Bone spurs can also form at the edges of the bones that make up your spinal column, called vertebrae. Bone spurs of the spine may not cause any symptoms and you can’t see them or feel them. But, if they grow large enough they can cause two spinal conditions. If they squeeze (compress) the spinal cord, they can cause a condition called spinal stenosis. If they squeeze the nerves leaving the spinal cord that go to your arms and legs, they can cause a condition called radiculopathy.

What causes spinal bone spurs?

By far, the most common cause of spinal bone spurs is osteoarthritis. Osteoarthritis is the most common cause of joint pain, stiffness, and swelling. It is often called “wear and tear” arthritis because it occurs over time. Joints are protected at their ends by cartilage. As cartilage wear down and thins out over years of use, bones start to rub on bones. The bones try to make more cartilage for protection, but this often results in overgrowth of bone called an osteophyte or bone spur.

Because osteoarthritis occurs over many years, it is most common in people over age 60. An injury to the spine can speed up the process. Other risk factors include being overweight, not getting enough exercise, and having bad posture. Having a job that requires years of lifting and bending may also be a risk.

What are the symptoms of spinal bone spurs?

Spinal bone spurs are common and most people do not have any symptoms, although they may show up on an x-ray. If they get large enough and cause spinal stenosis or radiculopathy symptoms occur. The most common areas for symptoms are the neck and lower back.

• Spinal stenosis of the lower back causes burning pain and aching in the lower back and buttocks. Pain may extend down into the legs and get worse with walking or standing. There may also be weakness and numbness in the legs. Spinal stenosis of the neck causes similar pain, but the weakness and numbness occur in the arms, hands, and fingers.
• Radiculopathy causes symptoms in the areas supplied by the nerves leaving the spine that become compressed by spinal bone spurs. Symptoms include sharp pain in the neck, shoulders, back, or legs. Pain gets worse with activity. There may also be weakness, numbness, or “pins and needles” sensations.

What is the treatment for bone spurs on the spine?

Home care may include ice, rest, and over-the-counter pain and inflammation medications called NSAIDs, like Advil or Motrin. Losing weight and staying active are also important. Physical therapy may be prescribed by a health care provider. When OTC meds and home care are not helping, injections of numbing and anti-inflammatory medications into the vertebral spaces may help. As a last resort, spinal bone spurs may be removed surgically.

Learn more about bone spurs on your feet.

Exercises for spinal bone spurs

Exercises that strengthen the spinal muscles and increase flexibility may reduce bone spur symptoms. These stretching and strengthening exercises can be started safely in physical therapy and continued at home. Losing weight, maintaining a healthy weight, maintaining good posture, and staying fit and active are the best ways to prevent spinal bone spur symptoms.

The post Bone Spurs on the Spine appeared first on University Health News.

By age 70, for about 40 percent of people, the knee joint cartilage has started to thin or wear away. Bones are grinding on bones, the joint space gets narrower, and symptoms of pain and stiffness start to be a problem. There is no cure for osteoarthritis and it tends to gets worse over time, but there are some effective treatments. For about 10 percent of people with knee osteoarthritis, knee injections are part of the treatment.

American Academy of Orthopedic Surgeons (AAOS) Treatment Guidelines

According to the AAOS, the first treatments for osteoarthritis should include physical therapy and home exercise, nonsteroidal anti-inflammatory drugs (NSAIDs), weight loss if needed, and low-impact aerobic exercise. These treatments are called non-invasive treatments because they do not involve any injections or surgery. They can be managed with your primary care doctor. Non-invasive treatments can’t reverse damage done by osteoarthritis or prevent damage from getting worse, but they can slow down the disease and relieve symptoms. For many people, this is enough to make the disease manageable.

NSAIDs can include both over-the-counter medications like Advil or Motrin, and prescription strength NSAIDs from your doctor. Physical therapy may include exercise, heat or cold applications, as well as massage or low-voltage transcutaneous electrical nerve stimulation (TENS) to reduce pain. Low-impact exercises reduce joint stress and can include swimming or walking.

There is not much evidence to support alternative treatments. Some studies suggest a role for acupuncture to reduce pain. There is less support for joint supplements like glucosamine and chondroitin. Although many people seem to get relief, studies suggest this is probably a placebo effect. Omega-3 fatty acids in fatty fish or fish oil supplements have better evidence than other supplements for relief of pain and improving function.

The Role of Knee Injections

Knee injections are invasive therapies, usually given by an orthopedic specialist. According to two 2022 studies presented at the annual meeting of Radiological Society of North America; people who had steroid knee injections had more progression of osteoarthritis on knee imaging studies than people who had no injections. Steroid knee injections were also associated with more progression than knee injections using a substance called hyaluronic acid. Steroids work by decreasing swelling in the knee, so they do relieve pain and improve movement. Hyaluronic acid is a lubricant that may help protect the remaining cartilage in the joint.

These new studies do not prove that steroid injections make knee osteoarthritis worse, and they are not the first studies to suggest that steroids may be linked to worse long-term outcomes. It may be that the patients who get steroid injections just have worse arthritis. According to AAOS guidelines, steroid injections are reserved for people who have significant changes on their knee x-rays, severe pain, and have not responded to non-invasive treatments.

AAOS guidelines say steroids should be used for severe pain and inflammation because most studies show that these injections reliably relieve pain and swelling. AAOS does not recommend hyaluronic acid as a first treatment for severe osteoarthritis because the research does not support it. AAOS also says steroid injections should be limited to three or four times per year to reduce the risk of worsening joint damage over time.

The Role of Knee Surgery

Knee replacement surgery is recommended when all other treatments are not helping. Advances in knee replacement surgery have made it one of the fastest growing surgical options, even in people under age 60. The main reason is that replacing the knee with a meatal and plastic joint takes the pain away and returns basic function. In the hands of an experienced orthopedic surgeon, these results benefits are very reliable, and can last from 15 to 25 years.

The post Knee Injections for Osteoarthritis Pain Relief appeared first on University Health News.

What is a Slipped Rib – Is My Rib Really Out of Place?

To understand how a rib slips and goes out of place, you have to know the anatomy of your ribs. Your rib cage protects your heart and lungs. Ribs attach to your spine and wrap around to attach to your chest bone (sternum). Your upper ribs attach directly to your sternum, but your eighth, ninth, and tenth ribs only attach to the rib above them by tissues called cartilage and ligament. These are called the false ribs.

Slipped rib occurs when a false rib develops a weak connection to the rib above it. The front tip of the rib curls and slips under the rib above it. A slipped rib can be very painful because it stretches the nerve that runs between the ribs called the intercostal nerve. Slipped rib pain may also cause pain due to stretching or tearing of cartilage or ligament tissue.

Slipped rib syndrome can happen to anybody, but is most common in middle-aged females. It may occur after a blow to the chest from a fall or contact sports injury. Motions like heavy lifting, pulling, throwing, or twisting may cause the rib to slip. It can also occur without any obvious trauma. It may be that some people are born with weaker connections between their false ribs, making them more moveable, called hypermobility.

Symptoms of Slipped Rib Syndrome

The most common way this syndrome starts is with sudden, one-sided, and intense pain in the lower chest, upper belly, or flank. The pain may start during an upper body movement and there may be a clicking or popping sound. There may or may not be a history of trauma to the chest. There may be a history of work, exercise, or sporting activity that has overused the chest muscles. The intense pain is usually followed by and aching pain and soreness. Intense pain may be triggered by turning in bed, lifting, pulling, or just getting out of a chair. Pressing over the rib also causes pain.

Diagnosis of Slipped Rib

The pain of slip rib syndrome can mimic many other chest or abdominal conditions including gall bladder disease, heartburn, pancreatitis, stomach ulcer, bronchitis, appendicitis, angina, kidney disease, or Tietze syndrome. Tietze syndrome is inflammation of the cartilage that attaches the upper rib to the sternum. Because many conditions mimic slipped rib syndrome, the diagnosis is often missed or delayed.

The diagnosis can be made with a physical exam, a diagnostic injection, or with an imaging study:

• During a physical exam the health care provider may press on the front of the ribs to see if the area is tender. A test called the hooking maneuver suggests a slipping rib. During this maneuver a health care provides slips fingers under the bottom of the rib cage and lifts it forward. This maneuver will cause pain and clicking from a slipped rib.
• Injecting a numbing medication into the area of the rib may be done to relieve pain and help with the diagnosis. If pain stops after the injection, it suggests slipped rib.
• Imaging studies like X-ray or CT scan often miss a slipped rib. The best imaging study is sound wave imaging (ultrasound) during movement, called dynamic ultrasound. This study detects slipped ribs in about 90 percent of cases.

Treatment of Slipped Rib

Slipped rib will often resolve on its own in a few weeks. Treatment may start with rest, avoiding any painful movements, heat or cold packs, and over-the counter pain relievers that reduce inflammation like Advil, Motrin, or Aleve.

If pain is severe, injecting a numbing medication with a steroid may help. Self-adjustment of a rib out of place is not recommended, but working with physical therapist and doing some physical therapy exercises at home may help. If all else fails, surgery may be done to remove the slipped rib.

The post What Is a Slipped Rib? appeared first on University Health News.

NCCIH says that about 9 to 10 percent of Americans use chiropractic care every year for relief of back or neck pain, headache, general wellness, disease prevention, energy, strengthening the immune system, and improving memory and concentration. Spinal manipulation of the neck or back is used mainly to treat low back pain, neck pain, and headache.

It is normal to have some increase in pain after spinal manipulation. According to the Mayo Clinic, side effects of spinal manipulation can include increased pain, fatigue, and headache. These side effects should not be severe or long-lasting. Although the risks from spinal manipulation by a trained and licensed chiropractor are low, complications can include damage to the disc between spine joints (herniated disc) or damage to nerves leaving the spinal column. These complications may cause longer-lasting pain, numbness, tingling, or weakness.

A very rare but very serious cause of pain and weakness after neck manipulation is a tear in one of the arteries that pass through the spine of the neck to supply the brain. A tear in one or more of these arteries can cause a stroke. This injury is called a cervical artery dissection. It may also be caused by a sports or whiplash injury that suddenly and forcefully moves the neck. The symptoms are sudden pain and loss of movement.

Should You Get Spinal Manipulation?

According to NCCIH, there is moderate evidence in studies to support spinal manipulation for low back pain and weak evidence for headache or neck pain. A review of 15 studies on spinal manipulation for low back pain, involving about 1,700 patients, found that spinal manipulation can give moderate relief to people with low back pain.

A review of 51 trials on spinal manipulation for neck pain, involving over 2,900 patients found that evidence for relief for neck pain was weak. A review of studies on spinal manipulation for headache rated the evidence of improvement to be low.

According to a 2020 review of alternative therapies for pain, published in the journal Advances in Therapy, there is a lack of evidence to support the use of spinal manipulation for migraine headaches, although over 50 percent of chiropractors use this treatment for migraines. This review also found that evidence for relief of neck pain was weak and that spinal manipulation was a poor choice compared to other therapies.

NCCIH says spinal manipulation has been studied for many other conditions including fibromyalgia, pediatric ear infections, COPD, bedwetting, menstrual pain, asthma, and high blood pressure without evidence of relief or improvement in these conditions.

Recommendation for Spinal Manipulation

The best evidence for the use of spinal manipulation is for low back pain. Clinical practice guidelines from the American College of Physicians recommend spinal manipulation as one of the options for treating low back pain.

NCCIH says this treatment is relatively safe when performed by a trained chiropractor, physical therapist, or osteopathic physician. The most common side effect is temporary pain and stiffness. If you see a chiropractor for back pain, you should tell your chiropractor about any medical conditions you have and any dietary supplements you take. Mayo Clinic advises against spinal manipulation if you have

• Severe osteoporosis
• Back or neck pain that includes tingling, numbness, or weakness
• Cancer in your spine
• A diagnoses of any type of spinal abnormality
• An increased risk of stroke

According to the CDC, common stroke risks include a previous stroke or transient ischemic attack, high blood pressure, high cholesterol, heart disease, diabetes, and obesity. Mayo Clin notes that spinal manipulation does not work for everyone, so if you do not see any improvement after several weeks, it might not be the best option for you.

The post Pain After Chiropractor Adjustment appeared first on University Health News.

Learn more about bone spurs on the spine.

What Causes Bone Spurs?

The most common cause of bone spurs is the wear and tear of a joint that comes with age. Over time, the protective coating over the end of bones – called cartilage – wears down. In an attempt to replace lost cartilage, bone thickens and may form a smooth, bony lump. Wear and tear of joint cartilage is called osteoarthritis, and bone spurs are most common in people with osteoarthritis. Younger people may also develop a bone spur if a joint is damaged by a joint injury or if they have a disease that causes joint swelling and irritation.

What Are the Symptoms of Bone Spurs?

Unless a bone spur obstructs the movement of a joint, or rubs against other tissues like bone, nerves, or tendons, there may be no symptoms. In fact, most people with bone spurs do not have symptoms. If you do have symptoms they may include:

• Aching pain that gets worse with activity and better with rest
• Swelling
• Tingling or numbness (pins and needles)
• Limited movement or stiffness

How Are Bone Spurs Diagnosed?

Your doctor may suspect a bone spur from your symptoms. Sometimes a bone spur can be felt under the skin. The best way to diagnose a bone spur is with an X-ray. Many people who have a bone spur without symptoms find out about it when they have an x-ray or other imaging study for another reason.

Home Remedies for Bone Spurs

Home remedies include rest, elevation, and icing to bring down swelling. Your doctor may recommend an over-the-counter medication to relieve pain and swelling called a nonsteroidal anti-inflammatory drug (NSAID). A painful bone spur in your foot may respond to wearing a padded insert in your shoe. Sometimes, a doctor will inject a steroid into a joint to reduce pain and swelling. A stiff joint may respond to physical therapy exercises. Losing weight may take some pressure off a bone spur and reduce symptoms.

Physical therapy may help relieve pain from stiff joints related to your bone spurs. ©Ivan-balvan | iStock / Getty Images Plus

Can Anything Dissolve Bone Spurs Naturally?

Although there are lots of supplements that claim to dissolve bone spurs, there is nothing that will make a bone spur go away. If you have a bone spur that is causing symptoms and has not responded to home remedies, the only treatment is surgical removal.

The post How to Get Rid of Bone Spurs on Your Feet appeared first on University Health News.

 Types of Arthritis Flares: Osteoarthritis | Rheumatoid Arthritis | Psoriatic Arthritis | Gout

According to the Arthritis Foundation, an arthritis flare is a period of increased disease activity that makes your symptoms worse. If you are taking medications to control your arthritis, they may not work as well during a flare. _[2]

Inflammatory Arthritis Versus Osteoarthritis

Knowing the type of arthritis, you have is the key to recognizing and managing a flare up. _[1,2] Osteoarthritis is the most common type of arthritis. It is caused by wear and tear of the cartilage linings of your joints. Since wear and tear takes time, this type occurs mostly in older people. It may be more common in a joint that you injured at some time. It causes pain, stiffness, and swelling, but not inflammation. _[3]

Inflammatory arthritis may be caused by a disorder of your immune system. Your immune system is your body’s defense system against foreign invaders like germs. If you have an immune system disease called an autoimmune disease, your immune system attacks normal body tissues, including your joints. The symptom of the attack is inflammation of tissue in around your joints. _[3]

Autoimmune inflammatory arthritis affects many joints all over your body at the same time. This is also called inflammatory polyarthritis. This type of arthritis is a long-term disease that is often diagnosed in young adults. Both rheumatoid arthritis and psoriatic arthritis are common types. Inflammation adds symptoms of redness and a feeling of warmth to affected joints along with pain and swelling.  _[3]

Gout is also an inflammatory type of arthritis, but it is not caused by autoimmune disease. It is caused by your body producing too much of a substance called uric acid, or your kidneys not removing enough uric acid from your blood. Normally you make uric acid to break down proteins that you eat. Too much uric acid in your blood acid can leak into your joints and form sharp crystals. When this happens, you have a gout attack with symptoms that include severe pain, warmth, redness, swelling, and stiffness. _[1,2,4]

Osteoarthritis Flare Up

An osteoarthritis flare up is usually caused by overusing or injuring an affected joint. This can happen with repeated movements or activity not interrupted by rest. _[1,2] It can be hard to tell a flare up from worsening of the arthritis that occurs over time. Symptoms may include increased pain, swelling, and stiffness. Less common flare triggers include cold weather and gaining weight. _[2] If you have a fare up, try warm heat to relieve pain and swelling, along with rest and an over-the-counter pain reliever. _[1]

Rheumatoid Arthritis Flare Up

Because rheumatoid arthritis always causes a low level of inflammation, flares are common and sometimes occur without a trigger. _[1,5] Symptoms of a flare may include increased pain, swelling, and stiffness. Because rheumatoid arthritis also affects the rest of your body, you may also have fever, fatigue, and weight loss. _[6]

A common cause of a flare is decreasing your anti-inflammatory medication or missing a dose. _[2] Other triggers include physical or mental stress, changes in the weather, exertion, lack of sleep, or an infection like the flu, an upper respiratory infection, or urinary tract infection. _[1,2,5,6]

A rheumatoid arthritis flare may last hours, days, or weeks. A flare that lasts more than a week should be reported to your doctor. Your doctor may need to add on a mechation like a steroid, or change your current medications. To manage a flare, you should alternate rest with some gentle activity to keep your joints moving. Take your usual anti-inflammatory medicines as prescribed. _[6] A cold compress over a sore joint may reduce pain and swelling. _[1]

Psoriatic Arthritis Flare

Psoriatic arthritis is inflammation that can affect both your joints and your skin. Many people may notice a flare of psoriasis before they get increased joint symptoms. Triggers for a flare may include stress, an injury to the skin, a medication reaction, allergic reaction, a change in diet, drinking alcohol, or smoking, as well as changes in the weather. Bacterial infections, especially a strep throat, are another common trigger. _[2] Like other inflammatory arthritis flares symptoms can include swelling, pain, fever, and fatigue. Home care is similar as rheumatoid arthritis. _[6]

Gout Flare Up

Gout symptoms almost always come as a sudden flare up. The most common trigger is eating too much of a protein food that is high in purines. Purines are molecules in proteins. Foods that trigger gout attacks include shellfish and other seafood, beer, red meat, liver, and foods that contain the sugar fructose. You may be able to avoid a got flare up by avoiding high-purine foods. _[1,2]

Gout flare ups occur suddenly, usually at night. The pain, redness, swelling, and stiffness of a gout attack may often affect your big toe. It can also affect the joints of your arms or legs. Injuring a joint, like stubbing your toe, can trigger an attack. _[4]

A gout attack usually peaks at about 12 hours and gradually gets better. To manage a gout attack, rest your joint. You should also call your doctor, because there are medications especially used to treat a gout attack. You can take an over-the-counter nonsteroidal anti-inflammatory medication (NSAID) and use a cold compress on the effected joint. _[1,4]

How Long Does an Arthritis Flare Last?

The length and severity of an arthritis flare is unpredictable and differs from person to person. Different people may also have different triggers for their flares. The best advice is to listen to your body and become aware of your flare triggers. _[5] It may help to keep a flare diary and work with your doctor to developing a flare management plan. Avoid treating a flare a supplement, unless you talk to your doctor first. _[1] If you are having frequent flares or a severe flare that is not responding to your usual home care, call your doctor. Sometime a flare needs medical treatment to prevent permanent joint damage. _[1,2,5]

Sources

1. Houston Methodist Hospitals, What Makes Arthritis Flare Up? Rheumatoid Arthritis, Osteoarthritis & Gout: What Causes Arthritis Flare-Ups | Houston Methodist On Health
2. Arthritis Foundation, What Triggers an Arthritis Flare? What Triggers an Arthritis Flare? | Arthritis Foundation
3. Hospital for Special Surgery, Inflammatory Arthritis, Inflammatory Arthritis: Rheumatoid & Reactive, Gout & More (hss.edu)
4. Mayo Clinic, Gout, Gout – Symptoms and causes – Mayo Clinic
5. Arthritis Foundation, Understanding Rheumatoid Arthritis Flares, Understanding Rheumatoid Arthritis Flares | Arthritis Foundation
6. Oxford University Hospitals, FAQ about managing a flare – Rheumatology (ouh.nhs.uk)

The post Arthritis Flare Ups: Why Flares Happen and How Long They Last appeared first on University Health News.

Osteoporosis causes your bones to become thin, weak, and brittle. Osteoporosis is a common cause of fractures that can lead to disability. A fractured hip or wrist may be the first sign of osteoporosis. Osteoporosis is five times more common in women than men. The reason is the female hormone estrogen. Estrogen helps prevent bone loss in women. But when estrogen starts to drop around the time of menopause, there is a rapid loss of bone that lasts about three years. [2]

The most common bone density test is called a DEXA scan. This test is a painless imaging study that scans your bones while you lay still for several minutes. Radiation exposure from the test is less than a chest x-ray. [2] DXA usually measure bone density in your hip and lower spine. Other bone density tests measure density of your arm, wrist, finger, or heel. These tests can’t diagnose osteoporosis, but they can suggest the need for a DXA scan if they are abnormal. [1]

What Is a T-Score?

Osteopenia (middle) and osteoporosis (right) occur when we lose more bone than we are able to make during normal bone remodeling as we age.

DXA reports your results as a T-score. Your bone density is compared to the normal bone density of a healthy young adult. Differences between your bone density and the normal density is measured in units called standard deviations: [1]

• A T-score of 0 means your score is the same as the healthy adult.
• A T-score 1 unit below normal (-1) is still considered within the normal range.
• A T-score between 1 and 2.5 units below normal (-1 to -2.5) is low bone mass, also called osteopenia.
• A T-score more than 2.5 units below normal (-2.5) means osteoporosis and an increased risk for bone fracture.

Who Should Get a DXA Scan?

DXA testing is recommended for all women age 65 and older. If you are postmenopausal, but under age 65, bone density testing may be recommended if you have risk factors for osteoporosis. These risk factors include: [2]

• A history of a bone fracture due to fragile bone
• A diagnosis of rheumatoid arthritis
• Body weight less than 127 pounds
• A history of smoking or alcohol abuse
• A history of hip fracture in a parent

If you have a normal DXA scan, you do not need to have another scan for up to 15 years. If you have an abnormal scan, your doctor may order testing more frequently to check for more bone loss. [2]

Do Men Need Bone Density Testing?

There is not enough evidence to recommend routine bone density testing in men. [1] Although osteoporosis is thought of as a woman’ disease, it can also occur in men, especially men over age 70. Just like women, the first sign in men may be a bone fracture of the hip, wrist, or spine. Men have larger and stronger bones than women and they do not have rapid bone loss like women do around menopause. However, by age 70 men are losing bone at the same rate as women. [3]

Bone density testing with DXA is the same for men as women, with the same T-score interpretation. Bone density testing for older men may be recommended if a physical exam shows that they are losing height or having a change in posture. A sudden fracture is another reason for treating. Testing is also done for men with these risk factors:

• Long-term disease of the kidneys, lungs, or stomach
• Use of steroid medication
• Signs of low testosterone
• Lack of physical activity
• Smoking or alcohol abuse [3]

How Is Osteopenia and Osteoporosis Treated in Men and Women?

If you have osteopenia, you may be able to prevent osteoporosis and a future fracture by increasing calcium and vitamin D in your diet. Calcium helps build bones and vitamin D helps you absorb calcium from your diet. You can also strengthen your bones with weight-bearing exercises like walking or jogging. [1]

How to increase bone density? Exercise is a key aspect in keeping bones strong.

Exercise helps because bone is living tissue that responds to exercise by adding more calcium. Recommendations for exercise are about 30 minutes on most days of the week. Weight-bearing exercise is any activity that that you do while standing, requiring your muscles and bones to work against gravity. [2]

Diet sources for calcium include leafy green vegetables, dairy foods, and canned fish with bones (like sardines). Vitamin D is not present in many foods so it is added to milk, juice, and cereal, fortified with vitamin D. To make vitamin D in your body, you need to be exposed to sunshine. Try to get outdoor sun exposure for about 15 minutes a few days each week. [2]

If you have osteoporosis, you should do all the same things you do for osteopenia, but your doctor may start you on a medication to treat osteoporosis. [1] Supplements for calcium and vitamin D may also be recommended by your doctor. [3]

RECOMMENDED FOR YOU

• Osteoporosis Guidelines: When Should I Get My First DEXA Scan?
• Exercises To Help Osteopenia and Osteoporosis
• 10 Tips to Fight Osteoporosis

SOURCES

1. NIH, Bone Mass Measurement: What the Numbers Mean, https://www.bones.nih.gov/health-info/bone/bone-health/bone-mass-measure
2. ACOG, Osteoporosis, https://www.acog.org/en/Womens%20Health/FAQs/Osteoporosis
3. NIH, Osteoporosis in Men, https://www.bones.nih.gov/health-info/bone/osteoporosis/men

The post Bone Density Test: What Your Osteoporosis T-Score Means for Your Bone Health appeared first on University Health News.

Once you have had an attack of gout, you need to start treatment to prevent another attack, because gout often comes back. Without treatment, you can expect another attack within two years. People with frequent attacks can develop a type of long-term gout that does not go away. It can cause painful lumps in or near joints and can cause damaging deformity of a joint. The good news is that treatment works well. Gout is very controllable for most people. [1]

What Causes Gout?

Gout occurs when you have too much uric acid. Uric acid is formed when your body breaks down a type of building-block molecule called a purine. Purines are naturally found in your body and they also come from certain types of food. It’s normal to have some uric acid in your blood, but if you have too much, uric acid can travel from your blood to your joints. Inside your joints, uric acid forms needle-shaped crystals. [2]

Your body’s defense system reacts to the crystals and tries to get rid of them. This reaction causes swelling and irritation called inflammation. Inflammation makes your joint red, swollen, hot, and tender. That is the gout attack. About two percent of people will have a gout attack at some time. Why this happens remains a mystery, because most people can have high levels of uric acid in their blood without having an attack. [1,2]

You may be at higher risk if:

• You are a man aged 30 to 45.
• You are woman over age 55.
• You have a family history of gout.
• You have high blood pressure, diabetes, or kidney disease.
• You are overweight.
• You drink alcohol.
• You eat foods high in purines or drink beverages sweetened with high-fructose corn syrup, like sodas. [1,2]

What to Do for a Gout Attack

Medication may shorten a gout attack. Your doctor may prescribe medication that blocks inflammation called a nonsteroidal anti-inflammatory drug (NSAID), you may also take a drug called colchicine or a strong anti-inflammatory steroid drug. Over-the-counter NSAIDs include ibuprofen and naproxen. [1,2]

These drugs will reduce the pain and inflammation, but there are also home treatments that will help. Home treatment includes resting your joint, elevating your joint above the level of your heart, and using ice packs to reduce pain and swelling. [1,2]

Prevention

Although gout usually starts in your big toe it can also affect your fingers, knees, or hips. [2] Gout can lead to kidney stones and can cause permanent damage to joints and tissues that surround joints. Medication and home treatments do a good job of preventing future attacks and long-term damage. [1]

If your doctor does a blood test that shows you have high uric acid levels after a gout attack, you may be started on a medication to lower uric acid. Medications to prevent attacks may be used for people who have more than three attacks per year, have severe gout, or kidney stones from gout. [2]

Lifestyle changes for prevention are an important part of treatment. They include:

• Losing weight if you are overweight
• Getting regular exercise
• Limiting alcohol
• Drinking lots of water to help your kidneys flush out uric acid
• Limiting fructose-sweetened drinks
• Limiting foods high in purines like red meats, organ meats (kidney and liver), shellfish, sardines, and anchovies
• Eating a diet low in salt and saturated fat.
• Including lots of fruits vegetables and whole grains in your diet [1,2]

RECOMMENDED FOR YOU

• Gout Foods: Keep These 6 Foods in Your Diet
• Add the DASH Diet to the List of Gout Remedies
• What Is Gout?
• What Could Be Causing Your Gout Symptoms?
• Gout in Ankles, Knees, and Feet: More Common Among Men

SOURCES

1. NIH, Overview of Gout
2. AAOS, Gout

The post How Long Does Gout Last? appeared first on University Health News.

Gout is caused by the buildup of uric acid crystals in the joints and is one of the few forms of arthritis that can be affected by diet. Scientists estimate that 6 million adults report having had gout at some time in their lives, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

What Foods to Avoid for Gout

Gout patients should:

• Avoid beef, pork, lamb, and liver (and other organ meats) along with such seafood selections as herring, mackerel, mussels, sardines, tuna, and smelt.
• Proceed with caution when it comes to foods moderately high in purines, including bacon, turkey, mutton, salmon, trout, and haddock.
• Steer clear of sugary soft drinks and energy drinks, beer, and distilled spirits.

What to Eat for Gout

According to the Arthritis Foundation, foods that are low in purine and that improve the excretion of uric acid from the body are ideal for patients suffering from gout. Fortunately for anyone dealing with gout, foods low in purine are fairly easy to introduce (and keep) in your diet.

Here are four choices that should play a main role in a gout diet:

• Vegetables: Until recently, mushrooms, asparagus, and spinach were on the list of foods to avoid because of their moderate purine levels. But a 2012 study showed no correlation between consuming these vegetables and developing gout. In other words, the benefits of eating these foods can outweigh the risks. Always welcome in a healthy gout diet: cauliflower, peas, beans, and sweet potatoes.
• Cherries: Eating cherries every day can lower your risk of a painful gout attack, according to a study published by Arthritis & Rheumatology. They found that gout patients who ate 10 to 12 cherries per day or took cherry extract over a period of two days reduced their attacks by 35 percent over a year. The chemicals in cherries reduce the amount of uric acid in the joints. Want to enjoy other fruits? Go ahead: All fruits are welcome in a gout diet; bananas make an ideal choice because they’re known to convert uric acid into a liquid form that your kidneys can filter.
• Low-fat dairy products: A higher level of low-fat dairy consumption has been linked to a decreased risk of gout attacks, according to a study published by The New England Journal of Medicine. Researchers found that patients who consumed one or more servings each day of low-fat milk or yogurt—which is high in protein but low in purine—had less uric acid in their blood than those who did not.
• Carbohydrates: The starchy variety of carbs will work; such items as oats, brown rice, potatoes, wheat bread (avoid white), and pasta bear only minor amounts of purines.

What to Drink for Gout

Drinking plenty of water every day has been proven to reduce the risk of gout attacks.

What about beverages? Again, eliminating or cutting back on fruit juices and sugary sodas will help reduce gout flare-ups. Instead, stick to the basics:

• Water: As the amount of water in your diet increases, your risk for recurring gout attacks decreases, according to the Arthritis Foundation. The amount of water you should drink on a daily basis will depend on your physical activity level as well as other medical conditions, so speak with your doctor about how much to consume each day.
• Coffee and tea: According to a study conducted by Korean researchers, uric acid levels were significantly lowered when women drank four to six cups of coffee per day and when men drank one to three cups. At the same time, avoid bingeing on caffeine. Black and green teas, meanwhile, contain anti-inflammatory polyphenols, as do white teas.

Talk to Your Doctor

While your diet can have a significant impact on how your symptoms are managed, it’s important to remember to follow your doctor’s instructions when it comes to taking medications and engaging in physical activity. Simply changing your diet won’t completely manage the condition.

“Physicians all too often see patients who believe they can successfully manage their gout with diet alone,” according to N. Lawrence Edwards, M.D., rheumatologist and chairman of the Gout & Uric Acid Education Society. “But even with extremely rigid diet restrictions, most gout patients will only be able to lower their uric acid levels slightly—not nearly enough to achieve a healthy level to control flares and reduce risk for long-term damage.”

RECOMMENDED FOR YOU

• Foods to Avoid with Gout
• What Is Gout?
• Gout in Ankles, Knees, and Feet: More Common Among Men
• How Long Does Gout Last? These 3 Factors Determine the Answer
• Gout in Foot? Here’s How It Happens-and How to Treat It

Originally published in 2016 and regularly updated.

The post Gout Diet: What Food Should I Avoid with Gout? appeared first on University Health News.

What is gout? It’s an inflammatory arthritis–some call it “gouty arthritis”—caused by the formation of needle-like uric acid crystals in the joint. Hyperuricemia (high blood urate levels) leads to crystal formation and severe episodes of acute pain, stiffness, tenderness, warmth, redness, and swelling, often striking along the base of the big toe.

In its chronic form, gout can cause irreversible damage to the joints, tendons, and other soft tissue.

The Pathology of Gout

Gout is primarily a metabolic disorder in which uric acid (also known as urate) accumulates in blood (hyperuricemia) and tissues. When tissue levels reach saturation, needle-like crystals form, causing inflammation. This occurs most commonly in the cooler joints, notably the metatarsophalangeal joint of the big toe.

Many people with hyperuricemia never develop gout, but those with the highest levels are most likely to suffer episodes. Hyperuricemia may also lead to kidney stones.

Gout in Foot: Causes and Risk Factors

In about 90 percent of hyperuricaemia cases, there is impaired renal excretion; in about 10 percent, there is a problem with overproduction.

• Urate overproduction can be linked to lifestyle factors and certain diseases such as bone marrow cancers, psoriasis, and hemolytic anemia. Lifestyle factors include being overweight and ingesting excess amount of fructose or alcohol.
• Renal impairment has multiple causes, including gene mutations, hypertension, diuretic drugs, lead exposure, and cyclosporine immunosuppressive therapy.
• Gender and age. Men are twice as likely to develop gout as women. In men, the risk rises with age. Gout is uncommon in younger women but the incidence increases dramatically after menopause, due to falling estrogen.
• Western diet. There is solid evidence from the Health Professional Follow-up Study (HPFS) of a link between gout and purine-rich foods. See gout diet.
• Medications. Diuretics, antihypertensives, niacin, aspirin, chemotherapy and immunosuppressive drugs increase the risk of gout.
• Other conditions. Certain conditions carry an increased risk of gout including: Recent joint injury or surgery, cardiovascular disease, chronic pulmonary disease, anemia, psoriasis, renal disease, blood cancers, and metabolic syndrome.

Symptoms and Signs of Gout in Foot

An attack of gout is often sudden. Symptoms:

• It may present with excruciatingly painful swelling of joints; in the big toe, it is known as Podagra. The joint may be stiff and appear red or purple, very swollen, and tender to even light touch. Other gout sites include the instep, wrist, ankle, fingers, and knee.
• Skin may peel and itch as healing begins.
• An attack often begins at night; the acute phase lasts up to 12 hours. If untreated, the inflammation may last up to two weeks. In 10 percent of people, acute episodes present in more than one joint.
• Kidney stones precede the onset of gout in 14 percent of patients.
• Chronic gout may develop, and it may affect more than one joint, mimicking rheumatoid arthritis.
• Tophi are soft tissue swellings caused by urate buildup in chronic gout. They may be found in the ear, fingers, toes, kneecap, and elbow.

Some people have a single attack of gout, others are affected intermittently, often when they have overindulged or experienced dehydration.

Diagnostic Evaluation of Gout in Foot

What goes into a gout diagnosis? These procedures are options:

• Joint aspiration. Fluid is withdrawn from the joint and inspected for crystals and bacteria.
• Blood tests. White blood cell count, ESR (erythrocyte sedimentation rate), triglycerides, and kidney function (urea and creatinine) may be elevated.
• X-ray. An x-ray of the affected joint is likely to appear normal during an initial acute episode, but in chronic gout, bone erosion and overhanging edges may be seen.

Treatment of Gout

Your doctor will determine the treatment for gout that you require, perhaps using the American College of Rheumatology (ACR) 2012 guidelines.

Initial treatment

• In an acute attack, a combination of NSAIDs (nonsteroidal anti-inflammatory drugs), corticosteroids, and colchicine may be needed. Steroids can be given orally or injected into the muscle or joint. Rest, elevation, ice packs, and increasing water intake may also help alleviate symptoms.
• Colchicine is a drug that decreases swelling and reduces the buildup of uric acid crystals. Side effects are common and include nausea, vomiting, and diarrhea. It may be used in the acute phase and to prevent further flare-ups.
• Urate-lowering-treatment (ULT) is usually commenced following an attack. These drugs may be considered if colchicine is not effective, if multiple joints are involved, or if there is a history of kidney stones. These include allopurinol (Aloprim), febuxostat (Uloric), and probenecid (Benemid).

Lifestyle change

• Regular exercise and eating a healthy diet will not only help you reach a healthy weight but may also reduce gout flare-ups. Purine-rich foods in particular should be restricted. See our article “Gout Foods: Keep These 6 Foods in Your Diet.”

RECOMMENDED FOR YOU

• Gout Foods: What Food Should I Avoid with Gout?
• How Long Does Gout Last?
• Gout: A Type of Arthritis That is Linked With Heart Disease

This post was originally published in 2017 and has been updated.

The post Gout in Foot? Here’s How It Happens—and How to Treat It appeared first on University Health News.