Call it the canary in the coal mine — or maybe a screaming eagle, to more aptly describe the pain. Identifying gout usually requires taking a patient’s medical history, conducting a physical exam and testing, Dr. Fields noted. A joint fluid analysis can detect the presence of monosodium urate crystals under a microscope.

Flares are typically treated with anti-inflammatory drugs and, in some cases, a cortisone injection in the affected joint. Medicine to lower uric acid levels, most commonly allopurinol, can prevent future flares, Dr. Fields noted, if a person is able to continue taking it. Medication side effects range from drowsiness and dizziness to joint pain, stiffness and swelling. 

Read the full article at aarp.org. 

If suddenly, your knee, ankle or big toe starts throbbing. It can be so sensitive that even touching the top of your bedspread is painful. After a night of suffering, you get out of bed, and your feet only feel worse. They’re throbbing, swollen, hot to the touch – and you can forget about putting your full weight onto it.

If any of these symptoms apply to you, there’s a heavy chance you suffer from gout.

Read the full article at usnews.com. 

Read the full article at huffpost.com. 

If you often find yourself sidelined by a sudden, throbbing pain in your joints, especially in your big toe, you may be suffering from a gout attack. Flare ups of this common type of arthritis can also cause the affected joint to feel swollen, tender and warm to the touch. 

“Gout is caused by an excess of uric acid in the body, which deposits in joints and causes intermittent episodes of inflammatory arthritis,” explained Dr. Fields. 

Uric acid is a waste product that the body creates when it breaks down chemicals called purines. These compounds are found in alcohol, high-sugar foods, red meat, turkey, certain seafood and high fructose corn syrup (as well as in some other foods). Everyone has uric acid in their body, but it’s when levels get too high that gout can be triggered. “If you have elevated uric acid, over time the blood carrying the uric acid ‘drops off’ some of the uric acid into the joints,” explained. Fields. “Gradually, the joints build up more and more uric acid. Ultimately, a person reaches a ‘critical level’ of uric acid in the joint, and then gets an ‘overflow’ of uric acid crystals into the joint fluid. Those crystals set off the inflammatory response we call a gout flare.”

While the joints are the most common place for uric acid to build up in gout patients, they aren’t the only spots. “Uric acid can deposit elsewhere in the body as part of the gout process, such as by having collections of uric acid form into kidney stones,” revealed Dr. Fields. “You can also get collections of uric acid felt below the skin, called tophi.” These are large bumps you can see and feel, though they usually aren’t painful. Common spots to develop tophi include the elbows, hands, feet, and the outer edge of the ear.

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The body makes uric acid when it breaks down purines found in the body, meat and some beverages. Hyperuricemia, an elevated level of uric acid in the blood, can lead to the formation of uric acid crystals in a joint, causing inflammation. People with gout also often have high levels of uric acid in their synovial fluid. However, hyperuricemia does not always cause gout.

Theodore R. Fields, MD, FACP,  rheumatologist at HSS who was not involved in the study, said the results illustrate more can be learned about the pathogenesis of gout.

“It makes sense that factors like lubricin deficiency might play a role in some patients, because we still have major gaps in our knowledge of why some patients get gout and others don’t, even when both have the same serum uric acid levels,” he said.

Read the full article at ustoday.news. 

Dr. Fields discussed stand out studies, including the MIRROR trial, a study pinpointing the role of lubricin deficiency in the pathogenesis of gout, and a Korean study that compared febuxostat and allopurinol treatment and the impact they had on adverse cardiovascular reactions. He went on to discuss regulatory news updates and issues that he hopes will be addressed in 2023, including continued education of the physician community about the patient benefit from an aggressive and targeted approach. 

Read the full article at rheumatologynetwork.com. 

Considered a type of arthritis, gout is very common, however “the thumb is quite an unusual place for gout to make its first appearance,” said Dr. Fields. Gout can occur in any joint in the body, but the most common spot for a first flare of gout is at the bunion joint of the big toe, followed by the mid-foot, then the ankle and the knee. “There’s some thought that gout in the lower extremity, and especially the big toe, may happen earlier than in other joints because of pressure from walking,” he explained. “In the first toe, it has been postulated that it being the coolest part of the body, you get more gout since we know that gout crystals are more likely to come out of solution in cooler temperatures.”

“For a flare of gout in the thumb, the treatment is similar to that of other sites of gout flares,” counseled Dr. Fields. Gout pain is generally treated in two ways: Medications to relieve gout attacks in the short-term; and preventive medications taken regularly to lower uric acid and stop gout attacks from occurring. Since gout in the thumb typically occurs later in the course of disease and is not the first sign of gout, it can be easily avoided if people seek medical attention for recurrent gout and adhere to their treatment, said Dr. Fields. If this is the case, people “will likely never get gout in the thumb, since their gout problem likely started in the foot or ankle and once on [medication like allopurinol] for a period of time gout almost always is ‘cured’ as long as the medication is continued.”

Read the full article at CreakyJoints.org.

People may be good candidates for an intravenous medication called pegloticase, which can dramatically lower uric acid levels over a short time. However, pegloticase is only effective about 40 percent of the time because many people form antibodies to it. This causes the medication to stop working for them or causes them to have reactions to it, explained Dr. Fields. At ACR this year, “a number of studies addressed a new strategy to prevent people from forming antibodies to pegloticase by using a medication with the pegloticase that suppresses antibody formation,” he continued. “These studies were small, but all suggested that the medications added to pegloticase all had a low risk of side effects during the treatment period, generally three to six months. All of them increased the effectiveness of the pegloticase.”

Read the full article at Creakyjoints.org.

To listen to episodes featuring Dr. Fields, visit Creakyjoints.org/thegoutshow/.

Researchers used ultrasounds to determine how common entheses abnormalities are among gout patients who were in the midst of a gout flare. Out of 31 participants, 22 had an abnormality in at least one enthesis — most often in the area where the quadriceps tendon connects to the patella in the knee.

HSS rheumatologist Theodore R. Fields, MD, FACP, who wasn’t involved in the study, commented on the findings, noting, “People with gout who get pain and swelling in the Achilles’ tendon, for example, may think it’s a tendon strain or other tendon injury, but there is a good chance it is a gout flare and will respond to gout treatment.”

Read the full article at Creakyjoints.org.

Dr. Fields explained the risk factors that affect both gout and COVID-19 such as obesity and cardiovascular disease, and suggested to work on improving any comorbidities that can make COVID-19 more risky. “Obesity is more common in gout patients [as overweight people produce more uric acid, which is what accumulates in the joints and triggers inflammation] than in the general population. There is evidence that obesity is also a risk factor for having more complications of COVID-19,” said Dr. Fields. Heart disease is more common in people with gout, and it is also linked with increased complications of COVID-19, he added, noting, “Elevated uric acid [in gout] may also raise blood pressure.”

Dr. Fields advised to not stop taking gout medications and also recommended exercise, prioritizing sleep, manage stress, and to also quit smoking and limit alcohol intake.

Read the full article at Creakyjoints.org.

CreakyJoints spoke to Theodore R. Fields, MD, FACP, rheumatologist at HSS, who explained, “Alcohol makes the uric acid be pulled back into the body, with less [expelled] in the urine. This leads to elevated blood levels of uric acid.” Dr. Fields added, “If you’ve been diagnosed with gout and are managing it with medication for the long term, occasional intake of high-purine foods, like red meat and shellfish, and a small amount of alcohol is generally okay. High quantities of any of these have a good chance of setting off gout flares, especially in the untreated patient or the patient early-on in the use of a medication such as allopurinol.”

Read the article at Creakyjoints.org.

CreakyJoints spoke to Theodore R. Fields, MD, FACP, rheumatologist at HSS, who explained the lack of symptoms during the first stage. “In this first stage of gout, the person has no joint pain, no red or swollen joints, just an elevated uric acid blood test,” said Dr. Fields. “This is the time that the uric acid, or urate, crystals are collecting in the joints and can cause inflammation later on,” he added.

In the second stage, otherwise known as acute gout, an unexpected attack might occur. “This is when the person has pain, redness, and swelling of a joint, most commonly in the big toe, the foot, the ankle or the knee, but gout can start in other joints as well,” cited Dr. Fields. “This is when the urate crystals are released into the joint fluid and cause an inflammatory reaction, bringing in many white blood cells and releasing inflammatory chemicals that cause the pain, redness, and swelling.”

Additionally, 75 percent of people will experience a second flare within a year, however some can go years before another attack. Dr. Fields cited this third, or in-between stage is where a person has had a gout flare but is presently not having any joint pain or swelling. “Almost all gout patients will go through this phase, since it is the nature of gout to have flares and then quiet down for a period of time before the next flare.”

The fourth stage is called “tophaceous gout” as uric acid deposits can form nodules called “tophi” develop at the big toe or at the elbow. “This stage is where a person can have some joint pain from gout just about all the time,” said Dr. Fields. “It usually takes many years of uncontrolled gout for someone to get into this stage,” he added.

“Anything that makes urate levels go suddenly up or down can set off gout,” said Dr. Fields. Factors include eating a diet high in purines (i.e., red meat and shell fish), alcohol, obesity, emotional or physical trauma. However, weight loss, diet and exercise, medications to limit the amount of uric acid the body produces, and treatments to calm gout flares, can aid with progression.

Dr. Fields concluded, “Treatments for gout are extremely good, and the vast majority of gout patients can expect to be ‘cured. ‘Cured’ is in quotes since it means that gout flares can completely disappear, but the person would need to stay on their medicine.”

Read the article at Creakyjoints.org.