Tips To Lower Uric Acid Levels In Joints
Higher than normal levels of uric acid can result in a condition called gout where the uric acid forms crystals in small joints. Elevated uric acid levels can also contribute to kidney stones and kidney failure, so its important to keep these in check.
Here are some tips to lower your uric acid levels in the bloodstream and joints in order to prevent health complications.
- Consume apple cider vinegar
What Are Gout Treatments And Home Remedies
When gout is mild, infrequent, and uncomplicated, it can be treated with diet and lifestyle changes. However, studies have shown that even the most rigorous diet does not lower the serum uric acid enough to control severe gout, and therefore medications are generally necessary. When attacks are frequent, uric acid kidney stones have occurred, tophi are present, or there is evidence of joint damage from gout attacks, medications are typically used to lower the uric acid blood level.
Medications for the treatment of gout generally fall into one of three categories: uric-acid-lowering medications, prophylactic medications , and rescue medications to provide immediate relief from gout pain.
Urate-lowering medications are the primary treatment for gout. These medications decrease the total amount of uric acid in the body and lower the serum uric acid level. For most patients, the goal of uric-acid-lowering medication is to achieve a serum uric acid level of less than 6 mg/dl. These medications also are effective treatments to decrease the size of tophi, with the ultimate goal of eradicating them. Uric-acid-lowering medications include allopurinol , febuxostat , probenecid, and pegloticase .
Gout home remedies
Home remedies for an acute gout attack include drinking plenty of water. Over-the-counter NSAIDs , such as ibuprofen and naproxen sodium , can be used when there are no contra-indications, such as decreased kidney function or stomach ulcers.
When Is Surgery Considered For Gout
The question of surgery for gout most commonly comes up when a patient has a large clump of urate crystals , which is causing problems. This may be if the tophus is on the bottom of the foot, and the person has difficulty walking on it, or on the side of the foot making it hard to wear shoes. An especially difficult problem is when the urate crystals inside the tophus break out to the skin surface. This then can allow bacteria a point of entry, which can lead to infection, which could even track back to the bone. Whenever possible, however, we try to avoid surgery to remove tophi. The problem is that the crystals are often extensive, and track back to the bone, so there is not a good healing surface once the tophus is removed. In some rare cases, such as when a tophus is infected or when its location is causing major disability, surgical removal may be considered.
Since it is hard to heal the skin after a tophus is removed, a skin graft may be needed. For this reason, we often try hard to manage the tophus medically. If we give high doses of medication to lower the urate level, such as allopurinol, over time the tophus will gradually reabsorb. In severe cases, we may consider using the intravenous medication pegloticase , since it lowers the urate level the most dramatically, and can lead to the fastest shrinkage of the tophus.
What Are Future Possible Treatments Of Gout
Fortunately, present medications are successful in the vast majority of gout patients. But some patients cannot tolerate our present arsenal of gout medications. For others, these agents are not sufficiently effective. Therefore, new treatments are continually being sought. Some of the more promising include anakinra, rilonacept, canakinumab, BCX4208 and arhalofenate.
Lowering Blood Levels Of Uric Acid
A high level of uric acid in the blood causes problems for people with gout and may increase the risk of kidney disease in people without gout. Lowering the level of uric acid in the blood helps dissolve deposits of uric acid in the tissues and prevent flare-ups.
People with gout who especially need their blood level of uric acid lowered include those who have the following:
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Frequent, severe flare-ups despite taking colchicine, an NSAID, or both
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Tophi that are found on examination
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Uric acid kidney stones
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Conditions that make NSAIDs or corticosteroids more complicated to take
People taking drugs to lower the blood level of uric acid should know their level, just as people with high blood pressure should know their blood pressure. The goal of drug therapy is to decrease the level to less than 6 milligrams per deciliter . If the blood level is maintained below 6 , uric acid will stop being deposited in the joints and in soft tissues, and the existing deposits will eventually dissolve, although this may take several years. Most tophi on the ears, hands, or feet shrink slowly when the uric acid level decreases to less than 6 milligrams per deciliter .
Febuxostat is another drug that lowers blood levels of uric acid. It is especially useful in patients who cannot take or have not been helped by allopurinol. As with allopurinol, flare-ups can occur as the uric acid level in the blood first decreases.
What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- dehydration
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
Who Is Most At Risk Of Gout
Some people are more susceptible to gout than others and there is often little correlation between the levels of uric acid in the blood and knee gout symptoms.
In fact, approximately 50% of people with gout do NOT have hyperuricemia, high uric acid levels.
There are a number of other factors that can predispose you to gout knee pain:
- Genetics: there is thought to be a genetic link inabout 20% of cases
- Age: most commonly affects people over 40 with the peakincidence at 75
- Obesity: especially rapid weight gain. A BMI greater than 35 increases the risk three times
- Diet: accounts for approximately 12% of cases. Risk factors include excessive alcohol intakeespecially binge drinking, fructose-based drinks and seafood
- Medical Conditions: Kidney disease and/or metabolism problems
- Drug Treatments: mostcommonly diuretics used to treat high blood pressure,heart failure and oedema
- Trauma: gout knee may develop after an injury or surgery
Gout knee can develop any time after puberty, although in women, ittends to be after the menopause. This is thought to be due to the positiveeffect of oestrogen until then.
Athlete Experiencing Arthritis Pain
Uric acid is a substance that is created when chemical compounds found in food, known as purines, break down and are dissolved into the blood.1 It is produced as a byproduct of protein digestion and typically excreted by the kidneys through urine.
But if the body produces too much uric acid or the kidneys dont eliminate enough of it, severe joint conditions may result.
Gout And Oawhats The Connection
A swollen, stiff knee might immediately lead you to suspect you have osteoarthritis , but the culprit could also be gout. Like many close relatives, the two conditions share common features. And because they often occur together, you might wonder which one is causing your symptoms.
Its definitely possible for people to have both conditions at the same time. Theyre the two most common types of arthritis, says Svetlana Krasnokutsky, MD, assistant professor of medicine in the Division of Rheumatology at NYU Langone Health. They can affect the same joints.
OA is a degenerative disease that gradually breaks down the cartilage that cushions bones. It causes pain, swelling, and stiffness in joints like the knees, hips, fingers, lower back, and neck. In gout, uric acid crystals build up in the joints. Gout often affects the big toe joint, but the ankles, knees, hands, and wrists can also be involved.
Knowing which condition you haveor whether youve got both gout and osteoarthritis can help your doctor fine-tune your treatment.
The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
What Else Should I Ask My Healthcare Provider About Gout
Consider asking your healthcare provider:
- What is causing the gout?
- Do I have any joint damage?
- What can I do to prevent future attacks?
- Can any gout medications help me?
- How long will I need to take gout medications?
A note from Cleveland Clinic
Gout is a painful form of arthritis. Extra uric acid in your body creates sharp crystals in the joints, leading to swelling and extreme tenderness. Gout usually starts in the big toe but can affect other joints. Gout is a treatable condition, and the uric acid level can be decreased by medication and lifestyle changes. Talk to your healthcare provider about medications that can reduce uric acid levels. They can also discuss changes you can make to your diet and lifestyle to prevent and reduce gout attacks.
Last reviewed by a Cleveland Clinic medical professional on 11/15/2020.
References
The Role Of Medication In Prevention Of Gout
Table 3: Medications to pevent attacks of gout
- Colchicine: to decrease the ability of uric acid crystals to cause inflammation.
- Allopurinol and febuxostat: to decrease production of uric acid
- Probenecid and lesinurad: to increase the excretion of uric acid
- Pegloticase: to increase the breakdown of uric acid
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Standard medications in preventing gout attacks
i. Colchicine : using the matches analogy discussed above1, using colchicine can be seen as dampening the uric acid matches. Colchicine does not lower the bodys store of uric acid, but it decreases the intensity of the bodys inflammatory reaction to these crystals. Recent studies have shown that at least one mechanism of colchicines action is by acting to prevent a cascade of reactions that lead to the production of interleukin 1-beta, which is an inflammatory protein , which is important in gouty inflammation.8
ii. Allopurinol: This agent is presently the most commonly used drug for the prevention of gout. Allopurinol blocks the enzyme xanthine oxidase, which blocks the breakdown of purines, thus decreasing the bodys total amount of uric acid. Allopurinol is effective in preventing gout no matter what the mechanism of the elevated uric acid was. Whether a person is making too much uric acid, or has difficulty excreting it via the kidney, allopurinols decrease in uric acid production leads to the same goal: a decreased total body uric acid.
Table 4: Reasons to use medication to lower uric acid
How Is It Diagnosed
The only way to diagnose gout with certainty is by your doctor finding urate crystals in fluid taken from your joint. Uric acid levels can be measured by blood tests, however these are not always accurate. Uric acid levels may be normal or even lowered during an attack of gout. Blood tests are most useful in ruling out other causes for your symptoms, such as joint infections or other forms of arthritis. X-rays are often normal in the early stages so are not very useful in diagnosing gout.
Arthritis In The Knee: What You Need To Know
Article Written by Rachel Nall RN BSN CCRNReviewed by William Morrison, MD | Featured on Medical News Today
Arthritis of the knee can make taking a step painful. Swelling, pain, and stiffness in the joint are just some of the symptoms that can occur when a person has this condition.
The knee joint is a hinge joint, named for its movement thats similar to the opening and closing of a door. The joint consists of three main bones. The areas where each of these bones meet are covered in a protective material called cartilage. Additional pieces of cartilage known as the meniscus further support the knee.
All of these protective pieces of cartilage keep the bones in the knee from rubbing together, which can be very painful. The daily demands on the knee and its potential for injury make it a common source for arthritis damage. Different types of arthritis exist, and the type determines which treatment a physician recommends.
How Does A Doctor Diagnose Gout
If you have sudden or severe pain in a joint, you should talk to your primary care provider . Your PCP may send you to a rheumatologist, a doctor who specializes in gout and other kinds of arthritis.
Healthcare providers consider several things when confirming gout:
- Symptoms: The provider will ask you to describe your symptoms, how often they happen and how long they last.
- Physical examination: Your provider will examine the affected joint to look for swelling, redness and warmth.
- Blood work: A test can measure the amount of uric acid in your blood.
- Imaging tests: You may have pictures taken of the affected joint with X-rays, an ultrasound or MRI.
- Aspiration: The provider may use a needle to pull fluid from the joint. Using a microscope, a team member can look for uric acid crystals or a different problem .
Causes Of Gout In Your Shoulder
An excess of uric acid in your bloodstream is thought to trigger gout by forming needle-shaped crystals that build up in your tissues and joints. Excess uric acid is technically known as hyperuricemia.
Uric acid is a waste product produced by the breakdown of purines, chemical compounds naturally present in your body. Uric acid is also produced when you digest foods containing purines.
Normally your kidneys remove uric acid waste via your urine. If your kidneys arent functioning properly, uric acid levels can build up in your bloodstream.
The crystals that form from this excess uric acid are attacked by your immune system as foreign bodies. Infection-fighting cells go to the area of the crystals, causing inflammation.
A of gout reports that only 10 percent of cases are caused by your bodys increased production of uric acid. The other 90 percent are caused by the failure of the kidneys to eliminate enough uric acid.
Causes Of Arthritis Of The Knee
Knee Pain, Pseudogout and Vitamin K2 Benefits â Prevent Gout with Vitamin K2 â Dr.BergEach type of arthritis in the knee has different causes. For example, osteoarthritis is considered a wear-and-tear condition. This means that use of the knee joint eventually wears out the cartilage and ligaments. Osteoarthritis usually affects those older than age 50 because it involves overuse.
Gouty arthritis may be linked to several causes. These include:
- Aging
- Family history of the condition
- Gender men more commonly have gout than women
- Obesity overweight people have more tissue that can be broken down into uric acid
- Certain medications
Doctors dont know exactly what causes rheumatoid arthritis. However, the condition seems to have a genetic component.
Post-traumatic arthritis occurs due to a previous injury to the knee joint. According to the Cleveland Clinic, an estimated 12 percent of patients with knee, hip, or ankle osteoarthritis have post-traumatic arthritis.
Signs Of High Uric Acid
When uric acid levels rise above normal in the bloodstream, they travel through the tissues and form crystal deposits in the joint spaces.The crystal deposits cause joint inflammation, swelling, limited range of motion and redness. The inflammation often occurs in the joint spaces of the large toe. Other areas of inflammation include the ankles, wrists, fingers and knees. Inflammation progresses quickly over a period of eight to 12 hours.A high uric acid buildup in the body is called gout, and when inflammation and pain develop, it is called a gouty arthritis attack.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
What Is High Uric Acid Level
Uric acid is a waste product found in blood. Its created when the body breaks down chemicals called purines. Most uric acid dissolves in the blood, passes through the kidneys and leaves the body in urine. Food and drinks high in purines also increase the level of uric acid. These include:
- Seafood
- Red meat
- Organ meats like liver
- Food and drinks with high fructose corn syrup, and alcohol
If too much uric acid stays in the body, a condition called hyperuricemia will occur. Hyperuricemia can cause crystals of uric acid to form. These crystals can settle in the joints and cause gout, a form of arthritis that can be very painful. They can also settle in the kidneys and form kidney stones.
If untreated, high uric acid levels may eventually lead to permanent bone, joint and tissue damage, kidney disease and heart disease. Research has also shown a link between high uric acid levels and type 2 diabetes, high blood pressure, and fatty liver disease.
What Triggers Gout
Something that causes a flare in one person might not do it in another. But common triggers include:
- Heavy alcohol use, especially drinking beer and hard liquor
- Foods high in purines, including red meat, organ meat , and some seafood, including shellfish
- Sugary sodas and foods with fructose, a type of sugar
- Some drugs used to treat high blood pressure, leg swelling, or heart failure
If you think something may trigger gout for you, talk to your doctor about ways to avoid it.
What Is Uric Acid
Uric acid is naturally developed in the human body. It is formed by the breakdown of the purines chemical, which is always presented in human tissue and also got from certain foods that we eat. Normally, uric acid dissolves in the blood and it carries through the kidneys. Finally, it becomes a waste product then passing out of the body via urine.
People Group Normal Uric Acid Range
Men 3.1-7.0 mg/dL
Can I Manage Gout
Although it cant be cured, gout can be managed effectively with medicine and lifestyle changes.
If your uric acid levels remain high after a gout attack, doctors may prescribe medication that can lower your levels. This can lessen your risk of long-term problems.
Self-care also is important if you have gout. A diet that avoids foods high in purine, high-fructose drinks, and alcohol can lessen your long-term risks. Losing weight also can lower your chances of gout. If you use medicines like diuretics, stopping that use can help prevent gout as well.
If you have a family history of gout or suspect you may have it, schedule an appointment with your doctor.
Can It Lead To Any Complications
If left unmanaged, gout-related inflammation can cause permanent damage to your knee joint, especially if you have frequent flare-ups.
Over time, lumps of uric acid crystals, called tophi, can also form around your knee. These lumps arent painful, but they can cause additional swelling and tenderness during a flare-up.
What To Do During An Attack
You should:
- take any medication you’ve been prescribed as early as possible after you notice an attack this should start to have an effect within two or three days
- rest and raise the limb
- avoid knocking or damaging the affected joint
- keep the joint cool remove surrounding clothing and apply an ice pack, such as a bag of frozen peas wrapped in a towel
- ensure you’re well hydrated
Apply the ice pack to your joint for around 20 minutes. Don’t apply ice directly to your skin and don’t apply it for more than 20 minutes at a time because this could damage the skin.
If necessary, you can keep reapplying an ice pack to your skin during an attack, but you should wait until your skin has returned to a normal temperature first.
Diagnosing Arthritis Of The Knee
What is gout arthritis? How does uric acid cause inflammation?Doctors diagnose knee arthritis through a physical exam, imaging studies, and lab testing. First, a doctor will review a persons medical history. Next, they will examine the knee by looking at it, touching it, and asking the person to walk on it . The doctor will look for signs of potential arthritis and injury. A doctor will look all over the body as some forms of arthritis often affect other areas of the body.
One consideration in diagnosing an arthritis type is where in the body a person experiences their arthritis. Some types of arthritis tend to only affect one knee while others usually affect both knees.
A doctor will also recommend imaging studies to look for changes in the knee joint. Examples could include an X-ray, computed tomography scan, or magnetic resonance imaging scan. The last two scan options help a doctor identify damage to the soft tissues surrounding the knee bones.
Lab tests for rheumatoid factor, an antibody often found in those with rheumatoid arthritis, can help a doctor confirm a diagnosis of rheumatoid arthritis. A doctor may also order a uric acid test for diagnosing gouty arthritis.
What Increases Your Chances For Gout
The following make it more likely that you will develop hyperuricemia, which causes gout:
- Being male
- Using certain medications, such as diuretics .
- Drinking alcohol. The risk of gout is greater as alcohol intake goes up.
- Eating or drinking food and drinks high in fructose .
- Having a diet high in purines, which the body breaks down into uric acid. Purine-rich foods include red meat, organ meat, and some kinds of seafood, such as anchovies, sardines, mussels, scallops, trout, and tuna.
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Foods To Limit Or Avoid
Cutting out or limiting foods that contain purines may help further reduce the amount of uric acid in the bloodstream and the risk of developing gout or experiencing gout flare-ups in the future.
Some foods rich in purines are the following:
- alcohol, especially beer and spirits
- certain meats, such as turkey, bacon, veal, liver, venison, and organ meats
- some types of fish and seafood, such as haddock, trout, scallops, , mussels, anchovies, sardines, and herring
Foods moderately high in purines include:
- beef
- avoiding extreme diets, especially diets low in carbohydrates and high in proteins
- eating a healthy diet that reduces the risk of diabetes, high blood pressure, and obesity, such as one that includes a lot of fruits, vegetables, nuts, and plant proteins
People with joint damage or tophi from gout may require surgery.
Treatment Of High And Low Levels
Certain foods contain purines, which create uric acid when the body breaks them down. Eating a diet that is too rich in purines can cause uric acid to build up in the blood.
It is not possible to avoid purines completely because small amounts are present in many foods. However, a person can follow a low purine diet and take other steps to help lower purine levels.
Foods that include moderate or high levels of purines include:
- alcohol
Home Remedies For Gout Pain In The Knee
- Cherries: Cherries have been touted as the most effective natural remedy for gouty arthritis. They are loaded with anthocyanins, which are potent anti-oxidants which help decrease inflammation and pain and also minimize gouty flare-ups to a very large extent.
- Ginger: Ginger is an excellent remedy for all kinds of inflammations and swellings. Gingerols in the ginger root help reduce inflammation and consequently pain; whats more, ginger will also help restore your range of motion.
- Water: Make sure you are well hydrated. Drink about 4 liters of fluid every day, with at least half of it being water. This prevents a buildup of urate crystals.
- Lime: Limes and lemons are known to prevent accumulation of uric acid in the joint and treat inflammations speedily.
- Steer clear of alcohol.
- Consume moderate amounts of protein, if possible from healthy sources, like, low-fat or fat-free dairy, eggs, soy and nut butters
- Restrict your everyday consumption of fish, meat and poultry to 4 ounces.
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