Handling Patients who have Gout

When a patient has gout, they will most likely be very uncomfortable, and possibly be limping as they approach. Gout used to be known as the rich man’s disease, since it was presumed gout is often caused by red wine and expensive cuts of meat. We now know that gout can affect any number of people.

What is Gout?

Gout is a form of inflammatory arthritis that develops in some people who have high levels of uric acid in the blood. The acid can form needle-like crystals in a joint and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling.

What Are The Different Types of Gout?

There are several stages of gout:

Asymptomatic hyperuricemia is the period prior to the first gout attack. There are no symptoms, but blood uric acid levels are high and crystals are forming in the joint. Acute gout, or a gout attack, happens when something (such as a night of drinking) causes uric acid levels to spike or jostles the crystals that have formed in a joint, triggering the attack. The resulting inflammation and pain usually strike at night and intensify over the next eight to 12 hours. The symptoms ease after a few days and likely go away in a week to 10 days. Some people never experience a second attack, but an estimated 60% of people who have a gout attack will have a second one within a year. Overall, 84% may have another attack within three years.

Interval gout is the time between attacks. Although there’s no pain, the gout isn’t gone. Low-level inflammation may be damaging joints. This is the time to begin managing gout – via lifestyle changes and medication – to prevent future attacks or chronic gout.

Chronic gout develops in people with gout whose uric acid levels remain high over a number of years. Attacks become more frequent and the pain may not go away as it used to. Joint damage may occur, which can lead to a loss of mobility. With proper management and treatment, this stage is preventable.

Gout occurs in about 4% of American adults – about 6 million men and 2 million women.

Gout Risk Factors:

Genes: If family members have gout, you’re more likely to develop it.
Other health conditions: High cholesterol, high blood pressure, diabetes and heart disease may raise your risk.
Medications: Diuretic medications or “water pills” taken for high blood pressure can raise uric acid levels; so can some drugs that suppress the immune system taken by rheumatoid arthritis and psoriasis patients, as well as transplant recipients.
Gender and age: Gout is more common in men than women until around age 60. Experts believe natural estrogen protects women up to that point.
Diet: Eating red meat and shellfish increases your risk.
Alcohol: For most people, more than two liquor drinks or two beers a day can increase the risk of gout.
Sodas: The fructose in sweet sodas has recently been shown to increase gout risk.
Obesity: Obese people are at a higher risk for gout, and they tend to develop it at a younger age than people of normal weight.
Bypass surgery: Those who have undergone gastric bypass surgery have an increased risk.

Related: Patients with Skin Breakdown

Treating Gout

Few things in life are more painful than a gout attack, so if you’re awakened in the wee hours by a joint that is tender, swollen, red and radiating heat, you’ll want to act fast. Here’s what you can do when a gout attack starts to ease the pain of the attack and reduce the risk of others.

Take medicine you have on hand: Start treatment immediately with over-the-counter ibuprofen (Motrin, Advil) or naproxen (Aleve), but never take aspirin, which can actually worsen an attack. If you have had an attack before and your doctor has prescribed an anti-inflammatory medication to take in the event of another, take your prescribed medication as your doctor directed. If you are already taking a uric acid-lowering drug to reduce the risk of attacks, continue to take that drug through this attack.

Ice down: Applying an ice pack to the painful joint may help ease pain and inflammation. Wrap a pack (a bag of crushed ice or frozen peas will also do) in a dish cloth and apply to the area for 20 to 30 minutes at a stretch several times a day. Getting treatment within the first 24 hours of the start of an attack can lessen its length and severity. Drink plenty of fluids. Staying hydrated helps flush out uric acid (the cause of your joint pain) and prevent kidney stones, another possible problem associated with high uric acid levels. Aim for eight to 16 cups of fluids a day, at least half of them water.

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