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Gout - Everything You Need To Know

Gout is a common type of arthritis that causes intense pain, swelling, and stiffness in a joint. It usually affects the joint in the big toe.

Gout attacks can come on quickly and keep returning over time, slowly harming tissues in the region of the inflammation, and can be extremely painful. Hypertension, cardiovascular, and obesity are risk factors for gout.

It is the most common form of inflammatory arthritis in men, and although it is more likely to affect men, women become more susceptible to it after the menopause.

The Centers for Disease Control and Prevention (CDC) report that 8.3 million Americans were affected by gout between 2007 to 2008.

Fast facts on gout

Here are some key points about gout. More detail and supporting information is in the main article.
  • Gout is a form of arthritis caused by excess uric acid in the bloodstream.
  • The symptoms of gout are due to the formation of uric acid crystals in the joints and the body's response to them.
  • Gout most classically affects the joint in the base of the big toe.
  • Gout attacks often occur without warning in the middle of the night.
  • Most gout cases are treated with specific medications.
Treatment

The majority of gout cases are treated with medication. Medication can be used to treat the symptoms of gout attacks, prevent future flares, and reduce the risk of gout complications such as kidney stones and the development of tophi.

Commonly used medications include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids. These reduce inflammation and pain in the areas affected by gout and are usually taken orally.

Medications can also be used to either reduce the production of uric acid (xanthine oxidase inhibitors such as allopurinol) or improve the kidney's ability to remove uric acid from the body (probenecid).

Without treatment, an acute gout attack will be at its worst between 12 and 24 hours after it began. A person can expect to recover within 1 to 2 weeks without treatment, but there may be significant pain during this period.



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 that 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 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 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 ultrasound scan. X-rays cannot detect gout, but may be used to rule out other causes.

Types

There are various stages through which gout progresses, and these are sometimes referred to as different types of gout.

Asymptomatic hyperuricemia

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.

Acute gout

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 in 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.

Pseudogout

One condition that is easily confused with gout is pseudogout. The symptoms of pseudogout are very similar to those of gout, although thr 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 treatment to gout.

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To learn more about gout, consider taking our online continuing nurse education course Gout: A Lesser Known Type of Arthritis

This instructional course has been designed to provide relevant information to healthcare clinicians regarding gout. Patients with gout may present in any healthcare setting. The nurse may be involved in obtaining a medical history, performing diagnostic procedures, providing patient education and/or medication administration to treat the disease. All clinicians involved in caring for patients receiving uric acid-lowering medications need a working knowledge of the diagnosis for which they are given, side effects of the drugs, appropriate interventions, and the psychological implications of having this disease and the treatments used to control it.

Objectives

Upon completion of this course, the participant will be able to:

o Explain the role of uric acid in gout
o Describe the 4 stages of gout
o Discuss treatments for gout, including lifestyle modifications, medications used for acute attack symptom relief, and uric acid-lowering drugs

Curriculum

Chapter 1: Introduction
Definition
Scope of the Issue
Risk Factors
Comorbidities

Chapter 2: Description of the Disease
Stages of the Disease
Symptoms

Chapter 3: Diagnosis

Chapter 4: Treatment
Colchicine
NSAIDs
Corticosteroids
Uric Acid Lowering Therapy
1. Allopurinol
2. Febuxostat
3. Probenecid
4. Lesinurad
5. Pegloticase

Chapter 5: References

Pedagogy course are available for purchase by the individual. Register with us to create your log in and password, click on the course title of interest and then click the BUY NOW button.

For facilities or institutions that would like to purchase education for their entire staff, email sales@pedagogy-inc.com let us know the course(s) of interest and for how many staff members. We will be happy to send you a price quote.

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