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GOUT

WHAT IS IT?
Gout is a form of arthritis that comes on quickly and causes intense pain and swelling in a joint. It can affect any joint but usually shows up in the big toe, hand, ankle, or knee.
Each year, gout strikes more than one million Americans, most of them middle-aged men. But women can get it, too, usually after menopause.
An attack of gout often lasts about a week, then clears up. Once you’ve had one attack, you may never have another, but chances are you will. These later attacks are likely to last longer, and you’ll want to do what you can to prevent them, as repeated attacks of gout can damage joints. Gout can also cause kidney stones, and, in the worst cases, kidney failure.
The good news is that with lifestyle changes you can do a lot to prevent gout. Medications can treat attacks when they occur and help prevent them in the future.
WHAT IS HAPPENING?
Gout occurs when there is too much uric acid in the blood. Uric acid is a waste product that normally passes through the kidneys and out of the body in your urine. Some people get gout when their bodies can’t get rid of the substance fast enough, make too much of it, or both.
Extra uric acid in the blood forms crystals, which tend to lodge in spaces in the joints. The body reacts to these crystals, causing the tissue around the joint to become swollen and painful.
WHAT CAUSES IT?
No one can say for sure why one person gets gout when another doesn’t. However, researchers have found a number of things that can raise your risk. Some-such as your age or sex-are outside your control. But you can do plenty about others, such as your weight, the foods you eat, and the amount of alcohol you drink.

THINGS YOU CAN’T CHANGE

Gender
About 80 percent of those with gout are men. Researchers think men get it more often because they are more likely to be overweight, to have high blood pressure, and to drink a lot of alcohol, all things that increase risk.

Age
The risk goes up as you get older. People usually have their first attack between 40 and 50.

Family history
If someone in your family has gout, your own risk is probably higher as well.

THINGS YOU CAN CHANGE

Medication
Some drugs can increase your risk. These include certain diuretics (“water pills”), used to get rid of excess body fluid and reduce blood pressure, and some antibiotics, such as pyrazinamide and ethambutol. Some of these drugs hamper the body’s ability to get rid of uric acid; others make the body produce even more.

Diet
Some experts think certain foods increase your risk. Suspect foods include nuts, anchovies, liver, and sweetbreads and other organ meats. These foods contain a chemical-purine-that produces a lot of uric acid when it breaks down.

Alcohol
Drinking too much alcohol can also increase your risk-alcohol makes it hard for your body to get rid of uric acid.

Excess weight
People who are overweight have higher uric acid levels. Extra weight also puts more pressure on weight-bearing joints.

High blood pressure
People with high blood pressure are more likely to get gout. Blood pressure is the force with which blood pushes against the artery walls. High blood pressure means that this pressure is above normal most of the time. Blood pressure is measured with two numbers: The top number, systolic pressure, is measured when the heart squeezes blood out to the arteries. The bottom number, diastolic pressure, is measured when the heart relaxes between beats and refills with blood. How high is too high? Usually above 139/89. Best is 110/70 or below.

Lead exposure
Exposure to lead can cause an increase of uric acid in the blood.
WHAT YOU CAN DO FOR YOURSELF
You can take steps to cut your risk of developing gout-or, if you already have it, to reduce the pain and the chance of another attack. You’ll need to make some wise choices about the foods you eat, as well as your drinking and other habits.

If you have an attack
Rest
Stay off your feet as much as possible to ease the strain on painful joints.

Take over-the-counter medicines
Over-the-counter pain relievers such as aspirin, ibuprofen (Advil or Motrin) and naproxen (Aleve) help reduce joint pain and swelling. However, they can upset your stomach and even cause it to bleed if you use them too often. To reduce side effects, buy coated pills, or take the medicine with meals. Check with your doctor if you’re using any of these medications repeatedly for several weeks at a time.

Use hot or cold treatments
Put a heating pad or cold pack on a painful joint. Apply for 10 to 15 minutes at a time, as needed. Cold treatments generally work best for sudden, severe pain. Heat is better for mild pain. But people react differently to hot or cold packs so you may want to try both to see which works best for you.

To make a heating pad, soak a washcloth in warm water, wring it out, and put in a plastic bag. Or just wrap a hot water bottle in a towel. Your local drugstore may sell hot compresses that you warm in a microwave. For a cold pack, use ice cubes or a bag of frozen vegetables-peas or corn work best-wrapped in a towel.

To prevent attacks:
Watch what you eat
Stay away from foods like organ meats, which contain lots of purines.

Drink plenty of water
Aim for at least 10 eight-ounce glasses a day. The water will help flush the uric acid crystals out of your body. Drinking lots of water is especially important if you are taking gout medication or have kidney stones.

Control your weight
If you’re overweight, drop those extra pounds. Forget about dieting, though-especially “crash” dieting. Losing weight quickly can actually raise uric acid levels. Besides, most dieters eventually gain back any weight they’ve lost. The best approach? Combine sensible eating with physical activity to lose weight slowly-no more than about 1 percent of your body weight each week, just a pound or two.

To lose a pound of fat, you need to burn 3,500 more calories than you eat. That’s because one pound of fat contains 3,500 calories. (A double cheeseburger contains about 1,000 calories; an apple, in contrast, has only about 100.)

Weight loss may sound daunting, but it doesn’t have to be. Here are some tips that can help:

Be as active as you can. A brisk half-hour walk burns about 150 calories. Take the stairs instead of the elevator if it doesn’t bother your knees. Park in a far corner of the lot when you go to the market. Or simply walk the dog each evening after dinner. It will help, and your dog will thank you.
Reduce the amount of fat in your diet. Fats have more calories than anything else we eat. Two pats of butter, roughly a tablespoon of pure fat, has about 100 calories. Simply not buttering your morning toast will save you hundreds of calories each week. Cut more calories by choosing low-fat foods like nonfat dairy products, fish, and lean cuts of meat.
Eat more vegetables, fruits, and grains. They have what your body needs for energy and good health, plus they’re low in fat and calories. Prepare them the low-fat way-steamed, or sauteed in water or broth, in a nonstick pan. A serving of steamed vegetables has few calories and no fat; the same vegetables sauteed in butter or oil have about 14 grams of fat (roughly 125 calories).
Limit sugar and alcohol. They have lots of calories but little of what you need for good health.
If you drink, drink moderately
Too much alcohol makes it hard for your body to get rid of uric acid. How much is too much? More than two drinks a day if you’re a man, one if you’re a woman. A drink is one bottle of beer (12 ounces), one glass of wine (5 ounces), or one shot of liquor (1 1/2 ounces).

Control high blood pressure
If you have high blood pressure, take steps to lower it.

If you’re overweight, dropping those extra pounds will help.
Eat less sodium, the main ingredient in table salt. Too much raises your blood pressure. Steer clear of salty foods like canned and prepackaged foods such as frozen dinners, potato chips, pretzels, airplane meals, fast foods, and pizza.
If you smoke, quit-smoking raises blood pressure.
Follow your doctor’s advice about taking medications to reduce your high blood pressure.
Consider new medications
If you’re worried that any drugs you’re already taking may cause gout-such as certain antibiotics and diuretics (water pills)-talk with your doctor about alternatives.
WHAT YOUR DOCTOR CAN DO FOR YOU
Your doctor will examine you, ask you to describe your symptoms, and perhaps take a blood test to measure your level of uric acid. He or she may also remove fluid from the joint that hurts and examine it for crystals. If you have gout, several medicines can reduce the pain and inflammation:

Prescription nonsteroidal anti-inflammatories (NSAIDs)

These joint pain medications include nabumetone, etodolac, indomethacin, and diclofenac sodium. Like aspirin and over-the-counter NSAIDs, they are good at reducing both pain and swelling. But they can also cause stomach upset, headache, and rash.

Colchicine
If NSAIDs don’t take care of the problem, your doctor may consider using colchicine. It can relieve acute pain and swelling and is usually taken every hour for four to eight hours. Side effects may include diarrhea, nausea, and abdominal cramps.

Corticosteroids
These medications, which are taken by mouth or injection, can relieve severe pain. Corticosteroids are similar to cortisole, a natural hormone that reduces inflammation and speeds healing.

Be sure to follow your doctor’s advice about these drugs. When these pills are used regularly for more than about two weeks, they can cause serious side effects, including osteoporosis (thinning of the bones), cataracts, diabetes, and high blood pressure. You should get injections no more than three or four times a year, since more frequent shots may cause joint damage.

Medications to control uric acid levels
One of these drugs, allopurinol, slows your body’s production of uric acid. Others, such as probenecid and sulfinpyrazone, make your body get rid of uric acid faster. Side effects of these drugs can include rash, stomachache, and headache.

If you have a rash along with hives, itching, fever, nausea, or muscle pain, you may be having an allergic reaction; call your doctor right away.

Surgery
In rare cases, surgery may be necessary to remove gout from a joint. In the absolute worst case, a surgeon can replace a painful, badly damaged joint with an artificial joint.

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November 2013
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