Gout

Musculoskeletal systemMusculoskeletal system terms

Oste/o Bone Osteitis, osteoma, osteocyte

Chondr/o Cartilage Chondritis, chondroma, chondrocyte

Arthr/o Joint Arthritis, arthroplasty

Myel/o Bone marrow Myeloma

Ten/o, tendin/o

Tendon (binds muscle to bone)

Tendonitis, tenorrhaphy

Ligament/o Ligament (binds bone to bone)

Ligamentous injury

Burs/o Bursa, “bag”, (shock absorber between tendons and bones)

Bursitis

My/o, myos/o

Muscle Myoma, myositis

-malacia Softening Osteomalacia, chondromalacia

-porosis Porous Osteoporosis

-asthenia Weakness, loss of strength

Myasthenia gravis

-trophy Development, stimulation, maintenance

Atrophy (shriveling of muscles), hypertrophy  (increase in size and strength of muscles)

-algia, Pain Myalgia, arthralgia,

algesia analgesia  (take away pain

I have long since stopped defining what “-itis” means, or “-oma.” Do you remember what “-plasty” means, or how about “-rrhaphy”? These word parts were introduced in previous modules. This program is all about building word roots, prefixes and suffixes into medical terms. The ultimate goal is for you to be able to figure out the meaning of new terms, or, at least, not be intimidated about looking it up in a medical dictionary.

Musculoskeletal system diseasesArthritis - As we age, our joint tissues become less resilient to wear and tear and start to degenerate manifesting as swelling, pain, and oftentimes, loss of mobility of joints. Changes occur in both joint soft tissues and the opposing bones, a condition called osteoarthritis. A more serious form of disease is called rheumatoid arthritis. The latter is an autoimmune disease wherein the body produces antibodies against joint tissues causing chronic inflammation resulting in severe joint damage, pain and immobility.

Osteoporosis – “Porous bone.” The bane of the old, especially, women. The hard, rock-like quality of bone is dependent upon calcium.

When too much calcium is dissolved from bones or not enough replaced, bones lose density and are easily fractured. Estrogen, the female sex hormone, helps maintain proper calcium levels in bones. Once the ovaries stop producing the hormone, women are at higher risk of developing osteoporosis. A collapse of bony vertebrae of the spinal column results in loss of height and stooped posture. Hip fractures are a common occurrence.Osteomalacia - “Soft bones.” If not enough calcium is deposited during early childhood development, the bones do not become rock-hard, but rubbery. Both adequate calcium in the diet and vitamin D, primarily, from normal sunlight exposure or supplementation, are necessary for normal bone development. Before vitamin supplementation to milk, “rickets,” another name for osteomalacia in children, was common resulting in the classic bowed legs of the afflicted child.Carpal tunnel syndrome - People whose job involves repeated flexing of their wrist (typing, house painting) may develop tingling and/or pain in their thumb, index and middle fingers along with weakness of movements of the thumb, especially, grasping an object. The main nerve for finely controlled thumb movements passes through a bony/ligamentous canal on the bottom of the wrist. Repetitive flexing movements may inflame and thicken the ligament over the “tunnel” through the carpal (wrist) bones trapping and compressing the nerve.Tendonitis- Repeated strain on a tendon, attachment of a muscle to bone, can inflame the tendon resulting in pain and difficulty with movement involving the muscle. Tendons have a poor blood supply; therefore, they typically take a long time to heal on the order of six weeks or more.

Rotator cuff tear - Muscles surrounding the shoulder joint are involved in rotating the shoulder with upper arm and hand forward and backward, among other movements. The tendons of these muscles also contribute to the structural strength of the shoulder joint. Hard, fast movements, such as in tennis and baseball can tear one of these tendons resulting in pain and decreased mobility of the shoulder. Surgery may be needed to repair a torn tendon.Bursitis - A bursa is a small, closed bag with a minimum amount of lubricatory fluid that serves as a shock absorber where bones make close contact and to minimize trauma and friction where tendons cross bones and joints. Inflammation leads to pain and immobility in a joint area.Muscular dystrophy - Muscular dystrophy is a group of inherited diseases in which the muscles that control movement progressively weaken. The prefix, dys-, means abnormal. The root, -trophy, refers to maintaining normal nourishment, structure and function. The most common form in children is called Duchenne muscular dystrophy and affects only males.  It usually appears between the ages of 2 to 6 and the afflicted live typically into late teens to early 20s.Myasthenia gravis - “Muscular weakness, profound”. This is an autoimmune disease that involves production of antibodies that interfere with nerves stimulating muscle contractions. Face and neck muscles are the most

obviously affected, manifesting as drooping eyelids, double vision, difficulty swallowing and general fatigue. There is no actual paralysis of muscles involved, but a rapid fatiguing of function.Lupus erythematosus - An autoimmune disease wherein the body produces antibodies against a variety of organs, especially connective tissues of skin and joints. Mild Lupus may involve a distinctive butterfly-shaped rash over the nose and cheeks. Mild lupus may also involve myalgia and arthralgia (remember these words?) Severe or systemic lupus (SLE) involves inflammation of multiple organ systems such as the heart, lungs, or kidneys. By the way, lupus means “wolf” in Latin. Maybe a reference to the facial rash that might give a patient a wolf-like appearance.

Musculoskeletal system proceduresOrthopaedist – “To straighten up children.” Orthopaedics is a surgical subspecialty that in the past devoted much of its time to treating musculoskeletal deformities in children. Now with improved prenatal diagnosis and better nutrition, orthopaedists still treat children with spine and limb deformities but also adults with complicated bone fractures, damaged tendons or ligaments, or needing surgery to replace a damaged hip or knee joint.Rheumatologist – “To study the flux of fluids.” Say, what? Rheuma is an old medical term for a watery discharge. Among other diseases, rheumatologists treat joint diseases such as the various forms of arthritis including rheumatoid arthritis. Inflamed joints accumulate “fluid” and swell among other signs and symptoms. This medical subspecialty also evaluates and treats osteoporosis, tendonitis, gout and lupus among many other chronic musculoskeletal pain disorders.Osteopath/osteopathic physician (D.O.) - The name sounds like a specialty limited to bone disease, but

actually, osteopathic physicians are one of two arms of the medical profession that differ in history and philosophy. At one time there were many kinds of medical schools originating from various philosophies; allopathic, osteopathic, homeopathic. Osteopathy originated in the 1890s in response to despair at the lack of effectiveness of many forms of then primitive treatments. Osteopathy developed an emphasis on the influence of the musculoskeletal system and its interrelationship to other body systems. D.O.s make use of osteopathic manipulation (bones, ligaments, joints) along with medication, surgery and all other medical treatments used by M.D. physicians. Also, preventive care has always been a major emphasis of osteopathic care. M.D.s and D.O.s are licensed by all state medical boards. Learn about the doctor of osteopathic medicine program at Des Moines University.Podiatrists, traditionally known as “foot doctors,” are surgical subspecialists in diseases and structural problems of the feet. They not only provide care for corns, calluses, ingrown toenails and heel spurs, but also treat foot and ankle injuries, deformities and diseases. Many systemic diseases manifest signs and symptoms in appearance of the feet such as poor wound healing in diabetes. They also can prescribe special shoes and inserts to treat chronic foot pain and walking problems. Podiatrists may further specialize in sports medicine, geriatrics or diabetic foot care. Learn about the doctor of podiatric medicine program at Des Moines University.Physical therapist – This health care professional has at least two years of specialized training beyond a college degree. PTs are rehabilitation specialists treating a multitude of medical problems including patients recovering from joint surgery, limb amputation, a stroke, heart attack and suffering with chronic neuromuscular diseases. In addition to other treatment modalities, they teach patients exercises to strengthen their body, increase mobility and how to prevent recurrence of

injury. Learn about the doctor of physical therapy program at Des Moines University.Arthroscopy - A fiberoptic instrument is introduced into a joint cavity in order to visualize surfaces of bones entering into a joint, find tears in internal joint structures and evaluate sources of inflammation.Bone scan – A radioactive element in very small amounts, not enough to cause any radiation injury to the patient, is introduced into the blood stream. The specially selected element accumulates in bone and using a much more sophisticated version of the old Geiger Counter instrument, the distribution of the element is used to diagnose potential bone tumors among other bone pathologies.

Electromyography - A big, scary word! But, you are experienced by now in taking them apart. I like to start at the end and work backward: “a recording of muscle electrical activity.” Fine needles are introduced into muscles in order to make recordings of contractile activity. This procedure is useful in evaluating causes of paralysis, diagnosing muscular dystrophy and other neuromuscular disorders.Muscle biopsy – Cutting out a small tissue sample of muscle in order to examine it under a microscope. This procedure can be useful in diagnosing muscular dystrophy and other neuromuscular disorders.

Musculoskeletal system medical recordFollowing is an abstract of a simulated patient medical record. Identify each italicized word. If the meaning doesn’t come right away, take apart the word. If you recognize the organ involved, use the context to help you figure out the full meaning. Terms are not limited to musculoskeletal system. Remember, this is a cumulative exercise!A 62 year old male comes to his family physician complaining of pain in his right knee. He walks with a limp which he says is getting worse and is related to an old football injury. During the course of the examination he reveals that he also suffers from a “nervous bladder” with polyuria, dysuriaand nocturia, but denies hematuria. He smokes two packs a day, breaths are wheezy and he is short of breath, but denies hemoptysis.Physical exam: right knee was swollen, warm and had limited range of motion which was painful to perform. Mild exercise increases wheezing and causes dyspnea. Examination of the heart size reveals cardiomegaly. No hepatomegaly or splenomegaly was found upon abdominal examination.Current medication: Prevacid for gastroesophageal reflux disease, nitroglycerine for angina pectoris.Past medical history: GERD diagnosed with esophagogastroduodenoscopy (EGD). Angina pectoris diagnosed with treadmill test, cardiac scan and cardiac catherization.Past surgical history: orchidopexy for cryptorchidism at age nine, tonsillectomy, appendectomy.Family medical history: mother has chronic nephritis; will be starting dialysis.Recommended treatments: refer to pulmonologist to evaluate possible emphysema. Refer to orthopaedist for arthroscopic evaluation of knee. Refer to urologist to evaluate for prostatic hypertrophy,

possible cystoscopy. Office phlebotomist drew specimens for lab work.Get a piece of paper and pencil and write down two column headings: “Signs” and “Symptoms.” Then take the following items and put them under the proper heading. You remember the difference between a sign and a symptom, right? You might want to review the context of these items in the case above before deciding.Item: cardiomegaly, pain in right knee, right knee is swollen, nervous bladder.

In plain English

A 62 year old male comes to his family physician complaining of pain in his right knee. He walks with a limp which he says is getting worse and is related to an old football injury. During the course of the examination he reveals that he also suffers from a “nervous bladder” with frequent urination, painful/difficult urination and getting up at night to urinate, but denies blood in the urine. He smokes two packs a day, breaths are wheezy and he is short of breath, but denies coughing up blood.Physical exam: right knee was swollen, warm and had limited range of motion which was painful to perform. Mild exercise increases wheezing and causes difficulty breathing. Examination of the heart size reveals an enlarged heart. No enlargement of the liver or spleen was found upon abdominal examination.Current medication: Prevacid for severe heartburn, nitroglycerine for chest pain related to the heart.Past medical history: GERD diagnosed with visual examination of the esophagus, stomach and duodenum with a fiberoptic instrument. Angina pectoris diagnosed with treadmill test, injecting a radioactive element into blood stream to evaluate heart structure and function and threading a hollow tube through arteries to the heart to inject dye opaque to X-rays to demonstrate coronary arteries.

Past surgical history: surgical fixation of the testis for undescended testicles at age nine, removal of tonsils, removal of appendix.Family medical history: mother has chronic inflammation of kidneys; will be starting medical procedure cleansing waste from blood in kidney failure.Recommended treatments: refer to specialist in lung diseases to evaluate possible destruction of lung membranes needed for oxygen exchange. Refer to specialist in musculoskeletal diseases for visualization of joints with a fiberoptic instrument (evaluation of knee). Refer to specialist in lower urinary tract diseases and diseases of the male reproductive tract to evaluate for enlargement of the prostate, possible visualization of the interior of the bladder with a fiberoptic instrument. Office technician or nurse trained to “cut into veins” to draw blood drew specimens for lab work.By the way, what the patient complains of or describes are symptoms: knee hurts, frequent urination. What the doctor observes and/or measures are signs: right knee is swollen, enlarged heart.http://www.dmu.edu/medterms

ArthritisArthritis is inflammation of a joint. Symptoms of arthritis may include pain, swelling, redness, warmth, and limitation of movement.There are over 100 types of arthritis. Three common types are osteoarthritis, rheumatoid arthritis, and gout.

Osteoarthritis is a condition in which the cartilage that protects and cushions joints breaks down over time. Eventually, the bones-formerly separated by the cartilage-rub against each other, resulting in damage to the tissue and underlying bone and causing painful joint symptoms.

Rheumatoid arthritis (RA) is an inflammation of the membranes or tissues lining the joints. Over time, rheumatoid arthritis may destroy

the joint tissues, including cartilage, ligaments, tendons and bone, and, in rare but severe cases, may cause organ damage.

Gouty arthritis (gout) is an inflammatory joint disease that causes acute pain and swelling. It is a form of arthritis that develops when uric acid crystals form in and around the joints, commonly affecting the big toe joint (this symptom is called podagra). People who have gout may have a very painful attack in one or two joints followed by the total disappearance of all symptoms until the next attack.

What is gout? Gout is a kind of arthritis. It can cause an attack of sudden

burning pain, stiffness, and swelling in a joint, usually a big toe. These attacks can happen over and over unless gout is treated. Over time, they can harm your joints, tendons, and other tissues. Gout is most common in men.

Gout - CauseGout is caused by too much uric acid in the blood (hyperuricemia). Hyperuricemia usually does no harm, and many people with high levels of uric acid in the blood never develop gout. The exact cause of hyperuricemia sometimes is not discovered, although inherited factors (genes) seem to play a role. When uric acid levels in the blood are too high, uric acid may form crystals that build up in the joints. Gout can seem to flare up without specific cause or can be brought on by factors such as:

Certain conditions related to diet and body weight, such as:o Obesity .o Moderate to heavy alcohol ingestion, particularly beer.o A diet rich in meat and seafood (high-purine foods).o Very low-calorie diets. Medicines that may increase uric acid concentration, such as:o Regular use of aspirin or niacin.o Medicines that reduce the amount of salt and water in the

body (diuretics).o Medicines that cause rapid cell death (chemotherapy,

usually used to treatcancer).o Medicines that suppress the immune system, such

as cyclosporine, that are used to prevent your body from rejecting an organ transplant.

Major illness or certain medical conditions, such as:o Rapid weight loss, as might happen in hospitalized patients

who have changes in diet or medicines.o Chronic kidney disease .o High blood pressure .

o Conditions that cause an abnormal rapid turnover of cells, such as psoriasis,multiple myeloma, hemolytic anemia, or tumors.

o Lead poisoning .o Hypothyroidism . Surgery. Having been born with a rare condition that causes high blood

uric acid levels. People with Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome have a partial or complete deficiency in an enzyme that helps to control uric acid levels.

Gout - SymptomsGout usually develops after a number of years of buildup of uric acidcrystals in the joints and surrounding tissues. Symptoms include:

Warmth, pain, swelling, and extreme tenderness in a joint, usually a big toe joint  . This symptom is called podagra. Symptoms sometimes start in a different joint, such as the ankle or knee.

Pain that starts during the night and is so intense that even light pressure from a sheet is intolerable.

Rapid increase in discomfort, lasting for some hours of the night and then easing during the next few days.

As the gout attack subsides, the skin around the affected joint may peel and feel itchy.Other symptoms may include:

Very red or purplish skin around the affected joint, which may appear to be infected.

Limited movement in the affected joint.Symptoms of gout vary.

Symptoms may occur after an illness or surgery. Some people may not experience gout as many painful attacks

but rather develop chronic gout. Chronic gout in older adults may be less painful and can be confused with other forms of arthritis.

Gout may first appear as nodules (tophi) on the hands, elbows, or ears. There may be no classic symptoms of a gout attack.By the time you have the symptoms of a gout attack, uric acid has been building up in your blood, and uric acid deposits have been forming on one or more of your joints.The big toe joint is most commonly affected. But the joints of the feet, ankles, knees, wrists, fingers, and elbows may also be involved. Inflammation of the fluid sacs (bursae) that cushion tissues may occur, particularly in the elbow (olecranonbursitis) and knee (prepatellar bursitis).There are many other conditions with symptoms similar to gout.

Gout - What HappensGout usually develops after a number of years of buildup of uric acidcrystals in the joints and surrounding tissues. A gout attack usually starts during the night with moderate pain that grows worse. A gout attack typically causes pain, swelling, redness, and warmth (inflammation) in a single joint, most often the big toe (this symptom is called podagra), followed by the eventual disappearance of all symptoms.

Most gout attacks stop after about a week. Mild attacks may stop after several hours or last for 1 to 2 days.

These attacks are often misdiagnosed as "tendinitis" or "sprain" even though there was no trauma or overuse.

Severe attacks may last up to several weeks, with soreness lasting for up to 1 month.

Many people have a second attack of gout within 6 months to 2 years after their first attack, but there may be intervals of many years between attacks. If untreated, the frequency of attacks usually increases with time.There are three stages of gout.1 Many people never experience the third stage.First stage: High blood uric levels

The uric acid level in the blood may be higher than normal, but there are nosymptoms of gout.

High uric acid in the blood (hyperuricemia) may never progress beyond this stage, and symptoms of gout may never develop.

Some people may have kidney stones before having their first attack of gout.Second stage: Episodes of acute gouty arthritis separated by periods without symptoms

This stage is also called intercritical or interval gout. Uric acid crystals begin to form in the joint fluid, usually in one

joint-most commonly the big toe-and the body often responds with a sudden inflammatory reaction: a gout attack.

Although the big toe is the most common site for a gout attack, gout may develop in other joints, including the knee, ankle, and joints in the foot, wrist, and fingers.

After the gout attack is over, the affected joint and surrounding tissues feel normal within days until the next attack, which often occurs within 2 years.

For many people this period becomes progressively shorter as attacks occur more often. Later attacks may be more severe, last longer, and involve more than one joint.Third stage: Chronic tophaceous gout

If gout symptoms have occurred off and on without treatment for several years, they may become ongoing (chronic) and frequently affect more than one joint. There may no longer be periods of time between attacks. This stage of gout is frequently confused with other forms of arthritis, most commonly osteoarthritis.

By this time, enough uric acid crystals have accumulated in the body to form gritty nodules called tophi. When located just under the surface of the skin, these deposits are usually firm and movable. The overlying skin may be thin and red. Tophi that are very near the skin may appear cream-colored or yellow.

At first, tophi are usually found on or near the elbow, over the fingers and toes, or on the outer edge of the ear.

If the condition progresses without treatment, tophi may form in the cartilage of the external ear or the tissues around the joint (bursae, ligaments, and tendons), resulting in pain, swelling, redness, and warmth (inflammation). Progressive crippling and destruction of cartilage and bone is possible.

This stage of gout is uncommon because of advances in the early treatment of gout.

Gout - What Increases Your RiskGout is caused by too much uric acid in the blood (hyperuricemia). The following risk factors can either cause hyperuricemia or make joints more susceptible to the formation of uric acid crystals:

Being male Family history of gout Obesity Moderate, regular, or heavy consumption of alcohol, especially

beer A diet rich in meat and seafood, which can be high in purines Use of medicines that remove salt and water from the body

(diuretics) Regular use of aspirin (more than 1 or 2 aspirin a day) Frequent episodes of dehydration Acute illness or infection Lead exposure (may occur through work, diet, or hobbies) Very low-calorie diets Injury to a joint

Gout and other conditionsCertain other conditions and diseases appear more often in people who have gout than in people who don't, though studies have not shown a clear relationship. It is thought that gout shares risk factors (such as obesity, hypertension, and high levels of triglycerides) with certain diseases, including:

Diabetes . Kidney (renal) disease . Hardening of the arteries (atherosclerosis). Heart disease .

Gout - When To Call a DoctorCall or see your doctor immediately if you have:

Severe pain in a single joint that comes on very quickly. Swollen, tender joints with overlying warm, reddened skin.

Watchful waitingDuring an acute gout attack, you may be able to relieve some of your discomfort by taking nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine and resting the affected joint until the attack eases. You can use ice to reduce the swelling.Although aspirin is an NSAID, don't take it for gout. Aspirin can actually make gout worse by abruptly changing the uric acid level in the blood.It is important that you see your doctor even if the pain from gout has stopped. The uric acid buildup that caused your gout attack may still be irritating your joints and could eventually cause serious damage. Your doctor can prescribe medicines that will prevent and even reverse the uric acid buildup.

Gout - Exams and TestsThe only certain way to diagnose gout is to have a joint fluid

analysis(arthrocentesis) test to see whether uric acid crystals are present. But for people with an acutely swollen, red, painful big toe, where it is often hard to obtain joint fluid, a diagnosis can be made by the presence of a high blood uric acid level.The following examinations and tests may help with diagnosis and treatment ofgout:

Medical history and physical exam Test to measure levels of uric acid in blood Test to measure levels of uric acid in urine

While X-rays of extremities (hands and feet) are sometimes useful in the late stages of the disease, X-rays are not usually helpful in the early diagnosis of gout. When gout is in a late stage, nodules (tophi) or even "punched-out" (worn away or eroded) areas of bone near joints may be seen. The pain of gout often causes people to seek medical attention before any long-term changes can be seen on an X-ray. But X-rays may help to rule out other causes of arthritis. See an X-ray of gout in the foot  .

Gout - Treatment OverviewThe goals of treatment for gout are rapid pain relief and prevention of future gout attacks and long-term complications, such as joint destruction

and kidney damage. Treatment includes medicines and steps you can take at home to prevent future attacks.Initial treatmentGout is treated with medicines to relieve symptoms and measures to eliminate causes. Specific treatment depends on whether you are having an acute attack or are trying to prevent future attacks.To reduce the pain, swelling, redness, and warmth of the affected joint(s) in an acute gout attack:

Rest the affected joint(s). Take one or more of the following medicines at the first sign of a

gout attack, as prescribed by your doctor.o Nonsteroidal anti-inflammatory drugs (NSAIDs) , such

as ibuprofen, naproxen, or indomethacin. Avoid aspirin, because it may abruptly change uric acidlevels in the blood and may make symptoms worse.

o Colchicine o Corticosteroids

To prevent recurrent attacks: Take a medicine that reduces uric acid levels in the blood, which

reduces the risk of future attacks.o Uricosuric agents  increase elimination of uric acid by the

kidneys.o Drugs  called xanthine oxidase inhibitors decrease production

of uric acid by the body. Take steps to reduce the risk of future attacks.o Control your weight. Being overweight increases your risk for

gout. If you are overweight, a diet that is low in fat may help you lose weight. But very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Weight Management.

o Limit alcohol, especially beer. Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.

o Limit meat and seafood. Diets high in meat and seafood (high-purine foods) can raise uric acid levels.

o Talk to your doctor about the medicines you take. Certain medicines that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin may raise the uric acid level. Low-dose aspirin may be important for theprevention of stroke or heart attack, so your doctor may want you to continue to take it.

o Follow a moderate exercise program.If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives.If the blood uric acid is high but a person has never had an attack of gout, treatment is rarely needed. But people with extremely elevated levels may need regular testing for signs of kidney damage. And they may need long-term treatment to lower their uric acid levels. Your blood uric acid level may be watched by your doctor until it is lowered to normal levels.Ongoing treatmentcontinued...If you have previously had a gout attack, you are likely to have another, especially if you are not managing the disease with medicines or other treatment. The goal of treatment is to prevent future attacks, to reduce high levels of uric acid (hyperuricemia), and to identify and treat the causes of your hyperuricemia. Your doctor will review your health history and current health status to identify other medical conditions and medicines that could be causing the elevated uric acid levels. Factors such as alcohol consumption, diet, and body weight can be modified to lower your uric acid levels and reduce the risk of future gout attacks.To reduce the pain, swelling, redness, and warmth of the affected joint(s) in an acute gout attack:

Rest the affected joint(s). Take one or more of the following medicines at the first sign of a

gout attack, as prescribed by your doctor:o Nonsteroidal anti-inflammatory drugs (NSAIDs) , such as

ibuprofen, naproxen, or indomethacin. Avoid aspirin, because it may abruptly change uric acidlevels in the blood.

o Colchicine o Corticosteroids

To prevent recurrent attacks: Take a medicine that reduces uric acid levels in the blood, which

reduces the risk of future attacks.o Uricosuric agents  increase elimination of uric acid by the

kidneys.o Drugs called xanthine oxidase inhibitors decrease

production of uric acid by the body.o Colchicine  is often prescribed to prevent flare-ups during

the first months that you are taking medicines that lower uric acid. Take steps to reduce the risk of future attacks.o Control your weight. Being overweight increases your risk

for gout. If you are overweight, a diet that is low in fat may help you lose

weight. But very low-calorie diets increase the amount of uric acid produced by the body and may bring on a gout attack. For more information, see the topic Weight Management.

o Limit alcohol, especially beer. Alcohol can reduce the release of uric acid by the kidneys into your urine, causing an increase of uric acid in your body. Beer, which is rich in purines, appears to be worse than some other beverages that contain alcohol.

o Limit meat and seafood. Diets high in meat and seafood (high-purine foods) can raise uric acid levels.

o Making changes in your diet may help with your gout. If you want to try an eating plan for gout, see:

 Gout: Changing Your Diet.

o Talk to your doctor about the medicines you take. Certain medicines that are given for other conditions reduce the amount of uric acid eliminated by the kidneys. These include pills that reduce the amount of salt and water in the body (diuretics, or "water pills") and niacin. Regular use of low-dose aspirin may raise the uric acid level. Low-dose aspirin may be important for the prevention of stroke or heart attack, so your doctor may want you to continue to take it.

o Follow a moderate exercise program.

Other Conditions With Symptoms Similar to GoutThe symptoms of gout (warmth, pain, swelling, and extreme tenderness in joints) may be related to other medical conditions. Some of the conditions that can have symptoms similar to those of gout are:

Rheumatoid arthritis (RA) . But rheumatoid arthritis affects more than one joint and generally affects both sides of the body. RA especially affect the hands and wrists. Most of the time, gout affects only one joint and is more common in thefeet or toes.

Osteoarthritis . Osteoarthritis develops slowly and is ongoing, while a gout attack develops quickly and you may not have symptoms between attacks.

A joint infected with bacteria (much less common than gout). The treatment of an infected joint requires intravenous antibiotics and hospitalization, so talk to your doctor if any of the following signs or conditions are present:

o Treatment with medicines that suppress your immune system

o HIV  infectiono Diabetes o Recent bacterial pneumonia

o Kidney or skin infectiono A swollen prosthetic jointo Fever Pseudogout, a disease in which calcium deposits collect in and

around joints. Pseudogout may show up as a swollen, painful knee, ankle, or wrist in older adults.

Gout - Treatment Overview(continued)continued...Long-term medicine treatment depends on how high your uric acid levels are and how likely it is that you will have other gout attacks in the future. If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives.Treatment if the condition gets worseGout can usually be successfully treated by eliminating its causes and taking medicines to relieve symptoms. But if gout symptoms have occurred off and on without treatment for several years, they may become ongoing (chronic) and may affect more than one joint. Uric acid crystals may have built up in the joints to form gritty, chalky nodules called tophi. Treatment of gout that has advanced to this stage includes medicines.

Take one or more of the following medicines, as prescribed by your doctor:

o Nonsteroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly raise uric acid levels in the blood.

o Colchicine o Corticosteroids If you are having pain in the joints from an attack, your doctor

may prescribe:o Nonsteroidal anti-inflammatory drugs (NSAIDs) , such as

ibuprofen, naproxen, or indomethacin. Avoid aspirin, which may abruptly raise uric acid levels in the blood.

o Colchicine .o Oral corticosteroids, such as prednisone or medrol.o A shot of corticosteroids in a muscle.o A shot of corticosteroids directly into the painful joint.o Pegloticase (Krystexxa). This medicine is for gout that has

lasted a long time and has not responded to other treatment. To prevent recurrent attacks, you may be prescribed:o Uricosuric agents  to increase elimination of uric acid by the

kidneys.

o Drugs called xanthine oxidase inhibitors to decrease production of uric acid by the body.

o Colchicine  to prevent flare-ups during the first months that you are taking medicines that lower uric acid.Treatment to eliminate tophi may include:2

Drugs called xanthine oxidase inhibitors, which may shrink the tophi until they disappear.

In rare cases, surgery to remove large tophi that are causing deformity.What to think aboutAfter an acute attack of gout, talk with your doctor about the causes of the elevated uric acid levels in your blood. A review of your overall health may reveal diseases, medicines, and habits that could be contributing to your uric acid levels.Most doctors will wait several days to weeks after a gout attack is over to begin medicine to lower the high uric acid levels. These medicines can cause uric acid stored elsewhere in the body to begin moving through the bloodstream and could make symptoms worse if treatment begins during a gout attack.If there is swelling that causes pressure in a large joint such as a knee or ankle, your doctor may relieve the pain and pressure by aspiration, in which a needle is inserted into the joint and fluid is drawn out (aspirated) with a syringe connected to the needle.

Gout - PreventionGout usually develops after a number of years of buildup of uric acidcrystals in the joints and surrounding tissue. You probably won't know that you have an elevated uric acid level in your blood until you have had your first gout attack. But you can help prevent or reduce the severity of future gout attacks.

If you have been prescribed medicines for gout, it is important that you take those medicines as instructed to prevent future attacks. Most people continue to take this medicine for the rest of their lives.

If you are overweight, take steps to lose weight. For more information, see the topic Weight Management.

You probably will be advised to reduce or stop your alcohol intake or to adjust your diet.

Making changes in your diet may help with your gout. If you want to try an eating plan for gout, see:

How is gout diagnosed? Your doctor will ask questions about your symptoms and do

a physical exam. Your doctor may also take a sample of fluid from your joint to look for uric acid crystals. This is the best way to

test for gout. Your doctor may also do a blood test to measure the amount of uric acid in your blood.

How is it treated? To stop a gout attack, your doctor can give you a shot of

corticosteroids, or prescribe a large daily dose of one or more medicines. The doses will get smaller as your symptoms go away. Relief from a gout attack often begins within 24 hours if you start treatment right away.

To ease the pain during a gout attack, rest the joint that hurts. Taking ibuprofen or another anti-inflammatory medicine can also help you feel better. But don't takeaspirin. It can make gout worse by raising the uric acid level in the blood.

To prevent future attacks, your doctor can prescribe a medicine to reduce uric acid buildup in your blood. If your doctor prescribes medicine to lower your uric acid levels, be sure to take it as directed. Most people continue to take this medicine for the rest of their lives.

Paying attention to what you eat may help you manage your gout. Eat moderate amounts of a healthy mix of foods to control your weight and get the nutrients you need. Avoid regular daily intake of meat, seafood, and alcohol (especially beer). Drink plenty of water and other fluids.

http://arthritis.about.com/

Gouty arthritis usually strikes a single joint, most commonly the big

toe (about 75% of people are affected at least once), however, it

can also affect the:

foot  (instep/heel)

ankles

knees

wrists

fingers

elbows

Gouty arthritis is rare in children and young adults. Men are more

likely to develop gouty arthritis than women.

The condition pseudogout (also called CPPD), can sometimes be

confused with gouty arthritis because it produces similar symptoms.

However, in CPPD, deposits are made up of calcium phosphate

crystals, not uric acid.

Four Stages Of Gouty Arthritis

Asymptomatic Hyperuricemia: In this stage, which usually

doesn't require treatment, a person has elevated blood uric acid

levels but no other symptoms.

Acute Gout / Acute Gouty Arthritis: In this stage,

hyperuricemia has caused deposits of uric acid crystals in joint

spaces, leading to gouty attacks.

Interval / Intercritical: In this stage, the periods between

acute gouty attacks, a person has no symptoms.

Chronic Tophaceous Gout: In this stage, the disease has

caused permanent damage. With proper treatment, most never

progress to this advanced stage.