January 27, 2015

Arthritis (Rheumatoid)

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(Gouty Arthritis, Hyperuricemia)

Diagnosing Gout

The symptoms and signs of an acute gout attack are so clear that a doctor can usually be quite sure of the diagnosis just from your history and physical exam. Blood tests showing hyperuricemia can support the diagnosis, but aren't necessary for it. To confirm the diagnosis, your doctor may insert a needle into the joint and draw out some fluid to examine under a microscope. If it's gout, needle-shaped uric acid crystals will show up when the fluid is viewed under polarizing light.

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.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.

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This condition and disease information is written and reviewed by the MedBroadcast Clinical Team.


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