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The True Facts about Gout

Updated on August 13, 2015

Major Gout Attack in both big toes, ankles and knees.

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Gout in both big toes and ankles

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Why it Is Important to Prevent Future Gout Attacks.

In 2012 new guidelines were developed after analyzing the best and most effective treatment for the different stages of gout. What ever your stage of gout it is clear that a good diet and limits on alcohol and fructose intake are important to help mitigate the risk of further attacks and your vulnerability to related diseases such as high blood pressure, chronic kidney disease, kidney stones, heart disease and diabetes. The higher the uric acid the higher your risk of developing these diseases.

First it is important to know the different stages of gout so you can determine your best plan of action.

  1. Hyperuricemia is when the uric acid level is above the level considered to be safe. It must be low enough to prevent build up of urate crystals. Not everyone who has hyperuricemia gets gout, but like gout sufferers they too have a higher rate of chronic kidney disease, kidney stones, heart disease and diabetes -- especially women. The higher the uric acid the higher the risk.
  2. If untreated It takes 10 to 11 years from the first gout attack to reach the last phase of chronic tophaceous gout. If you have had only three or four attacks there is still time to try using a gout diet without medication to bring down your uric acid levels. It is important to know how high your uric acid level is because the higher the uric acid level the more vulnerable you are to future gout attacks. The first attack usually occurs in the big toe and some people never have another attack while others will continue over time to have more and more attacks. At first the attacks may be years apart but they will begin to happen more often and occur in different joints and several joints at the same time.
  3. Tophi. (a collection of urate crystals) Ideally gout should be controlled before long term damage can occur. If the uric acid level in the blood is not reduced the urate crystals move through the body via the blood attaching themselves to soft tissue, cartilage and joints. the crystals will accumulate and further attacks will be more severe and occur in other joints such as the ankles, wrist, elbow, fingers and toes. These tiny microscopic crystals are like very short needles with points at each end. As they accumulate and grow in size they cause inflammation. Tophi become visible under the skin as the collection gets larger and as they collect in the joints and cartilage they cause severe damage. Tophi can result in deformity as it grows in size and sometimes it is excreted through the skin -- a white chalky substance made of urate crystals that looks like toothpaste. Once the tophi develop and begin to be visible the worst stage of gout begins.
  4. Chronic tophaceous gout is complete and total agony. There is little time if any between attacks, and the attacks will include multiple joints and move from one joint to another -- at this point the health care provider can do little more than manage the attacks. Gout in more than one joint is excruciatingly painful and debilitating. The tophi appear in places all over the body causing inflammation. It accumulates in the joints and cartilage causing destruction of joints and disfiguration.



Tophi oozing from fingernail

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The Finger is Beginning to Heal. Gout Has Caused the Finger to be Misshapen and the Swollen Finger Next to it is Loaded with Tophi.

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Tophi nodules can be seen on the ear

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Gout is not just eating the wrong food or drinking to much alcohol it is a serious metobolic disorder.

In some cases the kidneys are just not able to excrete enough uric acid from the body to succeed with diet alone. Some people produce to much uric acid or their kidneys do not excrete enough uric acid or both. There are new medications coming on the market that may be able to target the specific problem in this metabolic process.

By the time you have your second or third gout attack it is harder to lower the uric acid without the help of medication. Eating a healthy diet is still important, especially if you are overweight. If after the first or second attack you maintain a good diet and limit alcohol and sweet drinks over time you may be able to lower your uric acid to a safe level but you should have your blood tested to see if the uric acid level is dropping.

If you have had gout attacks on a regular basis for five to six years you are well on your way to chronic tophaceous gout. Temporary relief is not a cure, because between attacks the urate crystals are quietly accumulating and attacking your body causing inflammation and destruction.

At this stage It is futile to think that diet alone will prevent more gout attacks. Yes, there may be triggers but they usually work because your uric acid level is too high and tophi is loaded and ready to go -- it doesn't take much at this stage. You do not want to progress to chronic tophaceous gout. All people with gout are not the same, in order to make sure you are not at risk for more gout attacks or the diseases that are associated with gout is to have your uric acid level checked with a blood test, and take whatever steps necessary to get rid of the tophi and the uric acid.

Controlling the amount of uric acid in your blood is the most important in preventing gout. If you know how high your uric acid is you know how much work you have ahead of you to bring the uric acid down to a safe level.

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