DEAR MAYO CLINIC: Years ago, I had gout in my toe, but I didn't need medication other than ibuprofen. After it went away, I never had any other issues. But over the past few weeks, it has come back and is painful. Is there anything that I can do to reverse it at this point? What treatments are available?

ANSWER: Gout is a common form of inflammatory arthritis that can flare up quickly, causing intense pain. Successfully treating gout involves a combination of lifestyle changes and medication. Maintaining those changes over time can help keep gout at bay, and you may need to take medication long term, too.

Gout develops as a result of urate crystals building up in a joint. Those needle-like crystals form when you have high levels of uric acid in your blood. Your body produces uric acid as it breaks down purines — substances found naturally in the body, as well as in certain foods and beverages. Normally, uric acid dissolves in your blood and passes through your kidneys into the urine. But in some cases, your body makes too much uric acid, or your kidneys flush out too little uric acid, and it builds up to form urate crystals.

Although gout can affect any joint, it most often occurs at the base of the big toe. Symptoms include significant joint pain, swelling, tenderness and redness. Gout symptoms usually develop quickly, and they can linger from several days to several weeks.

There are steps you can take to ease gout symptoms and lower your risk of future flare-ups. First, assess your diet. To reduce your gout risk, eat fruits, vegetables, whole grains, and fat-free or low-fat milk products. Get your protein mainly from low-fat dairy products, which may have a protective effect against gout. Limit the amount of meat, fish, seafood and poultry that you eat.

Second, drink plenty of fluids: 8 to 16 cups, or about 2 to 4 liters, of fluid daily, with at least half of that water. Limit or avoid alcohol, especially beer, which can increase the risk of gout.

Third, exercise regularly and maintain a healthy weight. If you're overweight, your body makes more uric acid, and your kidneys have a harder time eliminating it. But even though losing weight may decrease uric acid levels, avoid fasting or rapid weight loss. That may temporarily raise uric acid levels and worsen gout symptoms.

Gout treatment also involves medication. An acute gout attack often can be managed with over-the-counter nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen. In severe cases, your health care provider may recommend a more powerful prescription NSAID, such as indomethacin or celecoxib.

Colchicine, a type of pain reliever that reduces gout pain, may be appropriate, too. Corticosteroid medications, such as prednisone, also may be used to control gout. Due to the potential for significant side effects, however, corticosteroids typically are recommended only for people who can't take NSAIDs or colchicine.

The overall goal of gout treatment is to reduce the level of uric acid in the blood to less than 6 milligrams per deciliter. In people with long-standing, aggressive disease, the target is less than 5 milligrams per deciliter. To achieve that, your health care provider may recommend a medication called allopurinol and adjust the dose over time until your blood uric acid level is at the goal. If you cannot tolerate allopurinol or if the allopurinol is not effective enough to achieve the blood uric acid goal, the medication febuxostat is an alternative. Once you've reached your goal blood uric acid level, you likely will need to continue taking allopurinol or febuxostat long term to prevent future gout attacks.

The specific type of gout medication that's right for you depends on your medical history and current health status. Your health care provider can work with you to decide what's best for your situation. — Dr. Ronald Butendieck Jr., Rheumatology, Mayo Clinic, Jacksonville, Florida

The post Mayo Clinic Q and A: Treating gout involves combination of lifestyle changes, medication appeared first on Mayo Clinic News Network.

THIS WEEK'S TOP TOPICS
Work-life balance: Tips to reclaim control 
There was a time when the boundaries between work and home were fairly clear. Today, work is likely to invade your personal life, and maintaining work-life balance can be a challenge. When your work life and personal life are out of balance, your stress level is likely to soar. But if you can learn to set limits and look after yourself, you can achieve the work-life balance that's best for you. Here are some strategies you can use to bring your life back into harmony.

Evaluating complementary and alternative medicine therapies
Complementary and alternative medicine treatments, from herbal remedies and dietary supplements to ancient healing systems and mind-body techniques, are growing in popularity. And thanks to increasing research, health care providers are better able to understand the role some of these complementary therapies can play in helping treat and prevent disease. But not all complementary and alternative medicine treatments have been studied well enough to know whether they're safe or effective. Here's what you need to know.

EXPERT ANSWERS
What are probiotics and prebiotics?
Probiotics are foods or supplements that contain live microorganisms intended to maintain or improve the "good" bacteria in the body. Prebiotics are foods that act as food for those "good" bacteria and improve the balance of these microorganisms. How can you include probiotics and prebiotics in your diet? Learn more from Katherine Zeratsky, a Mayo Clinic registered dietitian nutritionist.

Are ankle weights a good idea for fitness walking?
Although ankle weights can increase the energy you burn while walking, they may strain the ankle joints and leg muscles, which could increase your risk of injury. Learn about better ideas for adding to your walking workout from Dr. Edward Laskowski, a Mayo Clinic physical medicine and rehabilitation specialist and co-director of the Mayo Clinic Sports Medicine Center.

PLUS ADDITIONAL HIGHLIGHTS
Animal bites: First aid
Sun allergy
Gout
Cellulite

HEALTHY RECIPES
Sweet carrots
Tomato-basil pizza
Summer vegetable soup
Grilled snapper curry

HEALTH TIP OF THE WEEK
Do your sunglasses get the job done?
Sunglasses are more than a fashion statement. When you're shopping for shades, skip sunglasses that don't offer details about ultraviolent (UV) radiation protection. Instead look for sunglasses that block at least 99% of both UVA and UVB rays.

Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org. 

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The post Housecall: How balanced is your work-life balance? appeared first on Mayo Clinic News Network.

Other Mayo studies discussed at the conference chronicled a significant increase in gout; examined rare intestinal microbes in rheumatoid arthritis patients; and discovered that people with rheumatoid arthritis use opioid painkillers at a higher rate than the general public, but that it isn’t related to disease severity.

In the study on rheumatoid arthritis and heart disease, researchers looked at heart disease deaths within 10 years of rheumatoid arthritis diagnosis among two groups of people: 315 patients diagnosed with rheumatoid arthritis from 2000 to 2007 and 498 patients diagnosed with rheumatoid arthritis in the 1980s and 1990s. They also looked at heart disease deaths among 813 people without the rheumatic disease. Roughly two-thirds of patients studied were women, and the average age was 60.

They found a significantly lower rate of deaths from heart disease in the more recently diagnosed rheumatoid arthritis patients than in those diagnosed earlier: 2.8 percent and 7.9 percent, respectively.

Media contact: Sharon Theimer in Mayo Clinic Public Affairs, 507-284-5005 or newsbureau@mayo.edu.

The study also analyzed deaths among rheumatoid arthritis patients from a particular type of cardiovascular disease — coronary artery disease — and found those too declined in the 10 years after the patients studied were diagnosed with rheumatoid arthritis. Among the 2000-07 diagnosis group,  1.2 percent died of coronary artery disease, paralleling the general population, compared with 4.7 percent of those diagnosed with rheumatoid arthritis in the 1990s.

“More research is needed to confirm why heart disease deaths among rheumatoid arthritis patients have declined, but potential factors include earlier and more vigilant screening for heart problems, improved treatment for heart disease and rheumatoid arthritis, and in general, more attention to heart health in patients with rheumatoid arthritis,” says lead author Elena Myasoedova, M.D., Ph.D., a rheumatologist  at Mayo Clinic in Rochester, Minn.

Mayo Clinic has long studied the link between rheumatoid arthritis and heart disease to try to break it. As part of that effort, rheumatologists and cardiologists established Mayo’s Cardio-Rheumatology Clinic two years ago to pioneer new heart disease diagnostic, prevention and treatment tools for patients with rheumatoid arthritis and other rheumatic diseases.

Other Mayo research presented at the conference found:

• The incidence of gout has more than doubled in the past 20 years, and people with gout are likelier to have other serious diseases, such as high blood pressure, diabetes and kidney disease. In addition, people are now likelier to have gout in joint areas other than their big toes, which may make diagnosis more challenging.
• Rheumatoid arthritis patients have less diversity in their gut microbes than does the general population, and appear to have an abundance of certain gut bacteria whose numbers are rare in healthy people.
• Opioid medication use is significantly higher among rheumatoid arthritis patients than among others, and in general, isn’t related to disease severity. Rates of chronic opioid use are also higher in those with rheumatoid arthritis, particularly among younger patients and women.

Funding sources: Dr. Myasoedova’s study and the opioid study used the Rochester Epidemiology Project,  which is supported by National Institute on Aging award R01 AG034676 and National Institute of Arthritis and Musculoskeletal and Skin Diseases award R01 AR046849. The gout study used the NIH-funded Rochester Epidemiology Project and were also supported by National Center for Advancing Translational Sciences  Clinical and Translational Science Awards program grant UL1 TR000135. The gut bacteria study was funded by Mayo Clinic and Mayo's Center for Individualized Medicine.

Eric Matteson, M.D., chair of rheumatology at Mayo Clinic in Rochester and a co-author of the heart disease, gout, gut microbe and opioid use studies, made the following disclosures:  Novartis, Sanofi, Centocor-Jansen, Celgene, Amgen, Roche, Genentech, Mesoblast and Pfizer.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

The post Deaths From Heart Disease Declining Among Rheumatoid Arthritis Patients appeared first on Mayo Clinic News Network.

The chat, moderated by USA Today health reporter Liz Szabo, will cover symptoms, prevention and treatment of these painful and often debilitating diseases, plus coping techniques and promising research.

Participants include:

_ Mayo Clinic rheumatologists John Davis III, M.D.; Thomas Osborn, M.D.; and Steven Ytterberg, M.D.
_ The National Institutes of Health's National Institute of Arthritis and Musculoskeletal and Skin Diseases and National Center for Complementary and Alternative Medicine.
_ The American College of Rheumatology.
_ The Arthritis Foundation.
_ The Rheumatology Research Foundation.
_ The Centers for Disease Control and Prevention's Office on Smoking and Health.

Please tweet your questions and comments to #arthritischat.

The post What Are 3 Most Common Forms of Arthritis? Join #Arthritischat to Find Out appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC:

ANSWER: Gout is a form of arthritis that happens when sharp particles, called urate crystals, build up in a joint, causing severe pain, tenderness and swelling. As in your situation, treatment usually is not recommended after just one attack. But gout can come back. Being careful about what you eat may help prevent another gout flare-up. If it does come back, medication is available that can effectively control gout.

The urate crystals that lead to gout form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances found naturally in your body, as well as in certain foods. Uric acid usually dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either makes too much uric acid or your kidneys flush out too little uric acid. When this happens, gout is often the result.

Certain foods and beverages have been shown to increase the risk of gout attacks, including those that are rich in fructose, such as fruit-flavored drinks, non-diet soda and many processed foods. Seafood, fatty fish and red meat also are associated with increased risk of gout.

Drinking alcohol, especially beer, is a significant gout risk factor. Studies have suggested that drinking two or more beers a day can double the risk of a gout attack. So limit the amount of alcohol you drink, or avoid it completely.

One of the most helpful things you can do to prevent gout attacks is to stay at a healthy body weight. Research has shown that excess weight is a major risk factor for developing gout. If you are overweight, losing weight can lower uric acid levels in your body and significantly reduce your risk of gout attacks.

When it comes to the specific diet you should follow, traditionally it was thought that reducing all foods that contain purines could substantially decrease the risk of gout flares. However, managing a low-purine diet can be quite cumbersome, and the success of such a diet in lowering blood uric acid levels is actually quite low. Even if you strictly follow a low-purine diet, the amount it can decrease your blood uric acid level is rarely enough to cure gout.

Instead, a lower-calorie diet — one that replaces refined carbohydrates with more complex carbohydrates, limits meat, and increases vegetables and fruit — often can be much more effective at reducing blood uric acid levels than a low-purine diet.

Specifically, if you want to lower your risk of gout, eat fruits, vegetables, whole grains and fat-free or low-fat milk products. Get your protein mainly from low-fat dairy products, which may have a protective effect against gout. Limit the amount of meat, fish and poultry you eat to no more than 4 to 6 ounces a day. Drink 8 to 16 cups — about 2 to 4 liters — of fluid daily, with at least half of that being water.

If you have another gout attack, your doctor may recommend that you take medications. A drug called colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs) can be useful in reducing the symptoms of a gout attack. A group of drugs called xanthine oxidase inhibitors, including febuxostat and allopurinol, can help prevent future gout flare-ups. They work by causing the body to produce less uric acid.

These medications are often very effective in controlling gout. If you experience another episode of gout, talk to your doctor about your treatment options and which medications may be best for you. — Thomas Osborn, M.D., Rheumatology, Mayo Clinic, Rochester, Minn.

The post Tuesday Q & A: Paying attention to diet may help prevent gout flare-up appeared first on Mayo Clinic News Network.

Accurate diagnosis key because painful disease treated differently than other forms of arthritis

ROCHESTER, Minn. — March 25, 2014 — Gout is on the rise among U.S. men and women, and this piercingly painful and most common form of inflammatory arthritis is turning out to be more complicated than had been thought. The standard way to check for gout is by drawing fluid or tissue from an affected joint and looking for uric acid crystals, a test known as a needle aspiration. That usually works, but not always: In a new Mayo Clinic study, X-rays known as dual-energy CT scans found gout in one-third of patients whose aspirates tested negative for the disease. The CT scans allowed rheumatologists to diagnose gout and treat those patients with the proper medication.

The results are published in the Annals of the Rheumatic Diseases, the European League Against Rheumatism journal.

The study tested the usefulness of CT scans in finding uric acid crystals around joints across a wide spectrum of gout manifestations. The researchers found CT scans worked particularly well in detecting gout in patients who had experienced several gout-like flares but whose previous needle aspirates came back negative. After CT scans found what appeared to be uric acid crystals, ultrasound-guided aspirates were taken in those areas and tested for urate crystals.

“These were in part patients that had been falsely diagnosed with diseases like rheumatoid arthritis or labeled with a different type of inflammatory arthritis, resulting in a completely different and often not effective treatment approach,” says first author Tim Bongartz, M.D., a Mayo Clinic rheumatologist. “And there were patients who remained undiagnosed for several years with, for example, unexplained chronic elbow or Achilles tendinitis, where the CT scan then helped us to pick up uric acid deposits.”

The study isn’t meant to suggest that CT scans should be the first test used to look for gout, Dr. Bongartz says. Needle aspirates work well in most cases, and the research showed CT scans weren’t as effective a diagnostic tool among patients having their first gout flare-up, he says. In some of those acute gout cases, needle aspirates found uric acid crystals, but CT scans didn’t.

Five percent of adult African-Americans and 4 percent of whites in the U.S. have gout. The nation’s obesity epidemic is thought to be a factor behind the increase in gout cases.

Gout is often thought of as a man’s disease and associated with sudden sharp, burning pain in the big toe. It’s true that until middle age, more men than women get gout, but after menopause, women catch up in the statistics. And gout can hit more than the big toe: Other joints including parts of the feet, ankles, knees, fingers, wrists and elbows can be affected.

“The first flare of gout most commonly occurs in the big toe, but gout can affect pretty much every joint in the body, and the more gout flares you have the more likelihood that other joint areas will be affected,” Dr. Bongartz says.

An accurate and early gout diagnosis is crucial because gout patients are treated with different medication than people with other forms of inflammatory arthritis, and proper medication and dietary changes can help prevent further gout attacks and the spread of the disease to other joints.

“What we are learning from the dual-energy CT scans has really changed our perception of where gout can occur and how it can manifest,” Dr. Bongartz says. “The ability to visualize those deposits clearly broadens our perspective on gout.”

The study co-authors included researchers from Mayo Clinic radiology, rheumatology, orthopedic surgery, family medicine and biomedical statistics and informatics.

Financial disclosures: Siemens Medical Solutions provided software that was used on one of the systems involved in the study.  Senior author Cynthia McCollough, Ph.D., director of the CT Clinical Innovation Center at Mayo Clinic where the work was performed, is the recipient of a research grant from Siemens Medical Solutions. Co-author Katrina Glazebrook, M.B., Ch.B., received a travel grant from Siemens Medical Solutions.

Journalists: Sound bites from Dr. Bongartz are available in the downloads below. Click here to download the CT scan image on the right showing uric acid crystals in green.  Click here to download the CT scan image on the  left.

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About Mayo Clinic
Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, MayoClinic.org or https://newsnetwork.mayoclinic.org/.

MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, Email: newsbureau@mayo.edu

The post Gout Isn’t Always Easy to Prove: CT Scans Help Catch Cases Traditional Test Misses appeared first on Mayo Clinic News Network.

Join us Saturday, Feb. 22, at 9 a.m. CT, when we talk about men’s health.  We’ll discuss heart health with Stephen Kopecky, M.D., and prostate health with Matthew Tollefson, M.D., and we’ll talk with Thomas Osborn, M.D. about gout, a form of arthritis that affects an estimated 6 million Americans each year. Another important area regarding men’s health is testosterone. Endocrinologist Todd Nippoldt M.D., will be here to address testosterone deficiencies and testosterone therapy and respond to some of the media hype. We hope you’ll join us.

Myth or Matter of Fact: Higher testosterone levels cause baldness.

To listen to the program LIVE, click here.

Listen to this week’s Medical News Headlines: News Segment February 22, 2014 (right click MP3)

Mayo Clinic Radio is a weekly one-hour radio program highlighting health and medical information from Mayo Clinic. The show is taped for rebroadcast by some affiliates. On Twitter follow #MayoClinicRadio and tweet your questions.

The post MAYO CLINIC RADIO appeared first on Mayo Clinic News Network.

Join us Saturday, Feb. 22, at 9 a.m. CT, when we talk about men’s health.  We’ll discuss heart health with Stephen Kopecky, M.D., and prostate health with Matthew Tollefson, M.D., and we’ll talk with Thomas Osborn, M.D. about gout, a form of arthritis that affects an estimated 6 million Americans each year. Another important area regarding men’s health is testosterone. Endocrinologist Todd Nippoldt M.D., will be here to address testosterone deficiencies and testosterone therapy and respond to some of the media hype. We hope you’ll join us.

Myth or Matter of Fact: Higher testosterone levels cause baldness.

To listen to the program LIVE, click here.

For future topics, click on Upcoming Programs.

To listen to archived shows, click on Episodes.

If there is a topic you would like us to address, drop us a note.  Click here to create a guest account.

The post Men’s Health: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

In other findings, Mayo discovered a clue to why lupus tends to be worse in African-Americans, chronicled erratic blood pressure in rheumatoid arthritis patients found gout-like deposits in the joints of people with advanced osteoarthritis and examined why smoking doubles the risk of developing rheumatoid arthritis.

Read entire news release: EULAR61013

Journalists: Edited sound bites with Rheumatology chair at Mayo Clinic in Rochester, Minn., Eric Matteson, M.D., are in the downloads.

The post Big Toe Isn’t Biggest Culprit in Gout Flare-Ups; Other Joints Tied to Higher Risk appeared first on Mayo Clinic News Network.

"GOUT IS A FORM OF ARTHRITIS WHICH AFFECTS ONLY MEN."
This week's radio show is a previously aired program featuring Dr. Clem Michet and the topic is gout. We discuss risk factors, treatment, drugs and prevention.

Listen at http://radio.mayoclinic.org/ Saturday 9 - 10 am CST

Listen here for this week's Medical News Headlines. (right click for MP3)

Medical Edge Weekend is a weekly one-hour radio program that highlights health and medical information from Mayo Clinic specialists. Audio Demo 

The post FRIDAY MYTH OR MATTER-OF-FACT appeared first on Mayo Clinic News Network.