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Gout , Pseudogout & Joint Pain Everything You Need To Know Dr. Nabil Ebraheim
Dr. Ebraheim’s educational animated video describes the condition of gout and psuedogout arthritis and joint pain.
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Gout, Pseudogout, and Joint Pain
The most common joint affected by gout is the first metatarsophalangeal joint. The most common joint affected by pseudogout is the knee joint. Gout and pseudogout both show a sudden onset of pain, redness, and swelling typically affecting a single joint in 80% of the cases. Gout and pseudogout are similar problems with different causes. Gout is caused by the buildup of uric acid and the deposit of uric acid crystals inside a joint. The best test to diagnose gout is with a joint fluid analysis. Gout crystals are needle shaped and negatively bifringent. When placed under polarized light, they will be yellow. 90% of patients suffering from gout are men between the ages of 4060 years old. Gout symptoms and signs include joint pain, swelling and arthritis. Patients with gout have periarticular erosions along with the formation of uric acid soft tissue masses in and around the joint which can be seen on xray. Soft tissue tophus deposition with periarticular erosions “punchout” lesions. The tophi occurs due to deposition of uric acid crystals. The tophus aspirate may look like tooth paste. The sudden attack of gout can be brought on by anything that increases the level of uric acid in the blood such as: dehydration, increased consumption of alcohol, eating large amounts of meat or seafood, or trauma/surgery. Other risk factors for gout are obesity, hypertension, and diuretics. Red meats, seafood, liquor, beer, all increase the risk of gout. Vegetables, wine, dairy products, and total proteins do not increase the risk of gout. Aspiration and analysis of the joint fluid is the best method for diagnosis. Elevate uric acid is not diagnostic. 80% of people with elevated uric acid will not get a gouty attack. There are blood tests such as white blood cell count, Creactive protein, sedimentation rate, and uric acid level that are helpful in supporting the diagnosis if elevated, but if these levels are normal, it cannot definitively rule out gout or pseudogout. Every time you aspirate a joint and you get synovial fluid, you need to analyze it for cell count differential, find out if you have crystals or not and send the fluid for culture and sensitivity if you suspect infection. It might be difficult to differentiate an acute gouty attach from acute septic arthritis. Patients with an acute gouty arthritis may not have an elevated serum uric acid level. A patient with acute gouty arthritis may present with symptoms and a clinical picture that is similar to septic arthritis. Aspirate the joint fluid, and the joint fluid will look like pus, but it could be gout. The incidence of gout and associated septic arthritis of a joint is low (about 1.5%). The incidence of septic arthritis will increase to 11% or more if the cell count is more than 50,000. We aspirate the joint (aspirate will look cloudy, like pus). We look for crystals and if there is crystals, then it is gout, but the presence of uric acid crystals does not exclude septic arthritis. We look at the cell count (will be high, 50,000 or more). The neutrophil count may be 80% or more (we think there is an infection in addition to gout or maybe gout alone). We need to culture the fluid. After we aspirate the fluid and send the fluid for culture, then we give the patient empiric intravenous antibiotics pending the culture result. Remember that gout and septic arthritis can occur together, but the incidence is low. The incidence will increase significantly if the cell count is more than 50,000. Pseudogout or chondrocalcinosis is the deposition of calcium pyrophosphate dihydrate crystals in the hyaline cartilage or fibrocartilage (CPPD). Pseudogout is a metabolic disease where calcium pyrophosphate dehydrate crystals (CPPD) are formed within the joint space. Pseudogout most often affects the knee, occurs more in older patients, and is a calcification of fibrocartilage (chondrocalcinosis). Pseudogout crystals are rhomboid shaped and positively birefringent. Crystals will be blue when placed under polarized light. Associated conditions include hyperparathyroidism, rheumatoid arthritis, and gout. Aspirate to see if it is pseudogout or infection, because you do not want to inject the knee with steroids when there is an infection. You need to look for the rhomboid crystals of pseudogout. Xrays in pseudogout will show thin calcification in the articular cartilage or menisci. Calcifications of the synovium, tendon, and ligaments can also occur. Acute gout can be treated with indomethacin or colchicine if the patient cannot tolerate NSAIDs. Colchicine inhibits the inflammatory mediators and is indicated if the patient cannot tolerate indomethacin. Chronic gout can be treated with allopurinol to prevent buildup of uric acid.
The Link between Gout Heart Disease
In this recording, Malin Prupas, MD, FACP, Rheumatologist, discusses
the possible link between uric acid buildup which causes gout and cardiovascular disease. Gout is one of more than 100 different types of arthritis. Unfortunately gout is increasing in prevalence. Elevated uric acid levels result in a deposit of uric acid crystals in the joint which leads to an inflammatory response in the body that is extremely painful.
Tophaceous Gout, Hand
53yearold male with chronic pain, warmth, and swelling at the carpus, metacarpophalangeal, and interphalangeal joints of the right hand. The coronal T1 weighted images demonstrate circumscribed, T1 hypointense, soft tissue deposits with lobular margins most prominent at the radial aspect of the distal interphalangeal joint of the index finger where there are associated erosions along the cortical margins. There is additional involvement of the proximal interphalangeal joints of the index and long fingers as well as the metacarpophalangeal joint. The lesions are on the T2 and T1 axial images with heterogeneous enhancement. On radiography, numerous soft tissue calcific deposits are identified the sites with associated marginal osseous erosions. This is a case of tophaceous gout of of the hand. Gout falls in the classification of crystal arthropathy which includes other diseases such as calcium pyrophosphate, calcium oxalate, cholesterol, xanthine and cysteine deposition diseases. There is deposition of monosodium urate crystals both within and around joints. Typical cases arise in the greater than 40 years old with a strong male predilection. 15NMR253
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How to Get Relief from Gout Pain With Home Remedies?
How to Get Relief from Gout Pain With Home Remedies?
Along with any treatment for Gout, the dietary tips mentioned in the video will help you recover faster. For a complete treatment of Gout opt for our speciality treatment from Welling Homeopathy.
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How to reduce uric acid level and prevent Gout? Ms. Sushma Jaiswal
Uric acid is bi product of protein which needs to be eliminated.To eliminate uric acid from the body need to drink more water and take more vitamin c. To have good amount of vitamin c eat raw vegetables and fruits.You can take vitamin c supplements and cut down on meat. Drinking alcohol needs to be reduced to avoid dehydration.Do exercises and reduce weight.
Gout Pain Relief REMOVING WHITE CRYSTALS FROM A FOOT LET IT SNOW!!!
This patient has been suffering from painful joints in both feet due to multiple gout attacks over many years. He has had surgical treatment to have some of the foot joints scraped and cleaned to give him relief. Recently, his left 5th toe joint has been growing in size and giving him a lot of pain. Today, we will remove the uric acid crystal build up, gouty tophi, to give him some relief while he waits for further care with his orthopedic surgeon.
Bye bye white crystals…for now.
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10 Expert Tips on How to Fight Gout Attack
What is gout? This is basically joint inflammation in the ankle, wrist, elbow, knee, or (more often than not) in the big toe. It’s caused by high levels of uric acid in the blood, a condition called hyperuricemia. The intense pain it brings along can last for days, weeks, and even months on end! If left untreated, it can lead to joint deformities or even physical disability.
Like any health problem, gout doesn’t discriminate. It can affect anyone, including famous actors, athletes, and writers. In fact, Benjamin Franklin missed a lot of the meetings that were held to draft the Declaration of Independence because of gout!
What gout is 0:28
Get rid of excess weight 0:55
Check your family history 1:50
It occurs differently in men and women 2:07
Certain medications can trigger gout 2:40
Certain health conditions can increase the risk of developing gout 3:09
Change your diet 3:31
Eat more foods that can help you manage gout attacks and pain 4:44
Make use of natural remedies 6:52
Be careful about exercising 8:03
Some health warnings about using nonsteroidal antiinflammatory drugs 8:57
goatattack kneepain jointpain
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The body produces more insulin when people are overweight or obese. If you have high levels of insulin in your body, it slows down the elimination of the uric acid that causes gout.
Genetics also play a role here. If someone in your family has had gout, you do have a higher risk of getting it too.
Gout occurs differently in men and women. It’s the main cause of inflammatory arthritis for guys in their 30s and 40s, although men in their late 50s can also get it sometimes.
Medications like diuretics (or water pills), lowdose aspirin, immunosuppressants like cyclosporine and tacrolimus, as well as drugs containing salicylate have been found to trigger gout attacks.
Gout is historically known as the “disease of kings” or “the rich man’s disease” because it’s triggered by foods that only wealthy people could afford in the past: seafood and red meat.
Changing your diet doesn’t mean just cutting a bunch of bad foods out of it. Here are some products you should eat more of to prevent gout attacks.
When you’re under attack, doctors recommend staying in bed and putting ice on the affected area. You may lessen the pain by removing any clothes on the joint that’s flaring up.
Experts at the Centers for Disease Control and Prevention say that adults should be physically active for at least 2½ hours per week.
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Gout Diet Plan | Diet for High Uric Acid | English | Dr Tejas Limaye |
Gout Diet Plan | Diet for High Uric Acid | English | Dr Tejas Limaye |
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Sample Diet Plan For Gout (high uric acid)
High uric acid levels of gout is an extremely painful condition of joints (especially big toe). The diet (low in purine) has a major role in preventing uric acid buildup inside the body. Know what to eat, what to avoid with a sample diet plan.
GoutDiet DietforHighUricAcid uricaciddiet
What to eat
Milk and yogurt ,
low fat dairy foods ,
fresh vegetables and fruits ,
Vit C rich foods Orange, sweet lime , guava , Amla ,
coffee in moderation ,
berries strawberries , cherries , cranberries ,
12 16 glass of water , 34 list water ,
What to avoid
Sea foods ,
sweetened drinks , soft drinks , fruit juices ,
Oatmeal , lentils , wheat bran , wheat germ
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