Md consult: gout: patient education
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What is gout?
Gout is a kind of arthritis caused by uric acid crystals forming in one or more joints. Uric acid is asubstance that forms when your body breaks down a substance called purines. This substance normallydissolves in your blood and passes through your kidneys into your urine. In people who have gout, uricacid builds up and can then form sharp crystals in the joint space. This causes pain and swelling in theaffected joints.
Who can develop gout?
If you eat a lot of foods that are rich in purines, you may be at an increased risk for gout. Some of thesefoods are salmon, sardines, organ meats, asparagus, mushrooms and herring.
You are more likely to develop gout if you’re overweight, drink excessive amounts of alcohol or have highcholesterol, diabetes or high blood pressure. Men develop gout more often than women. Women are morelikely to develop gout after menopause. Gout also tends to run in families (is hereditary).
Medicines that may cause gout include the following: Certain diuretics (“water pills”) used to treat high blood pressure
Cyclosporine (brand names: Sandimmune, Neoral), which is used to prevent the body from rejectinga new organ after transplant surgery Pyrazinamide, which is used to treat tuberculosis What is a gout attack like?
The symptoms of gout may be sudden. They usually start at night, often in the big toe joint (but can alsooccur in the joints of the feet, ankles, knees, hands and wrists). The affected joint becomes red, feels hotand hurts. The joint hurts more when you touch it.
What should I do if I have a gout attack?
You should rest in bed during an attack of gout. Putting an ice pack on the joint may ease the pain.
Keeping the weight of clothes or bedding off the joint can also help. Medicines that you can take without aprescription that reduce inflammation and pain may also help, such as aspirin or ibuprofen (one brandname: Motrin). Your doctor can also prescribe medicine for you.
The sooner you get treatment, the sooner the pain will go away. Your doctor can prescribe medicine tohelp stop the joint swelling and pain. With treatment, your gout attack should go away in a few days.
While having a gout attack, you should also reduce the amount of animal protein you eat and avoid alcoholcompletely.
What if I don’t get treatment?
If you don’t get treatment, a gout attack can last for days or even weeks. If you keep having more attacks,more joints may become affected, and the attacks will last longer.
If you have gout attacks for many years, you may develop tophi (say “toe-fee”). These are uric acidcrystals that form lumps under the skin. Tophi usually form on the toes, fingers, hands and elbows. Youmay also develop kidney disease or kidney stones from uric acid crystals that collect in the urinary tract.
Over time, even the bone around a joint may be destroyed by gout.
What can I do to avoid gout attacks?
Your doctor can prescribe medicines to prevent future gout attacks. These medicines can wash the uricacid from your joints, reduce swelling and decrease the amount of uric acid in your body.
You should lose weight if you are overweight. If you have high blood pressure, high cholesterol ordiabetes, you should get treatment for these conditions and follow a low-salt, low-fat diet.
Avoid alcohol and foods that are high in purines. Drink lots of water and other fluids, which can help flushuric acid from your body.
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0031-6997/04/5602-159 –159$7.00PHARMACOLOGICAL REVIEWSCopyright © 2004 by The American Society for Pharmacology and Experimental Therapeutics PharmGKB Update: II. CYP3A5, Cytochrome P450, Family 3, Subfamily A, Polypeptide 5 E. G. SCHUETZ, M. V. RELLING, S. KISHI, W. YANG, S. DAS, P. CHEN, E. H. COOK, G. L. ROSNER, C. H. PUI, J. G. BLANCO,M. J. EDICK, M. L. HANCOCK, N. J. WINICK, T.

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