Tag: gout

Woman cradling her elbow and forearm with her opposite hand at a table

Elbow Pain: Several Common Causes and Treatment Options

On By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment
shutterstock_56557723Pain in the elbow is a common musculoskeletal complaint seen in the urgent care.  It can happen as a result of sports injury or trauma or can be symptoms of underlying infection, gout or bursitis.  Several causes are listed below: Elbow tendinopathy:  This is usually called golf or tennis elbow and is caused when then tendon, or strong band of tissue that connects muscles to bones is injured or inflamed.  The symptoms are pain, swelling and even weakness in the elbow. Olecranon bursitis:  A “bursa” is a small fluid-filled sac that sits near a bone.  Bursitis happens when the bursa gets irritated and swollen and can happen when a joint is moved over and over again in the same way over a short period of time.  It may also happen if the elbow sits on a hard surface or stays in a position that presses on the bursa for a long time. Nerve entrapment: The ulnar, median and radial nerves course in close proximity to the elbow.  Ulnar neuropathy is the most common compression neuropathy and it can cause sensory loss, pain and paresthesias over the ring and small fingers. Osteoarthritis:  Degenerative processes of the elbow are rare because it is non-weight bearing.  When present however osteoarthritis is usually related to prior fractures that involve the joint.  If there is an elbow deformity, we often think about underlying inflammatory arthritis. Radial head fracture:  Fracture of the radial head of the elbow most often occurs when the patient falls on an outstretched hand.  The radial head and neck make up the proximal portion of the radius.  Pain and swelling over the lateral elbow can be a sign of this type of fracture. Elbow dislocation:  Posterior elbow dislocation is the most common dislocation in children younger than 10 years of age and the second most common in adults, after shoulder dislocation.  Posterior elbow dislocations usually occur after a fall or a twisting injury to the elbow. Radial head subluxation (nursemaid’s elbow):  This is a common elbow injury in young children typically between 1-4 years old.  The mechanism of injury is sudden traction on the distal arm with the forearm pronated and the elbow extended.  A portion of the annular ligament of the patient’s elbow slips over the head of the radius and slides into the radiohumeral joint where it becomes trapped and causes pain.   The treatment is generally fairly easy by an experienced healthcare provider and the patient has immediate relief of pain when it is done properly. Gout:  Usually characterized by the sudden onset of severe elbow pain often with redness, swelling and tenderness.  There is no history of trauma.  It is caused from the uric acid crystals that develop in the joint (usually a single joint) and is less common in the elbow than the big toe. Treatment of elbow pain:  Identifying the cause of the patients elbow pain and treating that is the most efficient way to treat the patient’s pain.  Treatment may involve manipulation of the joint, using a shoulder sling and ice, or medication such as anti-inflammatories, and pain relievers, and possibly antibiotics.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Swollen, reddened big toe resting on a beige ottoman

Diagnosed With Gout? What It Means and How to Prevent Flares

On By Dr. Scott RennieIn Orthopedic/Musculoskeletal1 Comment
shutterstock_114066385At least once a week, I have patient who presents to the clinic due to pain from gout.  It is a painful condition that develops in some patients who have elevated levels of uric acid in their blood (hyperuricemia).  Up to 66% of patients who have elevated uric acid levels never develop symptoms.  We’re not sure why some people develop symptoms and others don’t have symptoms at all. Uric acid crystals most commonly affect one or multiple joints in the body, but may also cause uric acid crystals to develop within the kidney or urinary tract.  A stone within the kidney may cause impaired kidney function or pain.  Only 15% of people with gout develop kidney stones due to uric acid. Gout risk factors:  Gout is estimated to affect about 2% of the population in the USA.  It is most common in men between 30-45 and women between 55-70.  There is an increased risk of gout with the following: 1)   Taking medications that affect uric acid levels, such as diuretics 2)   Obesity 3)   Ingesting large amounts of meat or seafood 4)   High blood pressure 5)   Consuming high quantities of alcohol 6)   Overeating 7)   Recent surgery or injury Symptoms: 1)   Sudden severe joint pain (usually one joint), sometimes with redness and swelling 2)   Pain and inflammation are worst within several hours and improve over a few days to weeks completely even if untreated Gout phases: 1)   Acute gouty arthritis:  attacks usually involve the big toe or knee which become painful and inflamed 2)   Intercritical period:  The time between attacks.  Usually a second attack occurs within 2 years.  If uric acid levels are uncreated over several years the time between attacks may shorten or the symptoms may become more severe when attacks occur. 3)   Chronic tophaceous gout:  Large numbers of uric acid crystals may collect in joints, bones or cartilage and cause a nodule called a tophus to form.  This tophus is not usually tender, but cause erosion of bone and permanent deformity.  The tophi when the occur on the knuckles can cause an unfortunate cosmetic problem. Diagnosis:  Gout may be suspected if the person has the sudden onset of joint pain in the commonly affected joints such as the big toe.  If the patient has a period when there are no symptoms, and then symptoms return this is very typical of the disease.  The best way to diagnose gout is to examine fluid from the affected joint to look for uric acid crystals.  A medical provider uses a needle and syringe to withdraw a small sample of synovial fluid from the joint and this fluid is sent to the lab for microscopic analysis.  Other criteria for diagnosis gout may be: 1)   Blood testing showing high uric acid levels 2)   Rapid improvement of symptoms after the patient is treated with colchicine 3)   History of pain and inflammation involving one joint at a time, especially at the base of the large toe 4)   The symptoms totally go away between attacks Treatment:  The goals of gout treatment are to decrease the pain of a gout attack and also to reduce the frequency of their attacks.  Some of the treatment options are listed below: 1)   Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the swelling in the joint.  Examples of these are Ibuprofen or indomethacin.  They are most effective if started as soon as possible after the gout attack starts. 2)   Colchicine is a medication that may decrease the pain of a gout attack very rapidly. 3)   Steroids such as prednisone may be used if an NSAID is not used.  This type of medication can be injected directly into the affected joint or can be given as pills or intramuscular injection.  There is a risk of “rebound gout attack” as the steroids are stopped however, so usually steroids are slowly tapered over 7-10 days. Prevention therapy:  Some medications as well as dietary changes can be helpful to reduce the frequency of gout attacks. 1)   Uric acid lowering medications are used indefinitely because there is not a benefit from taking a break from the medications.  Examples of this are Probenacid, Losartan, and Allopurinol.  Rapid lowering of uric acid can cause a gout flare . 2)   Increased water intake – at least 2 liters/day are recommended Dietary changes:  Obesity is a major risk factor for gout so changing diet may decrease the frequency of gout attacks.  Current recommendations also include eating less of the following: 1)   Red meat 2)   Seafood 3)   Beer and hard alcohol (gin, vodka, etc.) 4)   Foods and drinks that contain high-fructose corn syrup (fond in some non-diet sodas for example) Some foods that may be good to eat or drink if you have gout may include: 1)   Low fat dairy 2)   Foods with complex carbohydrates such as whole grains, brown rice, oats and beans 3)   Vitamin C (500mg/day has been found to have a mild uric acid lowering affect). 4)   Coffee in moderation 5)   Wine in moderation – (1-2 5oz servings/day me be helpful) 6)   Pineapples – see my blog article about preventing gout by eating pineapples 7)   Drink plenty of water – twelve 8oz glasses of water during every day.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Can Eating Pineapple Help Treat Gout Pain Naturally?

On By Dr. Scott RennieIn Orthopedic/Musculoskeletal1 Comment

Gout is a common condition that happens when uric acid crystals build up inside the joints. The result is sudden, severe pain with swelling, redness, and loss of function. The joint at the base of the big toe is the one most often affected. Doctors call this podagra. But gout doesn’t stop there. I’ve seen it flare in the ankle, the wrist, the knee, and even the shoulder or hip. It can also involve the kidneys if crystals begin to form there, which can complicate the picture.

When someone has been diagnosed with gout, one of the first conversations is about diet. Certain foods can raise uric acid levels and set off an attack. Red meat, some seafood, beer, and drinks with high fructose corn syrup are well-known triggers (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2011). Patients often notice the pattern themselves after a few flares.

During an acute attack, the goal is relief. In the office, I’ll usually talk through standard treatment options. Nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen are often first line. Colchicine is another option, and in severe cases, a corticosteroid injection directly into the joint can bring fast relief (American College of Rheumatology, 2010). These treatments can be effective, but they aren’t without risk. Side effects, cost, and access are real considerations for many patients.

Some people ask about natural approaches. I’ve had patients report success with pineapple, which contains bromelain, an enzyme with anti-inflammatory properties. One patient told me that eating pineapple right after the onset of pain worked better for them than any pill. While that’s anecdotal, bromelain has been studied as a supplement and is available in capsule form as well (University of Maryland Medical Center, 2010). As with any supplement, I advise patients to check with their doctor before starting it.

Hydration is another piece of advice I return to often. Uric acid crystals form more easily in concentrated urine. Drinking water dilutes the urine and helps the kidneys flush uric acid more efficiently. The Arthritis Foundation has long recommended at least eight to twelve glasses of water a day for patients with gout (Arthritis Foundation, 2011). It’s a simple step but one that can make a difference.

Gout is painful, but with attention to triggers, thoughtful use of medications, and supportive measures like hydration, patients can reduce the frequency and severity of attacks.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources:

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Questions and Answers about Gout.” NIH, 2011.

  • American College of Rheumatology. “Gout Clinical Practice Guidelines.” ACR, 2010.

  • Arthritis Foundation. “Living with Gout: Lifestyle and Diet.” Arthritis Foundation, 2011.

  • University of Maryland Medical Center. “Bromelain.” UMMC Complementary and Alternative Medicine Guide, 2010.