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Last month I wrote an article about Gout. This will be a follow up to that article now focusing on aspects of management and treatment of this rather debilitating condition. The goals for treatment are to prevent and halt complications of the disease.
The complications of untreated of poorly treated gout include the following; gout tophi. Gout tophi are clumps of urate crystals that are hardened and form under the skin. They can also develop on the ears, cartilage and joints. They are usually painless. Other complications include joint deformities, formation of kidneys stones and kidney failure. Gout patients can also develop emotional and psychological stress related to having this chronic condition.
The management of gout is through non-medical and medical strategies. The non-medical strategies include weight loss. It has been shown that weight loss results in a decrease of the uric acid levels. It also results in a decrease in the number of flares.
Diet forms a very important component in the management of gout. There are certain food stuffs that must be restricted in order to decrease purines which eventually form uric acid. Some of the food that make gout worse are sugary drinks and sweets, high fructose corn syrup, organ meats such as liver and kidneys, game meat, red meats including beef, lamb, pork and bacon and certain sea foods.
They are certain foods that have been shown to have a beneficial effect in lowering uric acid levels and reducing gout flares. These include cherries, food that is rich in vitamin C like citrus fruits, fish and omega 3 fatty acid consumption as well as intake of coffee.
Chronic alcohol use has been shown to be associated with increased flare of gout, severe disease as well as development of tophi. People at risk or with established gout should reduce or ideally stop their intake of alcohol. In patients with well controlled uric acid levels who are on uric acid lowering treatment, the use of small amounts of alcohol is unlikely to trigger gout or cause disease progression.
The medical treatment of this condition can be complicated and often needs to be managed by a physician or rheumatologist. The medications are divided into those that manage acute flares and those that lower the uric acid chronically. The options for managing acute attacks include colchicine, non-steroidal anti-inflammatory drugs and steroids which can be taken per mouth or injected into the joints. They are several different classes of medications which can be used to lower uric acid in the long term, a commonly used one being allopurinol.
The management oof gout can be complicated and needs strict adherence to non-medical and medical strategies to avoid development of complications.