What is gout? It is an inflammatory arthritis – some call it ‘gouty arthritis’ – caused by the formation of needle-like uric acid crystals in the joint. Gout is a rheumatic condition: a sudden inflammation of a joint that is accompanied by intensely painful, swelling joints (most often in the big toe or other part of the foot) and/or indication of gout by bouts of arthritis that come and go.

Gout is a painful and potentially disabling form of arthritis. People have long incorrectly linked it to the kind of overindulgence in food and wine. In fact, gout can affect anyone, and its risk factors vary. The first symptoms usually are intense episodes of painful swelling in single joints, most often in the feet, especially the big toe, but any joint can be involved. The inflammation occurs because uric acid crystals precipitate in the joints. The swollen site may be red and warm. The duration of a gout attack can vary from a few days to a few weeks.
Fortunately, it is possible to treat gout and reduce its very painful attacks by avoiding food and medication triggers and by taking drugs that can help. However, diagnosing gout can be hard and treatment plans often must be tailored for each person.

Gout is indicated as a risk factor for getting cardiovascular disease, certain lung diseases and a metabolic syndrome, if you have at least 3 of the following 4 conditions: high blood pressure, diabetes, high cholesterol and obesity. Gout is strongly linked to obesity, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides) and diabetes. Some conditions, such as sarcoidosis and those due to the use of certain drugs may also be associated with gout.

In the U.S. it is estimated that gout affects more than three million Americans.
Gout mainly occurs in men after 30 years, women after menopause, and people with kidney disease. In men under 30 years and in women before their menopause, the condition hardly occurs. Because of genetic factors, gout tends to run in some families and in younger patients familial factors play a role. Gout rarely affects children. If gout occurs at a young age, the pain symptoms are often more severe than in older people.

Cause of gout

Gout is a sudden inflammation of a joint that is accompanied by severe pain. The inflammation occurs because excess uric acid (a normal waste product) collects in the body and needle‐like uric acid crystals deposit in the joints. This may happen because either the uric acid production in your body increases or, more often, your kidneys cannot remove uric acid from your  body well enough anymore.

Uric acid
Uric acid is a normal waste product from our metabolism. Normally uric acid dissolves in the blood, after which you urinate about 10% through the kidneys and bladder. There is always some uric acid present in the blood as a by-product of the breakdown of nucleic acid in the cells, because the body constantly breaks down cells and forms new cells.
In people with gout, this metabolic process works a little differently, since they urinate less uric acid and thus retain more uric acid, giving them a higher level of uric acid in their blood. These uric acid crystals can attract white blood cells, leading to severe, painful gout attacks and chronic arthritis. Uric acid also can deposit in the urinary tract, causing kidney stones. So in most cases, the uric acid concentration in the blood becomes abnormally high when the kidneys can not excrete sufficient uric acid from the urine via the bladder. With these higher blood values, a high concentration of uric acid is formed in the tissues and joints, so that uric acid crystals are formed more easily, which can then suddenly provoke an inflammatory reaction. The immune system that is already activated by the higher uric acid concentrations sees these uric acid crystals as unnatural invaders and gets to work to clean them up via an inflammatory reaction. The painful inflammation that accompanies that is called an acute gout attack.

Cause increased uric acid content
too much in-house production and storage of uric acid. The reason for this may include: degradation of nucleic acid in the cells, use of certain drugs, kidney failure, thyroid gland (hypothyroidism) that is too slow and alcohol consumption.
drugs, that may raise uric acid levels and lead to gout attacks, include:
low-dose aspirin (but because aspirin can help protect against heart attacks and strokes, it is not recommended that people with gout stop taking low-dose aspirin) and low doses of salicylic acid (used in the manufacture of aspirin).
certain thiazide diuretics (‘water pills’), such as hydrochlorothiazide (Esidrix, Hydro‐D) and furosemide (Lasix).
immunosuppressants, used in organ transplants, such as cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf).
used in treatments against tuberculosis (TB) such as pyrazinamide (antibiotic) and ethambutol.
drugs used in the treatment of thrombosis, such as warfarin. 
use of nicotinic acida
(vitamin of the B complex, which is widely distributed in foods such as milk, wheat germ and meat and can be synthesized in the body from tryptophan).
nutrition (purine rich food) is responsible for only 10% of the uric acid level in the blood. The remaining 90% is determined by factors within the body. But if you already have a lot of uric acid in your body, a wrong diet can provoke an attack. Certain foods (such as shellfish, anchovies, asparagus, herring, mushrooms, mussels, organ meats, red meats, sardines, sweetbreads, sugary drinks and foods containing high amounts of fructose) contain a lot of purines. A diet rich in purines combined with alcohol in excess can make the situation even worse. Alcohol in excess causes an increase in the production of uric acid and hinders its excretion through the kidneys.
insufficient drainage of uric acid and accumulation in blood. The reason for this can be: reduced kidney function, certain drugs and alcohol use. Normally, the kidneys expel the uric acid through the urine, but if there is too much uric acid, it accumulates in the blood. The uric acid can then form crystals (very small granules) that get into the joint or along the tendons and cause a severe inflammation.

The uric acid crystals usually settle in the joint of the big toe. But gout can also occur in the foot, ankle, knee, finger, wrist or elbow. The crystals are most common in these joints because they are colder than other joints. A low body temperature promotes the formation of uric acid crystals.

Underlying condition
In a smaller number of cases gout is caused by an underlying condition. This is called ‘secondary gout‘. For example, the body can produce very large amounts of uric acid due to a hereditary enzyme abnormality or a disease such as blood cancer (leukemia), in which cells multiply and are rapidly broken down.

Hereditary factors may play a role in the development of gout.

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Complaints with gout

In case of a gout attack, you get a severe, acute pain in a swollen joint, which makes movement painfully difficult. The joint is red, swollen, warm and painful. You can hardly move the joint because of the pain. Almost always the skin around the joint is bright red and tightly stretched. Sometimes, especially with a large joint such as the knee, you also get some fever. Gout can occur in other joints, such as the foot, ankle, knee, finger, wrist and elbows, sometimes even in several joints at the same time. The latter especially if the gout has been active for some time. Your tendons and mucus fights may also be affected by gout. In 50 to 60% of the cases, the first attack of gout affects the big toe.
Gout can be limited to a single attack, but sometimes it evolves to chronic gout.

Chronic gout
A first attack usually lasts from a few days to three weeks. Afterwards, the complaints usually pass automatically, but not always. Two thirds of the people will receive a second attack within a year after the first gout attack. The gout attacks can follow each other faster and faster, last longer and spread to multiple joints. The number of joints, that become inflamed, can increase.

Gout can also develop slowly without any prior acute gout attacks. Your joints are thick, painful and stiff and this makes it appear as if you have osteoarthritis or rheumatoid arthritis (RA).

Tophi or gout nodules
After some time, you see thickening under the skin – so-called tophus or tophi or gout nodules – that can occur at the joints due to accumulations of uric acid crystals in the elbows, the fingers, the toes and the outer edge of the ear. The tophi are small or larger, usually white nodules with uric acid crystals. When the skin around a tophus breaks down, a thick, chalk-like substance comes out. Usually they are not painful.

High blood pressure and a higher risk of cardiovascular disease
People with chronic gout often have high blood pressure and a higher risk of cardiovascular disease. Why that is so, we do not know exactly yet, presumably it has to do with the inflammations in the body. Therefore, you should limit risk factors for cardiovascular disease such as smoking, high blood pressure, high cholesterol levels in the blood, diabetes and obesity. If you have gout in combination with a high blood pressure, that is bad for your kidneys. The kidneys can function worse because the uric acid clumps together into grit or kidney stones. Doctors are now better able to check whether their gout patients are at risk of a cardiovascular disease. It is not yet clear whether reducing the uric acid helps protect the heart and its vessels.

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Diagnosis of gout

Your doctor will base your diagnosis on a combination of the medical history, his findings and additional test results.

At the first visit, the doctor asks you a number of questions to get a good picture of your condition. You can think of the following questions:
– When did your complaints start?
– Can you describe your complaints?
– How are your working conditions?
– What medication do you use?
– Do rheumatic diseases occur in your family?
– What is your medical history?
– Are you under the treatment of other specialists and for what?

The diagnosis of gout can be made in several ways. Gout is often diagnosed upon the finding of uric acid based crystals. These crystals can also be found in the tophi, that can appear under the skin and occur in advanced gout. Some other kinds of arthritis can mimic gout, so proper diagnosis (detection) is key.

Gout is suspected when a patient has joint swelling and intense pain in one or two joints at first, followed by pain‐free times between attacks. Early gout attacks often start at night. Gout can also be diagnosed based on the pattern of joint involvement, characteristic symptoms, time course, blood and urine tests for uric acid and an X-ray.

Blood and urine tests
Certain abnormal blood values are important for the diagnosis of gout.
Sedimentation speed. Blood tests also measure the degree of inflammation through the sedimentation rate of the red blood cells. The erythrocyte sedimentation rate (ESR) is measured by a laboratory test. An erythrocyte sedimentation rate (ESR) test is also called a sedimentation rate test or sed rate test. The test measures the sedimentation rate of red blood cells (erythrocytes) through the speed at which the red blood cells settle, due to gravity, in an upright, narrow tube of blood. The upper part of the blood in the tube is the plasma, which becomes visible as a column of clear, yellowish liquid after the sedimentation of the red blood cells. The length of this column of plasma is measured after one hour and expressed in millimetres per hour (mm/hour). This blood test does not diagnose one specific condition. Instead, it helps your doctor to determine whether you are experiencing an inflammation. This can be the result of infections (bacteria, viruses), tumors and autoimmune diseases (such as arthritis). 
C-reactive protein (CRP) is a substance produced by the liver in response to inflammation. A high level of CRP in the blood is a marker of inflammation. It can be caused by a wide variety of conditions from infection to cancer.
Cholesterol: an increased uric acid level sometimes goes hand in hand with an increased cholesterol level.
Uric acid levels in the blood are important to measure, but can sometimes be misleading, especially if measured at the time of an acute attack. Levels may be normal for a short time or even low during attacks. People who do not have gout can also have increased uric acid levels.
Uric acid: your blood and sometimes your urine is tested for uric acid.
Kidney function: if your kidneys are not functioning properly or you are using diuretics, your uric acid may be increased.

X-ray examination
Occasionally gout nodules or joint damage can be seen on the X-ray. Ultrasound and dual energy CT can show early features of gouty joint involvement. X-rays may show joint damage in gout of long duration.

Joint function
Most people with gout have an increased uric acid level in the blood, but not everyone with an increased uric acid level has gout. The doctor may use a needle to extract fluid from an affected joint and will study that fluid under a microscope to find whether uric acid crystals are present.

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Treatment for gout

What works well for one person may not work well for another. Therefore decisions about when treatment should be started and which drugs should be used should be well considered for each patient. Treatments depend on kidney function, other health problems, personal preferences and other factors. 
Why does not everyone get uric acid inhibitors after one gout attack? After a single gout attack, it is probably not yet necessary to take an uric acid inhibitor daily for the rest of your life. If there is a 100% certain diagnosis by the discovery of uric acid crystals in a joint puncture, uric acid inhibitors are sometimes given at two gout attacks within a year.

Drug treatment
Drugs without a prescription
• For the pain you can get a simple painkiller with the active ingredient paracetamol without a prescription. Paracetamol helps against pain and fever, does not cause stomach problems, usually does not cause side effects and can be easily combined with other medications.
• An NSAID, an anti-inflammatory analgesic in a lower dose. The abbreviation NSAID stands for Non-Steroidal Anti-Inflammatory Drugs. These painkillers inhibit inflammation. NSAIDs, such as diclofenac, naproxen and ibuprofen, can be purchased without a prescription at a lower dose.

Do you have physical complaints? Always go to your doctor or specialist for a proper diagnosis and proper treatment.

Drugs on prescription
This is provided by your doctor or rheumatologist or internist.
For the treatment of acute attacks and chronic gout can be prescribed:
• An NSAID, an anti-inflammatory analgesic, such as naproxen, ibuprofen, meloxicam or indomethacin. The abbreviation NSAID stands for Non-Steroidal Anti-Inflammatory Drugs. These are drugs that are effective against inflammation, pain, stiffness and fever, but do not contain corticosteroids (steroids). They do not prevent joint damage. There is no proof that any one NSAID is better than others. NSAIDs, such as indomethacin (Indocin), naproxen (Naprosyn), ibuprofen or diclofenac have become the treatment choice for most acute attacks of gout. Your doctor will prescribe these prescription drugs with a higher dose of the active substance. High doses of short‐acting NSAIDs give the fastest relief of symptoms. Given in the correct dose and duration, these drugs give great relief for most patients. The NSAIDs may cause stomach upset, ulcers or diarrhea, but they are well tolerated by most people when used for the short term. Some people cannot take NSAIDs because of health conditions such as ulcer disease, impaired kidney function or the use of blood thinners.
Colchicine. Colchicine is a medicine to slow down and prevent joint inflammation and alleviate the pain. It is a treatment for active gout flares. This medicine can be effective if given early in the attack. However, colchicine can cause unpleasant side effects of the intestines, such as nausea, vomiting, diarrhea and other side effects, such as dizziness. Side effects may be less frequent with low doses. Contact your doctor if you have these symptoms. Patients with kidney or liver disease or who take drugs that interact (interfere) with colchicine, must take lower doses or use other medicines. Colchicine also has an important role in preventing gout attacks. Sometimes the doctor gives colchicine to stop joint inflammation.
If colchicine does not work or if you experience side effects, an injection with a corticosteroid (prednisone) may be an option. Such an injection works within 24 hours and inhibits the inflammation.
• A corticosteroid (an artificial adrenal cortex hormone) is a drug that resembles the natural hormone that the body produces in the adrenal cortex. In patients with chronic undertreated gout, urid acid crystals can be found in uric acid deposits (called tophi) that can damage joints and appear under the skin. Corticosteroids, such as prednisone, methylprednisolone, and triamcinolone, are useful options for patients who cannot take NSAIDs. Corticosteroids are anti-inflammatory drugs that suppress the immune response in the body and inflammation. A corticosteroid drug can be quickly effective for a joint swelling that is localized (not widespread) by an injection or shot into the effected joint or tendon sheath (the membrane around a tendon). Given orally (by mouth) or by injection (shot) into the muscle, these medicines can be very effective in treating gout attacks. If only one or two joints are involved, your doctor can inject a corticosteroid directly into your joint.
• A biologic DMARD (biologic inhibitor). A biologic is a drug that can affect your immune system. If you are healthy, the immune system itself produces enough antibodies to defend itself against pathogens (viruses and bacteria). This balance is disrupted in people with a chronic inflammatory disease. A biologic can restore that balance. The doctor may prescribe anakinra (Kineret), an ‘interleukin 1 beta antagonist‘, for very severe attacks of gout. Though this rheumatoid arthritis drug is not approved by the FDA in the U.S. for gout treatment, it can quickly relieve gout symptoms for some patients. In almost all cases, it is possible to successfully treat gout and bring a gradual end to attacks. Treatment also can decrease the number and size of tophi (deposits of uric acid crystals).
• A biosimilar. A biosimilar drug is a drug that is developed to be highly similar and clinically equivalent to an existing biologic. A biosimilar drug contains a version of an active substance of an already approved biologic drug (the ‘reference drug’ or ‘originator drug’). Similarity to the reference biologic in terms of quality, structural characteristics, biological activity, safety and efficacy must be established, so that there are no clinically meaningful differences from the biologic in terms of quality, safety and efficacy. Research has shown that the biosimilar is just as effective as the original biologic inhibitor in the treatment of arthritis.
Biosimilar drugs are not the same as generic drugs, which contain simpler chemical structures and are identical, in terms of molecular structure, to their reference drugs.

Treatment to remove excess uric acid
Patients who have repeated gout flares, abnormally high levels of blood uric acid, tophi or kidney stones should strongly consider drugs to lower blood uric acid levels with their doctor. These drugs do not help to soften or prevent the painful flares of acute gout, so most patients should start taking them after acute attacks subside. Gout flares often can occur when you first start to use drugs that lower blood uric acid levels. Patients can help prevent flares when starting to use these drugs by also using a low‐dose of colchicine or NSAIDs. Often, doctors advise patients to keep taking colchicine in a low, preventive dose together with the uric acid-lowering medicine for at least six months. If you are taking a uric acid-lowering drug, your doctor should slowly raise the dose and keep checking your blood uric acid levels. Once your uric acid levels drop below 6 mg/dL (normal), crystals tend to dissolve and new deposits of crystals can be prevented. You probably will have to stay on this medicine for a long term to prevent gout attacks. The drug most often used to return blood levels of uric acid to normal is allopurinol.
Allopurinol. Allopurinol (Lopurin, Zyloprim) is a uric acid production inhibitor. It blocks the conversion of purine to uric acid and therefore reduces the amount of uric acid in your blood. This uric acid lowering drug is mainly prescribed for chronic gout. If the seizures occur more often, it is important to address the underlying cause: the excess of uric acid. A gout attack can also temporarily worsen if you start with allopurinol, so you will also temporarily be prescribed colchicine during the first weeks. If the uric acid level in the blood has dropped to normal levels, there will be no more gout attacks, but you must continue taking the medication to keep the uric acid level in your body low.
Some patients are allergic to this drug or it is not effective or applicable in an individual patient. One in ten patients experience bowel or skin complaints of allopurinol. For them there is febuxostat, a newer uric acid lowering drug, with almost the same effect or benzbromarone.
Febuxostat. Febuxostat (Uloric) is prescribed if you can not (no longer) be treated with or do not respond to treatment with allopurinol and should not use benzbromarone due to a contra-indication. Febuxostat blocks the conversion of purine to uric acid, which reduces the uric acid level in your blood, but there must be detectable uric acid crystals present in the joints before using this medicine.
Benzbromarone. Sometimes allopurinol gives insufficient effect or too many side effects. Sometimes benzbromarone is given, a medication that causes you to urinate more uric acid. Benzbromarone increases the excretion of uric acid, but you can only use benzbromarone if you have good kidney function, because you have a high risk of getting kidney stones when used. You should drink enough water with this medicine to prevent the formation of grit and kidney stones.
Probenecid (Benemid) and Lesinurad (Zurampic) help the kidneys remove uric acid. Only patients with good kidney function, who do not overproduce uric acid, should take these therapies.
Pegloticase (Krystexxa) is given by injection and breaks down uric acid. This drug is for patients who do not respond to other treatments or cannot tolerate them. New drugs to lower uric acid levels and to treat gout inflammation are under development.

Use of drugs and adherence

• It is important that you take the drugs as prescribed. In order to get your illness under control, it is very important that you take your drugs on a regular basis every day. If you do not, there is no good concentration of the drug in your blood and therefore the drug will work less well.
• Do you have trouble remembering when and how many of your drugs you should take on a daily basis and at what time of the day? Then buy a drug dispenser, in which you can sort your drugs per day.
• Do you have difficulty or objection to taking the drug prescribed to you, for example because of possible side-effects? Then that can lead to you no longer taking the drug regularly. Discuss this with your doctor!

Deterioration of your illness and/or complications
The doctor will look at:
• The dosage and amount of drugs you use.
• Switching to another drug in the same type or a completely new type of drug.
• Combining different drugs at the same time.

Your doctor can tell you
• whether the drug can work for you.
• how you can best use the drug.
• how much and how often you can use the drug.
• how you can best reduce the drug.

You should always tell your doctor or specialist
• if you use other drugs (bought or prescribed by another doctor).
• if you have another medical condition.
• whether you will be operated on soon.
• if you have previously been prescribed an anti-inflammatory analgesic that has caused side-effects.
• whether you want to become pregnant or are pregnant.
• if you are breast-feeding.
This is important because your doctor or specialist has to make a careful choice between different drugs.

• All drugs may have side-effects when used, so ask your doctor or pharmacist what side-effects you can expect or read the leaflet.

Reduce or stop
• If you stop using a drug yourself or reduce the number of drugs yourself, your symptoms may worsen. Always consult your doctor or specialist first if you want to use less drugs or want to stop.

Alternative treatments

There are many types of alternative treatments. This refers to all treatments that fall outside normal scientific medical care. No scientific evidence has been provided for the operation of these treatments. The alternative treatments are also called ‘complementary‘ because they can supplement the regular medical treatment by your doctor.
Many people choose an alternative treatment in addition to their regular medical treatment. They hope that this helps extra against their complaints or better helps to deal with the complaints.

Can an alternative treatment be a replacement for your regular medical treatment?
No, if you opt for an alternative treatment method, it is always a supplement to your regular medical treatment. You should not stop your regular treatment, because otherwise you run unnecessary health risks. Always consult your attending doctor before you start an alternative treatment.

What alternative treatments are there for example?
There are many different alternative treatment methods available, which can also be combined. Some examples are:
• Chinese medicine (acupuncture, pressure point massage, nutrition and tai chi).
• homeopathy (products made from plants and minerals).
• Bowen therapy.
• Ayurveda.
• Bach flower treatment.
• shiatsu, foot-sole and classic massage.
• Touch for Health.
• Reiki.
• dietary supplements.

What do you have to pay attention to?
• Many alternative treatments have not shown that they actually work. If you choose to try alternative treatment, make sure that your complaints do not increase. Stop an alternative treatment as soon as your symptoms increase.
• Always consider first why you want to follow an alternative treatment.
• Prepare yourself by looking up and reading information about the alternative treatment. Consult with your attending doctor, because certain complaints may be reduced by some alternative treatment methods.
• Determine yourself in which alternative method you trust for the relief of your complaints and whether you want to start.

What can you do best when choosing an alternative treatment?
• Always consult your doctor about the alternative treatment method you want to follow.
• Consult with your attending doctor and with the alternative therapist if they want to discuss your treatment with each other.
• Choose an alternative therapist who has followed a recognized vocational training and is affiliated to a professional organization.
• Ask your alternative therapist in advance about the purpose, duration, costs and risks of the treatment. How much money you spend depends on which treatment you choose and how long it takes.
• Do not stop your regular medical treatment, as this may worsen your symptoms.
• Weigh during treatment whether you want to continue or stop if your symptoms get worse, if you do not notice any effect of the alternative treatment or if you get side-effects.

Why is your food important?

• Healthy nutrition is important to get the vitamins and minerals and other nutrients that your body needs.
• Obesity creates risks for your health and disease progression. In the case of arthritis and obesity, for example, obesity plays an important role in overburdening and osteoarthritis in the knees, hips and ankles. The pressure on your joints is then simply too great. Healthy eating and exercise (exercising a sport and active in the home and outdoors) can help to reduce or prevent excess weight.
• A healthy diet is always important and the dietitian can support you with the right dietary advice.

What is a healthy diet?
With a healthy diet your body gets the right amount of good nutrients, which it needs. You eat the quantities that your body needs. The dietitian can support you with the right nutritional advice.
The 5 courses to choose from are:
• Vegetables and fruit
• Bread, cereal products and potatoes
• Fish, legumes, meat, egg, nuts and dairy
• Lubrication and preparation fats
• Drinks

Where can you get advice for a healthy diet?
• You can request advice from your doctor or a dietitian. The doctor can refer you to a dietitian. Some diets may possibly help against your symptoms. Consult with your doctor or dietitian if you want to try a certain diet. And make sure that you do not omit important foods from your daily diet.

Some home remedies may help to ease the gout pain and reduce gout flares.
• Cherry products such as whole cherries or unsweetened cherry juice may reduce gout flares.
• A glass of skimmed milk daily may also help to lower uric acid over time and low‐fat dairy products may help lower uric acid levels.
• Limiting your alcohol intake and limiting meals with meats and fish rich in purines can also help control gout.
• Vegetables with purines appear to be safe to use as new research suggests.
But what you eat can also increase uric acid levels.
• Limit the amount of high-fructose drinks, such as non-diet soda.
• Also, do not drink alcohol, especially beer.
• Restrict eating foods that are rich in purines, compounds that break down into uric acid. These compounds are high in meat and certain types of seafood.

What can you do with a painful or dry mouth?
Sometimes you can suffer from a dry or painful mouth for various reasons, also due to your illness. Tips:
• by chewing (for example piece of cucumber, sugar-free candy or chewing gum) and sucking (ice cube) the salivary glands are stimulated to produce saliva.
• good oral care is important: good tooth brushing, flossing and the use of mouthwash.
• rinse your mouth regularly, drink small amounts of water and use a mouth sprayer if necessary.
• let hot drinks cool down first.
• use ice or cold dishes, because the cold numbs the pain.
• do not use sharp herbs and spices, fruit juice, carbonated soft drinks, alcoholic beverages, very salty foods and sour food.
• food with hard crusts, nuts, bones and bones can cause injuries.
• use soup, gravy or sauce with the hot meal to make the food smoother.
• spreadable cheese, spreadable paté or salad, jam or honey on bread, porridge, drinking breakfast and custard, for example, swallows easier than dry spreads.
• if you need to use ground or liquid food, you can use a mixer to grind your meal with some extra moisture.

In some forms of arthritis or use of certain drugs intestinal complaints can occur. The intestinal complaints can arise from the influence of certain drugs on food intake. Conversely, the food you eat can have an effect on the way your drugs work.

Dietary supplements, fish fatty acids, glucosamine and vitamin D?
• Dietary supplements are available as pills, powders, drops, capsules or drinks and are intended as a supplement to inadequate daily nutrition. They contain vitamins, minerals or bio-active substances. These synthetic or isolated vitamins, minerals or bio-active substances have the same effect as the vitamins and minerals that are already naturally in your food and drink.
Many people choose an additional supplement, in addition to their daily diet. The users of dietary supplements indicate that they experience positive effects of the use of certain herbs, vitamins and minerals. The body absorbs the nutrients in pills more easily than the nutrients in food. But if you eat healthy and varied, you do not need additional nutritional supplements, because you already get enough nutrients, minerals and vitamins. Always report to your doctor and pharmacist that you are using dietary supplements.
• Fish fatty acids appear to have a mild anti-inflammatory effect with a high intake. Research has been done especially in rheumatoid arthritis. The advice is to eat oily fish twice a week.
• Glucosamine can act as a mild painkiller for osteoarthritis in the knee, but does not stop arthritis.
• Our body naturally makes vitamin D under the influence of outdoor sunlight. Vitamin D may have a beneficial effect in inflammatory arthritis, but that has not yet been proven sufficiently. People with Lupus erythematosus get vitamin D prescribed as they are not often outside, because sun exposure can lead to lupus flares and skin problems. Vitamine D is given with calcium tablets to ensure a good intake in the body, when you have osteoporosis or osteoarthritis.

Living with gout

Gout affects your quality of life by both the intermittent attacks and the potential for chronic (lasting) arthritis. Lifestyle changes may make it easier to manage this disease.

Measures to cure or avoid and reduce the risk of a gout attack:
• when you have an attack of gout, raise the affected joint and cool it with a wet cloth or a piece of ice in a cloth.
• it is important to keep moving during a gout attack or if you do not have a gout attack. This prevents you from experiencing stiffness.
• drink 2 to 3 liters of water per day. This causes urination and more uric acid excretion.
• avoid the use of alcohol, especially beer.
• reduce your consumption of fructose‐containing drinks. The risk of a gout attack can be increased by fructose. Fructose is found in sugary soft drinks, biscuits, orange juice or sweets and so on. Light soft drinks and products without sugar, honey or fructose with sweetener, for example, do not have this effect.
• ensure sufficient intake of low-fat dairy products, such as milk. Some proteins in dairy products promote the excretion of uric acid, such as drinking coffee and eating sweet cherries.
• avoid foods high in purines. Be careful when eating protein-rich foods that contain a lot of purines and limit your meat and shellfish consumption. Vary your diet and ensure a healthy diet alongside your medication.
• go for a gradual weight loss. A weight loss of 5-10% already helps to improve your uric acid excretion. Ask for a referral to a dietitian for a healthy diet, in which you gradually lose weight.
• practice sports such as swimming, cycling or walking, that are good ways to keep moving and to maintain your fitness level. Later on you may be able to pick up a different, more taxing sport.

Osmosis I Gout - causes, symptoms, diagnosis, treatment, pathology

Medicurio I Gouty Arthritis (Gout) and Uric Acid

Sources videos
AstraZeneca I Gout Education Video I https://youtu.be/4edrfpzg9wQ
Osmosis I Gout – causes, symptoms, diagnosis, treatment, pathology I https://youtu.be/bznoU5bke4U
Medicurio I Gouty Arthritis (Gout) and Uric Acid I https://youtu.be/ojCiCcM2Wu4

Accountability text Gout
The information about gout is general.
Every situation is different, so if you have any questions or complaints, always consult your doctor, medical specialist or pharmacist.

Patient videos
The patient videos are provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

The Caribbean Arthritis Foundation does not provide medical advice, diagnosis or treatment!
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