a procedure where a small, flexible tube is inserted to do surgery), repair of bone deformity, rebuilding of the joint, or bone fusion. Joints that may benefit from surgery include knees, hips, shoulders, and certain joints in the hands and the feet.
For people with hip and knee OA that has progressed to the point of disability, joint replacement surgery is highly effective and a reasonably safe treatment option (essentially at any, even advanced, age). Many people are able to return to nearly completely normal activity after recovering from the surgery. When considering joint replacement surgery, talk to your doctor about the benefits and risks.
Many cases of OA can be prevented. To prevent the development of OA later on in life, maintain a healthy weight. Excess weight can put stress on weight bearing joints such as knees or hips and increase the wear and tear on the cartilage. Protect your joints from injury. Repeated minor injuries due to constant kneeling, squatting, or other postures that place stress on the knee joint can cause cartilage to breakdown. Exercise can help reduce joint pain and stiffness. Talk to your physiotherapist or occupational therapist about how low-impact exercise such as bicycling, swimming, or water exercise could be beneficial for you.
Athletes should understand that OA later in life is common for people who have lived a very active and rigorous lifestyle. For most, this risk is probably worth the value they receive from their athletic passion. They should be particularly careful to take immediate care of all injuries, even seemingly minor, and to carefully follow their doctor's advice.
Friday, October 18, 2013
How to cure Gout
Treating and Preventing Gout
The first priority is to relieve pain and shorten the acute attack. NSAIDs (nonsteroidal anti-inflammatory drugs) such as indomethacin, diclofenac, ketoprofen, and naproxen are the mainstay of treatment. These medications help with the swelling and pain. Another medication called colchicine can lessen joint pain after only 12 hours and even end an attack in 36 to 48 hours, but may have side effects such as diarrhea and vomiting that can limit its use in some cases. Corticosteroids, either injected directly into the joint or taken orally, can control the inflammation.
For chronic gout or repeated attacks, daily colchicine therapy can prevent future attacks, but it can't prevent the joint damage caused by tophi. However, medications that lower the blood levels of uric acid, such as allopurinol, probenecid, and sulfinpyrazone, can be very effective at preventing attacks and joint damage. Among these medications, allopurinol is the most commonly used. Another advantage of these medications is that drastic changes in diet are not required. Another medication, febuxostat, can be used in place of allopurinol if it has caused side effects or been ineffective.
Prevention is an important part of managing gout. It's crucial to control weight and blood pressure and to drink at least 3 litres of fluid (preferably water) daily to prevent attacks. Triggering attacks also can be avoided by cutting down on:
dehydrating drinks such as alcohol (beer, wine, etc.), coffee, tea, and cocoa
animal proteins such as seafood, liver, kidney, heart, gizzard, sweetbreads, meat extracts, and gravy
vegetables such as peas, beans, spinach, and lentils
With early diagnosis and treatment, it's possible to control gout, prevent joint damage, and live a normal life.
How to treat gout pain and prevent gout flares
Cortisone shots
Gout diet: What's allowed, what's not
Water: How much should you drink every day?
Alcohol use: If you drink, keep it moderate
The first priority is to relieve pain and shorten the acute attack. NSAIDs (nonsteroidal anti-inflammatory drugs) such as indomethacin, diclofenac, ketoprofen, and naproxen are the mainstay of treatment. These medications help with the swelling and pain. Another medication called colchicine can lessen joint pain after only 12 hours and even end an attack in 36 to 48 hours, but may have side effects such as diarrhea and vomiting that can limit its use in some cases. Corticosteroids, either injected directly into the joint or taken orally, can control the inflammation.
For chronic gout or repeated attacks, daily colchicine therapy can prevent future attacks, but it can't prevent the joint damage caused by tophi. However, medications that lower the blood levels of uric acid, such as allopurinol, probenecid, and sulfinpyrazone, can be very effective at preventing attacks and joint damage. Among these medications, allopurinol is the most commonly used. Another advantage of these medications is that drastic changes in diet are not required. Another medication, febuxostat, can be used in place of allopurinol if it has caused side effects or been ineffective.
Prevention is an important part of managing gout. It's crucial to control weight and blood pressure and to drink at least 3 litres of fluid (preferably water) daily to prevent attacks. Triggering attacks also can be avoided by cutting down on:
dehydrating drinks such as alcohol (beer, wine, etc.), coffee, tea, and cocoa
animal proteins such as seafood, liver, kidney, heart, gizzard, sweetbreads, meat extracts, and gravy
vegetables such as peas, beans, spinach, and lentils
With early diagnosis and treatment, it's possible to control gout, prevent joint damage, and live a normal life.
How to treat gout pain and prevent gout flares
Cortisone shots
Gout diet: What's allowed, what's not
Water: How much should you drink every day?
Alcohol use: If you drink, keep it moderate
What is Gout?
Gout causes attacks of pain and swelling in one or more joints. An anti-inflammatory painkiller usually eases an attack quickly. Lifestyle factors may reduce the risk of having gout attacks. These include losing weight (if overweight), eating a healthy diet, and not drinking much alcohol or sugar-sweetened soft drinks. If gout attacks recur, then taking vitamin C supplements and/or allopurinol each day can prevent them.
What is gout and what causes it?
Gout causes attacks of painful inflammation in one or more joints. It is a type of arthritis (although it is very different to the more common rheumatoid arthritis and osteoarthritis). The pain of a gout attack can be severe.
Gout is caused by a chemical in the blood called uric acid (urate). Uric acid is usually harmless, and is made in the body. Most is passed out with the urine, and some from the gut with the faeces (stools). In people with gout the amount of uric acid in the blood builds up. From time to time the level may become too high and tiny grit-like crystals of uric acid may form. The crystals typically collect in a joint. The crystals irritate the tissues in the joint to cause inflammation, swelling, and pain - a gout attack.
Note: some people have a high level of uric acid but do not form crystals or have gout. Also, rarely, some people with a normal level of uric acid have gout attacks. However, as a rule, the higher the level of uric acid, the greater the chance of developing gout.
Related articles Medicines and drug information
Calcium Pyrophosphate Deposition - including Pseudogout
Why does uric acid build up?
Normally, there is a fine balance between the amount of uric acid that you make, and the amount that you pass out in the urine and faeces. This keeps the level of uric acid in the blood in check. However, in most people with gout, their kidneys do not pass out enough uric acid and the blood level may rise. They are said to be under-excreters of uric acid. Their kidneys usually work otherwise normally.
In some people, the build-up of uric acid may due to other factors. For example:
Drinking too much alcohol can cause uric acid to build up.
If you do not have enough vitamin C in your diet.
If you drink sugar-sweetened soft drinks high in fructose it can cause uric acid to build up. A recent research study found that having two drinks a day of a sugar-sweetened soft drink increased the risk of developing gout by 85%. (Drinks labelled as 'diet' or drinks containing artificial sweeteners were not found to increase the risk.) Fructose-rich fruits and fruit juices may also increase the risk.
Certain foods may 'tip the balance' to raise your uric acid higher than normal. In particular, eating a lot of heart, herring, sardines, yeast extracts, or mussels may increase the level of uric acid. However, eating a normal balanced diet should not have much effect on the uric acid level.
Some medicines may raise the level of uric acid. For example, diuretics (water tablets) such as bendroflumethiazide, aspirin (at full painkiller dose - not low-dose aspirin used to prevent blood clots), and some chemotherapy medicines.
More uric acid is made than usual in illnesses where the cells of the body have a rapid turnover. For example, severe psoriasis and some blood disorders.
People with certain other conditions have an increased risk of developing gout. These include: obesity, high blood pressure, kidney damage, diabetes mellitus, bone marrow disorders, lipid disorders (especially hypertriglyceridaemia), vascular disease, enzyme defects such as hypoxanthine guanine phosphoribosyltransferase (HGPRT) deficiency and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
How common is gout and who gets it?
Gout affects about 1 in 200 adults. Men are more commonly affected than women. A first attack of gout typically develops in middle age, but it sometimes occurs in younger people. It tends to run in some families as there is a family history of gout in about 1 in 5 cases. It may be that the genetic make-up that you inherit from your family may be a factor in becoming an under-excreter of uric acid.
What are the symptoms of gout?
Gout usually occurs in attacks. An attack typically develops quickly over a few hours. It usually causes severe pain in one joint. The base of the big toe is the most commonly affected joint. Walking can be very painful and even the weight of bedclothes can hurt.
However, any joint can be affected. Sometimes two or more joints are affected. Affected joints usually swell, and the nearby skin may look red and inflamed. If left untreated, a gout attack may last several days, but usually goes completely within 7-10 days. Less severe attacks can occur which may be mistaken at first for other forms of arthritis. Weeks, months or even years may go by between attacks. Some people only ever have one attack.
Is gout serious?
A gout attack can be very painful. However, other effects from gout are uncommon. Joint damage may occur if you have recurring attacks. In a few people, uric acid crystals form kidney stones or may cause some kidney damage. Sometimes the crystals form bumps (tophi) under the skin. These are usually harmless and painless, but sometimes form in awkward places such as at the end of fingers. Tophi occasionally become infected.
Related blogsSarah Jarvis' blog posts
Gout – it’s a red hot subject!
How is gout diagnosed?
Gout is usually diagnosed if you have the typical gout symptoms and a raised blood level of uric acid. If there is doubt as to the cause of the pain and swelling, your doctor may take some fluid out of a swollen joint. This is done with a needle and syringe. The fluid is looked at under the microscope. Crystals of urate (uric acid) can be seen in the fluid to confirm the diagnosis of gout.
What is the treatment for a gout attack?
General measures
If you are able to, then raise the affected limb (usually a leg) to help reduce the swelling. The easiest way to raise your leg is to recline on a sofa with your leg up on a cushion. An ice pack (or pack of frozen peas) held against the inflamed joint may ease the pain until the gout treatment medicines (below) start to work:
Wrap the ice pack (or peas) in a towel to avoid direct skin contact and ice burn.
Apply for about 20 minutes, and then stop. (It should not be applied for long periods.)
Repeat as often as required BUT ...
Make sure the temperature of the affected part has returned to normal before applying again.
Anti-inflammatory painkillers
A short course of an anti-inflammatory painkiller will quickly ease most gout attacks (within 12-24 hours). There are several types and brands, such as diclofenac, indometacin, and naproxen. Your doctor will prescribe one. Many people with gout like to have a supply of tablets in the home on standby just in case an attack occurs. They are usually needed only for a few days until the inflammation and pain go.
Most people can take short courses of anti-inflammatory painkillers without any problem, although side-effects occur in some people:
Bleeding from the stomach is the most serious possible side-effect. This is more of a risk if you are aged over 65, or have had a duodenal or stomach ulcer. Stop the tablets and see a doctor if you develop indigestion, upper abdominal pain, pass black stools (black faeces), or if you vomit or pass blood. Read the leaflet that comes with the tablets for a list of other possible side-effects.
Some people with asthma, high blood pressure, certain kidney problems, and heart failure may not be able to take anti-inflammatory painkillers.
Some people taking certain other medicines should not take anti-inflammatory painkillers. This is because of a possible risk of the two medicines interacting. Therefore, check with your doctor or pharmacist if you are taking other medication, before taking anti-inflammatory painkillers.
Also, don't take more than one anti-inflammatory painkiller at a time unless specified by a doctor. For example, some people take low-dose aspirin every day (which is classed as an anti-inflammatory drug) to prevent blood clots. Aspirin plus another anti-inflammatory drug increases the risk of bleeding from the stomach.
Therefore, if you are already taking aspirin and develop gout, you need to discuss the options with your doctor. For example, your doctor may advise that you take another medicine to 'protect the stomach' if you need to take aspirin and another anti-inflammatory drug. Remember - some painkillers that you can buy from pharmacies contain aspirin.
Other treatments
Colchicine is an alternative medicine that eases gout attacks. It is usually only used if you have problems or side-effects with anti-inflammatory painkillers. Steroid tablets or injections can also reduce the pain and inflammation. They are another alternative if there are problems or side-effects with anti-inflammatory painkillers and colchicine.
Can further gout attacks be prevented?
Lifestyle measures and medicines can help to prevent gout attacks.
Current discussions Discussions your condition in our forums
Get help and support from hundreds of other people like you in our discussion forums:
gout.
margaret edwards 2 replies
Gout
jed 1 replies
Gout
Guest 0 replies
Our discussion forumsShare your story now ?
Lifestyle suggestions
If you are overweight, try to lose some weight. This can help to lower the uric acid level. However, do not use diets that increase urate levels, such as high-protein diets or starvation diets.
Eat sensibly. A high uric acid level may be lowered a bit by avoiding a high protein intake and foods rich in purines, such as liver, kidneys, and seafood. Also avoid eating foods high in yeast extracts, such as Marmite®.
If you drink a lot of alcohol then it may help if you reduced the amount that you drink. You do not need to stop drinking alcohol altogether, but cutting down may help if you drink a lot. In particular, avoid binge drinking. Keep to within the recommended levels of alcohol - these are 21 units per week for men and 14 units per week for women.
If you drink a lot of sugar-sweetened soft drinks, especially those containing fructose, it may help to reduce the number or cut them out all together.
If you are taking any medicines, check whether they are a cause of gout (see above). An alternative medicine may be available. Your doctor will advise.
Avoid dehydration by drinking plenty of water (up to two litres per day unless there is a medical reason why not to).
Have your blood pressure checked at least once a year. High blood pressure is more common in people with gout.
With the help of lifestyle changes, many people only have an attack of gout every now and then. All you may need is to have some anti-inflammatory painkillers on standby to treat each attack.
For some people, attacks occur more often. In this situation, you can take a medicine to prevent attacks.
Allopurinol is used to prevent gout attacks
Allopurinol is a commonly used medicine to prevent gout attacks. Allopurinol does not have any effect during a gout attack, and it is not a painkiller. It works by lowering the level of uric acid in the blood. It takes 2-3 months to become fully effective. You need to take it every day to keep the uric acid level normal to prevent gout attacks.
As a general rule, regular allopurinol may be advised by your doctor if you:
Have had two or more attacks of gout within a year.
Have one or more tophi (described above).
Have any joint or kidney damage due to gout.
Have one or more kidney stones made from uric acid.
Have had a gout attack and are taking long-term medication that can cause gout.
When you first take allopurinol, it can sometimes cause a gout attack. This is because it may cause the level of uric acid to rise slightly before it falls. For this reason it is not normally started during a gout attack. It is best to start it about 3-4 weeks after an attack has settled. Also, an anti-inflammatory painkiller is often prescribed for the first 2-3 months after you start allopurinol, just in case the allopurinol causes a gout attack. Once the level of uric acid has been brought down, taking allopurinol each day usually works well to prevent gout attacks.
The dose of allopurinol needed varies from person to person. Treatment is usually started with a low dose. A blood test is often done after a month or so to check that the level of uric acid has come down. If not, the dose may need to be increased. Most people end up taking about 100-300 mg each day to stop gout attacks.
If a gout attack occurs while you are taking allopurinol, you can still take an anti-inflammatory painkiller to relieve the pain. However, this may indicate that you need an increased dose of allopurinol. Side-effects are uncommon with allopurinol. Read the information that comes with the packet of tablets for details about possible side-effects. If side-effects do occur, other medicines with a similar action are sometimes prescribed. For example, a medicine called febuxostat may be an option if you cannot take allopurinol for medical reasons or due to side-effects.
Vitamin C supplements
A study published in 2009 showed that vitamin C can reduce the risk of developing gout. In the study, 46,994 men were followed up over several years. Compared with men with a vitamin C intake of less than 250 mg a day:
Those whose intake was 1,000-1,499 mg per day had a 34% lower risk of gout.
Those whose intake was 1,500 mg per day had a 45% lower risk of gout.
This study concluded that supplemental vitamin C intake may help to prevent gout. However recent studies have not supported these findings and Vitamin C is not routinely used in gout prevention.
What is gout and what causes it?
Gout causes attacks of painful inflammation in one or more joints. It is a type of arthritis (although it is very different to the more common rheumatoid arthritis and osteoarthritis). The pain of a gout attack can be severe.
Gout is caused by a chemical in the blood called uric acid (urate). Uric acid is usually harmless, and is made in the body. Most is passed out with the urine, and some from the gut with the faeces (stools). In people with gout the amount of uric acid in the blood builds up. From time to time the level may become too high and tiny grit-like crystals of uric acid may form. The crystals typically collect in a joint. The crystals irritate the tissues in the joint to cause inflammation, swelling, and pain - a gout attack.
Note: some people have a high level of uric acid but do not form crystals or have gout. Also, rarely, some people with a normal level of uric acid have gout attacks. However, as a rule, the higher the level of uric acid, the greater the chance of developing gout.
Related articles Medicines and drug information
Calcium Pyrophosphate Deposition - including Pseudogout
Why does uric acid build up?
Normally, there is a fine balance between the amount of uric acid that you make, and the amount that you pass out in the urine and faeces. This keeps the level of uric acid in the blood in check. However, in most people with gout, their kidneys do not pass out enough uric acid and the blood level may rise. They are said to be under-excreters of uric acid. Their kidneys usually work otherwise normally.
In some people, the build-up of uric acid may due to other factors. For example:
Drinking too much alcohol can cause uric acid to build up.
If you do not have enough vitamin C in your diet.
If you drink sugar-sweetened soft drinks high in fructose it can cause uric acid to build up. A recent research study found that having two drinks a day of a sugar-sweetened soft drink increased the risk of developing gout by 85%. (Drinks labelled as 'diet' or drinks containing artificial sweeteners were not found to increase the risk.) Fructose-rich fruits and fruit juices may also increase the risk.
Certain foods may 'tip the balance' to raise your uric acid higher than normal. In particular, eating a lot of heart, herring, sardines, yeast extracts, or mussels may increase the level of uric acid. However, eating a normal balanced diet should not have much effect on the uric acid level.
Some medicines may raise the level of uric acid. For example, diuretics (water tablets) such as bendroflumethiazide, aspirin (at full painkiller dose - not low-dose aspirin used to prevent blood clots), and some chemotherapy medicines.
More uric acid is made than usual in illnesses where the cells of the body have a rapid turnover. For example, severe psoriasis and some blood disorders.
People with certain other conditions have an increased risk of developing gout. These include: obesity, high blood pressure, kidney damage, diabetes mellitus, bone marrow disorders, lipid disorders (especially hypertriglyceridaemia), vascular disease, enzyme defects such as hypoxanthine guanine phosphoribosyltransferase (HGPRT) deficiency and glucose-6-phosphate dehydrogenase (G6PD) deficiency.
How common is gout and who gets it?
Gout affects about 1 in 200 adults. Men are more commonly affected than women. A first attack of gout typically develops in middle age, but it sometimes occurs in younger people. It tends to run in some families as there is a family history of gout in about 1 in 5 cases. It may be that the genetic make-up that you inherit from your family may be a factor in becoming an under-excreter of uric acid.
What are the symptoms of gout?
Gout usually occurs in attacks. An attack typically develops quickly over a few hours. It usually causes severe pain in one joint. The base of the big toe is the most commonly affected joint. Walking can be very painful and even the weight of bedclothes can hurt.
However, any joint can be affected. Sometimes two or more joints are affected. Affected joints usually swell, and the nearby skin may look red and inflamed. If left untreated, a gout attack may last several days, but usually goes completely within 7-10 days. Less severe attacks can occur which may be mistaken at first for other forms of arthritis. Weeks, months or even years may go by between attacks. Some people only ever have one attack.
Is gout serious?
A gout attack can be very painful. However, other effects from gout are uncommon. Joint damage may occur if you have recurring attacks. In a few people, uric acid crystals form kidney stones or may cause some kidney damage. Sometimes the crystals form bumps (tophi) under the skin. These are usually harmless and painless, but sometimes form in awkward places such as at the end of fingers. Tophi occasionally become infected.
Related blogsSarah Jarvis' blog posts
Gout – it’s a red hot subject!
How is gout diagnosed?
Gout is usually diagnosed if you have the typical gout symptoms and a raised blood level of uric acid. If there is doubt as to the cause of the pain and swelling, your doctor may take some fluid out of a swollen joint. This is done with a needle and syringe. The fluid is looked at under the microscope. Crystals of urate (uric acid) can be seen in the fluid to confirm the diagnosis of gout.
What is the treatment for a gout attack?
General measures
If you are able to, then raise the affected limb (usually a leg) to help reduce the swelling. The easiest way to raise your leg is to recline on a sofa with your leg up on a cushion. An ice pack (or pack of frozen peas) held against the inflamed joint may ease the pain until the gout treatment medicines (below) start to work:
Wrap the ice pack (or peas) in a towel to avoid direct skin contact and ice burn.
Apply for about 20 minutes, and then stop. (It should not be applied for long periods.)
Repeat as often as required BUT ...
Make sure the temperature of the affected part has returned to normal before applying again.
Anti-inflammatory painkillers
A short course of an anti-inflammatory painkiller will quickly ease most gout attacks (within 12-24 hours). There are several types and brands, such as diclofenac, indometacin, and naproxen. Your doctor will prescribe one. Many people with gout like to have a supply of tablets in the home on standby just in case an attack occurs. They are usually needed only for a few days until the inflammation and pain go.
Most people can take short courses of anti-inflammatory painkillers without any problem, although side-effects occur in some people:
Bleeding from the stomach is the most serious possible side-effect. This is more of a risk if you are aged over 65, or have had a duodenal or stomach ulcer. Stop the tablets and see a doctor if you develop indigestion, upper abdominal pain, pass black stools (black faeces), or if you vomit or pass blood. Read the leaflet that comes with the tablets for a list of other possible side-effects.
Some people with asthma, high blood pressure, certain kidney problems, and heart failure may not be able to take anti-inflammatory painkillers.
Some people taking certain other medicines should not take anti-inflammatory painkillers. This is because of a possible risk of the two medicines interacting. Therefore, check with your doctor or pharmacist if you are taking other medication, before taking anti-inflammatory painkillers.
Also, don't take more than one anti-inflammatory painkiller at a time unless specified by a doctor. For example, some people take low-dose aspirin every day (which is classed as an anti-inflammatory drug) to prevent blood clots. Aspirin plus another anti-inflammatory drug increases the risk of bleeding from the stomach.
Therefore, if you are already taking aspirin and develop gout, you need to discuss the options with your doctor. For example, your doctor may advise that you take another medicine to 'protect the stomach' if you need to take aspirin and another anti-inflammatory drug. Remember - some painkillers that you can buy from pharmacies contain aspirin.
Other treatments
Colchicine is an alternative medicine that eases gout attacks. It is usually only used if you have problems or side-effects with anti-inflammatory painkillers. Steroid tablets or injections can also reduce the pain and inflammation. They are another alternative if there are problems or side-effects with anti-inflammatory painkillers and colchicine.
Can further gout attacks be prevented?
Lifestyle measures and medicines can help to prevent gout attacks.
Current discussions Discussions your condition in our forums
Get help and support from hundreds of other people like you in our discussion forums:
gout.
margaret edwards 2 replies
Gout
jed 1 replies
Gout
Guest 0 replies
Our discussion forumsShare your story now ?
Lifestyle suggestions
If you are overweight, try to lose some weight. This can help to lower the uric acid level. However, do not use diets that increase urate levels, such as high-protein diets or starvation diets.
Eat sensibly. A high uric acid level may be lowered a bit by avoiding a high protein intake and foods rich in purines, such as liver, kidneys, and seafood. Also avoid eating foods high in yeast extracts, such as Marmite®.
If you drink a lot of alcohol then it may help if you reduced the amount that you drink. You do not need to stop drinking alcohol altogether, but cutting down may help if you drink a lot. In particular, avoid binge drinking. Keep to within the recommended levels of alcohol - these are 21 units per week for men and 14 units per week for women.
If you drink a lot of sugar-sweetened soft drinks, especially those containing fructose, it may help to reduce the number or cut them out all together.
If you are taking any medicines, check whether they are a cause of gout (see above). An alternative medicine may be available. Your doctor will advise.
Avoid dehydration by drinking plenty of water (up to two litres per day unless there is a medical reason why not to).
Have your blood pressure checked at least once a year. High blood pressure is more common in people with gout.
With the help of lifestyle changes, many people only have an attack of gout every now and then. All you may need is to have some anti-inflammatory painkillers on standby to treat each attack.
For some people, attacks occur more often. In this situation, you can take a medicine to prevent attacks.
Allopurinol is used to prevent gout attacks
Allopurinol is a commonly used medicine to prevent gout attacks. Allopurinol does not have any effect during a gout attack, and it is not a painkiller. It works by lowering the level of uric acid in the blood. It takes 2-3 months to become fully effective. You need to take it every day to keep the uric acid level normal to prevent gout attacks.
As a general rule, regular allopurinol may be advised by your doctor if you:
Have had two or more attacks of gout within a year.
Have one or more tophi (described above).
Have any joint or kidney damage due to gout.
Have one or more kidney stones made from uric acid.
Have had a gout attack and are taking long-term medication that can cause gout.
When you first take allopurinol, it can sometimes cause a gout attack. This is because it may cause the level of uric acid to rise slightly before it falls. For this reason it is not normally started during a gout attack. It is best to start it about 3-4 weeks after an attack has settled. Also, an anti-inflammatory painkiller is often prescribed for the first 2-3 months after you start allopurinol, just in case the allopurinol causes a gout attack. Once the level of uric acid has been brought down, taking allopurinol each day usually works well to prevent gout attacks.
The dose of allopurinol needed varies from person to person. Treatment is usually started with a low dose. A blood test is often done after a month or so to check that the level of uric acid has come down. If not, the dose may need to be increased. Most people end up taking about 100-300 mg each day to stop gout attacks.
If a gout attack occurs while you are taking allopurinol, you can still take an anti-inflammatory painkiller to relieve the pain. However, this may indicate that you need an increased dose of allopurinol. Side-effects are uncommon with allopurinol. Read the information that comes with the packet of tablets for details about possible side-effects. If side-effects do occur, other medicines with a similar action are sometimes prescribed. For example, a medicine called febuxostat may be an option if you cannot take allopurinol for medical reasons or due to side-effects.
Vitamin C supplements
A study published in 2009 showed that vitamin C can reduce the risk of developing gout. In the study, 46,994 men were followed up over several years. Compared with men with a vitamin C intake of less than 250 mg a day:
Those whose intake was 1,000-1,499 mg per day had a 34% lower risk of gout.
Those whose intake was 1,500 mg per day had a 45% lower risk of gout.
This study concluded that supplemental vitamin C intake may help to prevent gout. However recent studies have not supported these findings and Vitamin C is not routinely used in gout prevention.
Thursday, October 17, 2013
Just pictures :)
with my housemate ~ BBQ aka bakar2 :) lovely memories ...
**place : tmn indah permai
**year: 2013
I'm Back !!!!
assalamualaikum and hi ...
:) guess im back in the blogging world!!
rasanya x mau la english2 ..lol pakai in bahasa + campur2 okay jgk bh kan ...
sebenarnya saya agk stress mau bt ne assignment yg tidak ada 1 pun kena start..
diirii sendiri yg stress..
bah itu saja ..next time la yaa
:) guess im back in the blogging world!!
rasanya x mau la english2 ..lol pakai in bahasa + campur2 okay jgk bh kan ...
sebenarnya saya agk stress mau bt ne assignment yg tidak ada 1 pun kena start..
diirii sendiri yg stress..
bah itu saja ..next time la yaa
Tuesday, November 8, 2011
MY RESULT ~
 |
| ne la result sy last sem..hrp nxt sem akn meningkat lg owh.. Law ,,sedihnya sy..err..fail wooh.. tu saja bah tuh,,nti sy blogging lg yaa ..heheh bah yala.....addict sy tul sm twitter ne huhauahua |
Tuesday, November 1, 2011
November
yeah its november!!! 011111 :D great number 01.11.2011 ..
but yesterday there is horrific incident happent in kota kinabalu..
there was a train collision between oil tank lorry..
Update @1030pm: Tanker Train Collision in Kota Kinabalu
31/10/2011
Shell Timur Sdn Bhd confirms that one of its tankers, operated by an independent contractor, was involved in a collision with a passenger train at approximately 5:30 p.m. today near a Shell station at Jalan Kepayan-Jalan Lintas junction near the Kota Kinabalu international airport.
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