Arthritis

Updated 04 March 2016

Treating gout

How do you treat gout and how is it prevented?

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Generally, because gout is such a painful affliction, people seek help and receive treatment. If the diagnosis is made early, current therapy can permit a normal life.

However, if gout treatment is not followed or urate levels remain high, the disease can eventually cause serious joint afflictions and kidney problems.

For those with advanced disease, it is possible to correct joint structure to a degree.
Tophi can be resolved, joint function improved, and kidney problems stopped.

Read:  What is Gout?

About 10 to 20% of gout sufferers develop kidney stones. These may lead to obstruction and infection, which may damage kidney tissue.

Many people with gout have high blood pressure. This condition can also damage the kidneys. In these cases, progressive destruction of kidney tissue may lead to further problems with urate excretion, which further raises urate levels.

When gout appears before the age of 30 it tends to be more severe.

General treatment

When you seek treatment for an acute gout attack, your doctor’s main treatment objectives will be:

• Termination of the acute attack and relief of pain

• Prevention of recurrent attacks (if they are frequent) by daily prophylactic use of medication

• Prevention of further deposition of urate crystals and resolution of existing tophi (achieved by lowering the urate levels in body fluids)

A preventative maintenance programme should be followed to avert the erosion of bone and joint cartilage, and kidney damage. Underlying obesity, high blood pressure and high cholesterol levels should be controlled.

Read: Is gout a chronic condition?

Surgery


Withdrawal of fluid from the affected joint (arthrocentesis) may help, and often corticosteroids can be injected into the joint space at the same time. (In addition, the most reliable way of making an accurate diagnosis is to examine the aspirated fluid under the microscope.)

Surgical removal of tophi is occasionally done, but can lead to serious secondary infection and generalised sepsis.

Extracorporal lithotrypsy can help destroy large kidney stones. During this procedure, shock waves are transmitted through the body and focused on the kidney stone. The stone is cracked up into small pieces that can be passed normally in the urine. It might be necessary to remove the stones in an operation if this fails.

Read: Cherries may ward off gout

Prevention


– Avoid certain protein-rich foods that can lead to decreased urate excretion: organ meats (liver, brains and kidneys), shellfish, fatty fish, asparagus, spinach and most dried beans. Some people find particular foods which affect them as individuals. These should be avoided in that instance.

– Increase your fluid intake – this is very important to decrease the possibility of urate crystal formation in the kidney tracts.

– Avoid alcohol, as it retards elimination of urate.

– If you are obese, control your body weight.

If you are a man and gouty arthritis runs in your family, these preventative measures are particularly important. Blood and urine tests during routine check-ups will alert your doctor to a potential for gout attacks.

He or she may prescribe drugs to reduce the body's production of urate and to encourage the excretion of excess urate. It is a treatable disease. Lowering the uric acid level to an acceptable level is paramount.

Read: Coffee may fight gout

When to see a doctor


Call your doctor if:

• Joint pain develops suddenly, especially when there has been no physical injury and if the pain is associated with redness and extreme tenderness.

• Joint pain recurs or lasts more than a few days, especially when associated with chills or fever (rheumatoid arthritis needs to be excluded).

• When, in known gout, symptoms become more severe or side effects of medication (allopurinol or colchicine) occur.

• When any severe colicky back pains develop and radiate into the groin – this may be caused by a kidney stone.

• If you are developing lumps (tophi).

• If attacks are more frequent or if they are affecting different or multiple joints.

• If the attacks are frequent and not settling and/or tophi are developing, consider asking your doctor about seeing a specialist.


Read more:

Causes of Gout

Signs and Symptoms of Gout 

'Boererate' for gout




Previously reviewed byDr David Gotlieb, rheumatologist, MBChB FCP(SA), September 2004

Reviewed by Dr Ingrid Louw, rheumatologist, MBChB, MMED Int Med, (private practice), August 2011

 

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Arthritis expert

Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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