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Gout

Gout is an intensely painful and disabling inflammatory form of arthritis. Gout is characterized by the sudden onset, often overnight, of severe joint pain, with redness, swelling and tenderness of the joint. The pain typically reaches peak intensity within 12 to 24 hours and usually resolves after a few days to a few weeks.Gout is an intensely painful and disabling inflammatory form of arthritis. Gout usually affects a single joint, but more than one joint may be affected simultaneously. The joint most commonly affected is the big toe, but the knee and other joints can be affected as well. An acute attack of gout usually resolves after a few days to a few weeks, but the condition can be chronic and recurrent. Gout develops in people who have a chronically elevated level of uric acid in their blood. It affects up to 4 percent of adults in the U.S. In men, it usually occurs between ages 30 and 45, and in women after age 55. The risk factors for gout include obesity; hypertension; kidney disease; excessive alcohol intake; and consumption of significant amounts of meat, seafood and high-fructose corn syrup.

Gout is characterized by the sudden onset, often overnight, of severe joint pain, with redness, swelling and tenderness of the joint. Movement is usually limited due to the pain, and affected individuals often keep their feet out of their bed sheets, as pressure from the fabric can elicit pain. Those with gout may be able to walk, but often only with a lot of pain. The pain typically reaches peak intensity within 12 to 24 hours and usually resolves after a few days to a few weeks. Many conditions other than gout can cause joint pain and inflammation, including infections, rheumatoid arthritis, pseudogout and inflammatory conditions. The definitive way to diagnose gout is to withdraw some joint fluid from the affected joint and look for the presence of uric acid crystals. However, gout can be tentatively diagnosed based on the individual's symptoms and a physical examination. The criteria for suspecting gout include rapidly developing pain and inflammation, initially involving one joint at a time, especially the joint at the base of the big toe; complete resolution of pain in between attacks; and a blood test showing elevated uric acid levels.

In case of an acute attack of gout, the goal is to reduce pain, inflammation and disability quickly and safely. Deciding which medication to use is usually based on a patient's risk of bleeding, kidney function, and response to previous treatments. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first-line treatment for patients without a history of stomach ulcers or kidney disease. Indomethacin, naproxen and ibuprofen have all proven effective at treating acute attacks of gout. Naproxen is considered the safest medication in terms of cardiac side effects. NSAIDs should be started as soon as possible after an attack's onset and should be continued for a day or two after the symptoms resolve. Side effects of NSAIDs can include peptic ulcer disease, abdominal pain, nausea and worsening kidney function. Colchicine may be used instead of an NSAID, as it does not increase the risk of ulcers and does not affect kidney function. Colchicine can be just as effective as NSAIDs if it's started early, but it does have some bothersome side effects at higher doses, including nausea, vomiting, diarrhea and abdominal pain. Corticosteroids — such as prednisone, prednisolone and methylprednisolone — may be used if NSAIDs or colchicine cannot be used. However, recurrence of gout is common after steroids are initiated, so steroids must be tapered over a period of 10 to 14 days. The side effects of steroids include increased appetite, insomnia, abdominal pain and hyperglycemia (high blood sugar).

Even if you have been diagnosed with gout or have suffered an acute attack of gout, you can probably safely engage in boating. However, if you are planning a prolonged boat voyage, be sure you have appropriate medications on board in case you experience an attack while you're at sea. If your doctor has prescribed a uric-acid–lowering drug on a long-term basis, be sure that you continue taking it while you're boating and that you also have with you appropriate medication for treating an acute attack. Bear in mind that NSAIDs are available over the counter only in the United States, as well as the fact that if colchicine or corticosteroids are appropriate for your situation, your physician needs to prescribe them prior to your departure. If you suffer an acute attack of gout while boating, be particularly careful while walking, as pain can limit your ambulation, which can make moving about on deck unsafe. Keep in mind, too, that a first-time attack of gout usually requires a thorough evaluation, as joint infections can look identical to gout. If your pain becomes intolerable, you are unsure of the diagnosis, or the possibility of joint infection exists, you may need to be evacuated to a location where you can receive expert emergency care.

Medications that lessen uric acid levels may help prevent attacks of gout. Such medications include allopurinal, probenecid, lesinurad and pegloticase. These drugs are not used to treat acute attacks, but rather to prevent them from occurring in the first place. Dietary changes may also lessen the frequency of attacks; foods high in compounds known as purines can increase uric acid levels. Weight loss has been shown to lessen the incidence of attacks as well. Patients with gout are encouraged to consume low-fat dairy products, foods made with complex carbohydrates (such as whole grains, brown rice and oats), coffee, foods high in vitamin C, cherries and moderate amounts of wine (while limiting their consumption of beer and hard liquor). And they are advised to avoid foods high in purines, such as organ meats, high-fructose corn syrup and alcohol. If you have suffered from gout, you should limit your serving sizes of beef, lamb and pork and decrease the amount of high-purine seafood you eat, such as sardines, shellfish and mackerel.


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