Tips for Gout patients to stay healthy

· To help prevent future attacks, take the gout medications that your doctor prescribes. Carefully follow instructions about how much medicine to take and when to take it. Acute gout is best treated when symptoms first occur.
· Tell your doctor about all the medicines, dietary supplements, and vitamins you take. He or she can tell you if any of them increase your risk of hyperuricemia.
· Plan followup visits with your doctor to evaluate your progress.
· Exercise regularly and maintain a healthy body weight. Lose weight if you are overweight, but do not go on diets designed for quick or extreme loss of weight because they increase uric acid levels in the blood.

Survival Tips

Tips:
1. Maintain adequate fluid intake.
2. Keep your weight under control. Obesity has been linked to gout.
3. Dietary changes can help prevent gout attacks. Avoid a purine-rich diet. Reduce alcohol consumption.
4. Medications can help control pain and inflammation of a gout attack and help prevent future attacks by eliminating excess uric acid or affecting the production of excess uric acid.
5. Be compliant with the treatment plan your doctor recommends.
What You Need:
· Diet low in purines.
· Medication to control pain.
· Medication to control inflammation.
· Medication to control level of uric acid.

Did you know these are used to treat gout?

1. Colchicine is used to treat acute flares of gouty arthritis and to prevent recurrent acute attacks. Colchicine does not cure gout or take the place of other medicines that lower the amount of uric acid in the body. It prevents or relieves gout attacks by reducing inflammation. Colchicine may be used in 2 ways: some people take small amounts of it regularly for months or years, while others take large amounts of colchicine during a short period of time (several hours).
2. Corticosteroids or adrenocorticotropic hormone can be used for patients who cannot take NSAIDS or colchicine. Patients with acute gout typically receive daily doses of prednisone (20-40mg) or its equivalent for 3 to 4 days, then it is tapered gradually over one to two weeks. ACTH is administered as an intramuscular injection (an initial dose and subsequent doses over several days as needed).
3. Allopurinol (brand name - Zyloprim) is prescribed for chronic gout or gouty arthritis and works by affecting the system that manufactures uric acid in the body. It is used to prevent gout attacks, not to treat them once they occur.
4. Probenecid (brand names - Benemid, Probalan) is prescribed for chronic gout and gouty arthritis. It is used to prevent attacks related to gout, not treat them once they occur. It acts on the kidneys to help the body eliminate uric acid. Probenecid is known as a uricosuric agent.
5. ColBenemid (other brand names are Col-Probenecid and Proben-C) is a gout medication that contains Probenecid, which is a uricosuric agent, and Colchicine, which has anti-gout properties.
6. Sulfinpyrazone (brand name - Anturane) is also known as a uricosuric agent and is used to treat gouty arthritis. It works by lowering the amount of uric acid in your blood, preventing gout attacks. The drug helps prevent attacks but is not used to treat an attack once it has started.
7. Losartan, (brand names - Cozaar and Hyzaar), is not specifically a gout medication but is an angiotensin II receptor antagonist, antihypertensive drug that may help control uric acid levels. Fenofibrate, (brand name - Tricor), is not a specific gout medication but it a lipid-lowering drug that may help uric acid levels.

Medications for gout include:

o non-steroidal anti-inflammatory drugs (NSAIDS)
o colchicine
o corticosteroids
o adrenocorticotropic hormone (ACTH)
o allopurinol
o probenecid
o sulfinpyrazone
2. NSAIDS, specifically indomethacin, are commonly the first medication prescribed to treat acute gout. Other NSAIDS may be equally effective. NSAIDS are initially prescribed at maximum dosage and reduced as symptoms subside. The medication should be continued until pain and inflammation are non-existent for at least 48 hours. NSAIDS which are COX-2 inhibitors may be useful for patients with gastrointestinal concerns but their use for acute gout has not been specifically reported yet.

Drinking Four Or More Cups Of Coffee A Day May Help Prevent Gout

Coffee is a habit for more than 50 percent of Americans, who drink, on average, 2 cups per day. This widely consumed beverage is regularly investigated and debated for its impact on health conditions from breast cancer to heart disease. Among its complex effects on the body, coffee or its components have been linked to lower insulin and uric acid levels on a short-term basis or cross-sectionally. These and other mechanisms suggest that coffee consumption may affect the risk of gout, the most prevalent inflammatory arthritis in adult males.

To examine how coffee consumption might aggravate or protect against this common and excruciatingly painful condition, researchers at the Arthritis Research Centre of Canada, University of British Columbia in Canada, Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health in Boston conducted a prospective study on 45,869 men over age 40 with no history of gout at baseline. Over 12 years of follow-up, Hyon K. Choi, MD, DrPH, and his associates evaluated the relationship between the intake of coffee and the incidence of gout in this high risk population.

Their findings provide compelling evidence that drinking 4 or more cups of coffee a day dramatically reduces the risk of gout for men.
Subjects were drawn from an ongoing study of some 50,000 male health professionals, 91 percent white, who were between 40 and 75 years of age in 1986 when the project was initiated. To assess coffee and total caffeine intake, Dr. Choi and his team used a food-frequency questionnaire, updated every 4 years. Participants chose from 9 frequency responses -- ranging from never to 2 to 4 cups per week to 6 or more per day -- to record their average consumption of coffee, decaffeinated coffee, tea, and other caffeine-containing comestibles, such as cola and chocolate.

Through another questionnaire, the researchers documented 757 newly diagnosed cases meeting the American College of Rheumatology criteria for gout during the follow-up period. Then, they determined the relative risk of incident gout for long-term coffee drinkers divided into 4 groups -- less than 1 cup per day, 1 to 3 cups per day, 4 to 5 cups per day, and 6 or more cups per day -- as well as for regular drinkers of decaffeinated coffee, tea, and other caffeinated beverages.

They also evaluated the impact of other risk factors for gout -- body mass index, history of hypertension, alcohol use, and a diet high in red meat and high-fat dairy foods among them -- on the association between coffee consumption and gout among the study participants.
Most significantly, the data revealed that the risk for developing gout decreased with increasing coffee consumption. The risk of gout was 40 percent lower for men who drank 4 to 5 cups a day and 59 percent lower for men who drank 6 or more cups a day than for men who never drank coffee.

There was also a modest inverse association with decaffeinated coffee consumption. These findings were independent of all other risk factors for gout. Tea drinking and total caffeine intake were both shown to have no effect on the incidence of gout among the subjects. On the mechanism of these findings, Dr. Choi speculates that components of coffee other than caffeine may be responsible for the beverage's gout-prevention benefits. Among the possibilities, coffee contains the phenol chlorogenic acid, a strong antioxidant.

While not prescribing 4 or more cups a day, this study can help individuals make an informed choice regarding coffee consumption. "Our findings are most directly generalizable to men age 40 years and older, the most gout-prevalent population, with no history of gout," Dr. Choi notes. "Given the potential influence of female hormones on the risk of gout in women and an increased role of dietary impact on uric acid levels among patients with existing gout, prospective studies of these populations would be valuable."

Quick Gou Facts

Here's How:
1. Typically, gout patients are about 95% men, 5% women. An initial attack of gout (50% of initial attacks involve the big toe) may last several days and disappear even if untreated. Subsequent attacks may not occur for weeks, months, years, or not at all. In severe cases, repeated attacks occurring over a long period may cause damage to the joints and loss of mobility. The big toe is eventually affected in 90% of cases. Knowing how to treat gout is important for preventing attacks.
2. Gout is often related to an inherited abnormality in the body to process uric acid. Uric acid levels can become elevated by eating alot of purine-rich foods such as meats, by the overproduction of uric acid by the body, or if the kidneys do not eliminate excess uric acid.
3. Treatment goals include terminating acute gout attacks, rapid and safe relief of pain and inflammation, preventing future attacks, and avoiding complications (formation of tophi, kidney stones, and joint destruction).
4. Though gout treatment is most often treated successfully and without complications, it becomes more of a challenge if other conditions exist along with gout or if there is poor patient compliance to recommended lifestyle changes or a medication regimen.
5. Dietary alterations are recommended, such as avoiding a purine-rich diet. Other preventive measures include maintaining adequate fluid intake, weight reduction, reduction in alcohol consumption, and medications to reduce hyperuricemia.

Who is affected by gout?

Approximately one million people in the United States suffer from attacks of gout. (Did you know that none other than Benjamin Franklin had terrible gouty arthritis!) Gout is nine times more common in men than in women. It predominantly attacks males after puberty, with a peak age of 75. In women, gout attacks usually occur after menopause.
While an elevated blood level of uric acid (hyperuricemia) may indicate an increased risk of gout, the relationship between hyperuricemia and gout is unclear. Many patients with hyperuricemia do not develop gout, while some patients with repeated gout attacks have normal or low blood uric acid levels. Among the male population in the United States, approximately ten percent have hyperuricemia. However, only a small portion of those with hyperuricemia will actually develop gout.

Gout

Gout generally appears in the form of short attacks, sometimes lasting for several days or weeks. Much like those with kidney stones, gout sufferers can be symptom-free for several years between attacks. Uric acid crystals are also responsible for one form of kidney stones. Gout can become chronic over time, which means the sufferer must take daily medications in order to prevent the onset of major symptoms and extreme pain.
Gout is usually treated through dietary changes and nonsteroidal anti-inflammatory drugs (NSAIDs). During a gout attack, physicians may inject prescription NSAIDs directly into the affected joint, along with a drug designed specifically to reduce the size of uric acid crystals. The use of aspirin for pain relief from gout is strongly discouraged. An over-the-counter NSAID such as Ibuprofen may take the edge off the pain, but will not mask it completely.
At one time in history, gout was viewed as a disease of the wealthy, since the foods which triggered it were primarily available to richer citizens. Research has since shown that the main culprit for the formation of gout is an organic substance called purine. Foods with high levels of purine, including organ meats, beans and red meats, contribute to the body's level of uric acid.

source- wisegeek.com

Gout Symptoms

The first symptom of gouty arthritis is typically the sudden onset of a hot, red, swollen joint. The most common joint involved is at the base of the big toe (podagra), but almost any joint can be involved. In some people, the acute pain is so intense that even a bed sheet on the joint causes pain.

Even without treatment, the first attacks stop spontaneously after 1-2 weeks. While the pain and swelling completely go away, gouty arthritis almost always returns in the same joint or in another joint.

With time, attacks of gouty arthritis occur more frequently and tend to last longer. While the first attacks usually involve only one or two joints, over time multiple joints can be involved simultaneously.

Kidney stones are more frequent in patients with gout.
Uric acid crystals can form outside joints. Collections of these crystals, known as tophi, can be found in the earlobe, elbow, and Achilles tendon (back of the ankle). Typically, these tophi are not painful but can be a valuable clue for the diagnosis.

Diagnosis

The diagnosis is generally made on a clinical basis, although tests are required to confirm the disease.
Hyperuricemia is a common feature; however, urate levels are not always raised.

Hyperuricemia is defined as a plasma urate (uric acid) level greater than 420 μmol/L (7.0 mg/dL) in males (or 380 μmol/L in females); however, high uric acid level does not necessarily mean a person will develop gout. Additionally, urate is within the normal range in up to two-thirds of cases.

If gout is suspected, the serum urate test should be repeated once the attack has subsided. Other blood tests commonly performed are full blood count, electrolytes, renal function and erythrocyte sedimentation rate (ESR). This serves mainly to exclude other causes of arthritis, most notably septic arthritis.

A definitive diagnosis of gout is from light microscopy of joint fluid aspirated from the joint (this test may be difficult to perform) to demonstrate intracellular monosodium urate crystals in synovial fluid polymorphonuclear leukocytes. The urate crystal is identified by strong negative bi-refringence under polarised microscopy, and their needle-like morphology. A trained observer does better in distinguishing them from other crystals.

In much the same way that carbohydrate-rich foods can negatively affect diabetics, foods high in purine can have a serious impact on those with a condition called gout. Gout is essentially a crystallization of excess uric acid not processed by the intestines and kidneys. These crystalline deposits tend to collect in the feet and other major joints, leaving the sufferer in a nearly-constant state of pain unless deposit-busting medications are prescribed. Gout was originally considered a disease of wealth, because only those who could afford a diet rich in purine seemed to contract it.
Today we know that foods high in purine are only one of several contributors to gout. Compromised kidney function or circulatory problems may also be factors. The standard medical advice for gout patients is to begin a diet with no more than 15% protein consumption per day. Not all meats have high levels of purine, but it is still better to restrict protein intake rather than risk temptation from the richer meats and proteins.
Some of the foods rated high in purine include the following: sweetbreads (internal organs), anchovies, sardines, canned liver, kidneys, hearts, meat extracts (broths and bouillon), gravies, and various canned seafoods. Other foods which contain slightly lower levels of purine include wild game and lentils. These are usually the items found on a typical do not eat list for gout patients. Other protein sources such as nuts or ground beef are limited to one serving per day.
As with other restrictive diets, the idea is to reduce the amount of a substance which cannot be naturally rendered harmless. Many healthy people can safely consume larger quantities of purine-rich foods with few problems. Those on high protein diets for weight loss are often encouraged to consume foods high in purine. As long as the body continues to flush away excess uric acid through the kidneys, high protein diets only increase the risk of developing gout, but do not cause the condition directly.
Eating excessive amounts of any foods, whether it be processed carbohydrates or purine, is rarely a good idea from a health perspective, but foods high in purine should be limited to an occasional treat, not a daily part of an average diet. source- wisegeek.com

Foods that cause Gout are...

In general, foods that cause gout are high in fat, which is why dietary recommendations for people with this kind of arthritis advise that less than 30% of their calories come from fat. Proteins with large concentrations of purines include meat and dairy products. Fish, like mackerel, sardines, oysters, mussels, and scallops, should be avoided, as well as red and white meat like poultry, pork, and beef. Sweetmeats, or organ meat, like kidney, heart, or liver, are especially bad for those suffering from gout. Even foods related to meat, like chicken or beef broth, caviar, and bouillon might produce high levels of uric acid.
Other foods that cause gout are dairy and vegetables, because they have lots of purines as well. High-fat dairy, like whole milk, ice cream, butter, and cheese, must be avoided in favor of low-fat dairy, or soy replacements. Spinach, mushrooms, cauliflower, peas, and asparagus have been shown to be rich in purines. In an unrelated food category, lentil beans and yeast increase one's chance of gout flaring up. For this reason, even beer and alcohol, because they are derived from yeast and grains, can increase the discomfort of gout.
Ingesting purines is not the only way to build up an unusually high concentration of uric acid, called hyperuricemia. Poor kidney function, since the kidneys filter out uric acid, works in conjunction with foods that cause gout. Thus, drinking plenty of water and eating tofu, olive oil, and nuts, actually seems to counteract weakened kidneys to eliminate uric acid from the bloodstream. A diet rich in complex carbohydrates, in the form of vegetables, fruits, and whole grains like bread and pasta, may ease the symptoms of gout. A doctor might combine these diet restrictions with anti-inflammatory medication and an overall weight loss plan.