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Gout is a type of arthritis caused by uric acid crystals building up in the joints. Gout attacks can be extremely painful and often come on without warning. Like other forms of arthritis, gout can affect nearly any joint in the body but is most commonly felt in the big toe before the condition spreads to other areas.

Gout frequently occurs in episodes known as “gout attacks”. It is during these spells that symptoms occur. Gout attacks can flare up suddenly, and often occur at night. Episodes of gout may last anywhere from a few days to a week or two. These attacks may recur in the same joint over and over again or may affect other joints in the body such as the wrist, knees, or elbows.

Gout is caused by an excess of urate crystals. These crystals are the result of uric acid, which in turn, is created by the breakdown of purines - a naturally occurring substance - in the body. When purines are broken down, most uric acid is passed through the kidneys and cleared out of the body via urine.

If your body produces too much uric acid, or if your kidneys are unable to excrete enough uric acid, the remaining substance crystallizes and turns into urate crystals. These sharp crystals can lodge themselves in the cartilage tissue in your joints, causing swelling, inflammation, and pain.

Gout symptoms are most commonly experienced during an “attack”, or a flare-up that occurs suddenly. These attacks are common at night and may last for several days to weeks. Common symptoms of a gout flare-up include:

• Intense, sharp joint pain
  
• Joint discomfort (often lingering after an attack)
  
• Inflammation
  
• Redness
  
• Swelling
  
• Tenderness
  
• Burning, or warm feelings in the affected area
  
• Limited range of motion
  

A buildup of uric acid in the body is the primary cause of gout. Men are more likely to have higher levels of uric acid in the blood, although post-menopausal women tend to have uric acid levels similar to that of men. Common risk factors for high levels of uric acid - a risk factor for gout - include:

- Obesity: Diets rich in red meat, seafood, drinks sweetened with fruit juice (fructose), and alcohol can contribute to higher levels of uric acid in the body. Extra weight can also put added stress on the kidneys, increasing uric acid levels and decreasing internal organ function. Diet and obesity tend to be linked, and both of these are risk factors for gout.

- Hypertension: High blood pressure and blood pressure medication can increase levels of uric acid in the blood.

- Chronic diseases: Chronic diseases, such as diabetes, congestive heart failure, kidney disease, and metabolic syndrome can lead to increased uric acid in the body and a greater risk of developing gout.

- Family history: If you have a family history of gout, you are more likely to develop the disease yourself.

If you are experiencing the signs and symptoms of gout, or have a condition that may increase your risk of developing gout, you can talk to your primary care provider about the disease. They may refer you to a Doctor of Rheumatology - also known as a rheumatologist - a gout specialist that provides health care services for patients dealing with rheumatic diseases (like gout and arthritis).

Rheumatologists may examine gout patients for joint damage, and physical signs of gout. They may also order blood work or imaging tests (such as an X-ray) to check for uric acid levels in the body and examine affected joints.

Once these screening trials have been performed, your rheumatologist will work with you on treatment options and therapies to control symptoms and lower levels of uric acid in the body.

Gout treatment is focused on mitigating pain caused by attacks, and lowering your risk of future flare-ups by lowering uric acid levels in the body. Common forms of medication prescribed by doctors to treat gout include:

- NSAIDs: Nonsteroidal anti-inflammatory medications are available over-the-counter or at prescription strength. These drugs will help relieve pain and reduce inflammation.

- Colchicine: Colchicine is a prescription medication that can help relieve inflammation caused by gout and reduce uric acid levels in the body. Colchicine is not a pain reliever and will not cure gout. It can, however, help prevent and treat attacks of gout.

- Corticosteroids: Corticosteroids (usually administered orally or through injection) can help relieve pain and reduce inflammation caused by gout.

- Uric acid reducers: Medication such as allopurinol (sold as Zyloprim) reduces uric acid levels in the blood. Allopurinol is commonly prescribed as a long-term preventative measure against gout and kidney stones.

In addition to prescription medication (and while you’re waiting for your appointment), there are a few steps you can take to relieve pain and reduce the likelihood of further gout flares. These include:

- Take an over-the-counter anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (generic for Aleve) and ibuprofen may help to reduce inflammation and pain. Stay away from aspirin, though, as it can alter uric acid levels in the blood and make the symptoms of gout worse.

- Elevate and ice. Another way to reduce swelling and pain is to elevate the affected toe higher than the heart and apply a bag of ice to it for 20-30 minutes at a time. Do this several times throughout the day.

- Stay hydrated. Drinking plenty of water can help prevent gout attacks and reduce the risk of developing kidney stones. Stay away from alcohol and sugary drinks, as these can antagonize flares and make complications more probable.

- Watch what you eat. Try to stay away from purines. Purines are naturally occurring chemicals that are broken down into uric acid. Eating foods rich in purines can raise uric acid levels in the blood and increase the risk of gout. Some purine-rich foods include red meat, organ meats, and some seafood (particularly sardines, anchovies, mussels, scallops, tuna, and trout).

- Maintain a healthy weight. Risk factors for gout include obesity, excessive weight gain, moderate to heavy alcohol intake, and diabetes. Eating a healthy diet and getting regular exercise can help you avoid gout flares and other health problems. Biking, swimming, and walking are all low-impact activities that are easy on the joints.

Rheumatologists complete nearly 10 years of schooling to specialize in rheumatic diseases and autoimmune disorders. Some conditions a rheumatologist may diagnose or treat include:

• Rheumatoid arthritis
  
• Osteoarthritis
  
• Psoriatic arthritis
  
• Sjögren’s disease
  
• Tendonitis
  
• Osteoporosis
  
• Fibromyalgia
  
• Lupus
  
• Scleroderma
  
• Gout
  
• Polymyositis
  
• Vasculitis
  

Autoimmune disorders occur when your body’s immune system mistakenly attacks healthy tissue. The cause of these conditions is unknown, but they are commonly passed through genetics. As your immune system attacks healthy tissue in the body, it causes inflammation in the affected area (usually the joints). Common autoimmune disorders include:

• Rheumatoid arthritis
  
• Psoriasis/ psoriatic arthritis
  
• Lupus
  
• Sjögren’s disease
  
• Multiple sclerosis (MS)
  
• Type 1 diabetes
  

Each of these conditions affects different areas of the body and results in diverse symptoms. Most autoimmune diseases cause physical pain, inflammation, fatigue, and swelling in the affected area. Many of these conditions are chronic, meaning that they persist throughout a lifetime. There is no cure for many of these conditions, but they can be managed and treated with help from a rheumatologist and other specialists.

Inflammatory diseases are conditions that are characterized by symptoms caused by your immune system’s response to bacteria, viruses, or toxins. When these offenders are detected by your immune system, it will release certain cells to attack the foreign organism. This process can result in pain, swelling, tenderness, redness, and other adverse effects.

Common inflammatory diseases include:

• Arthritis
  
• Fibromyalgia
  
• Vasculitis (inflammation of the blood vessels)
  
• Scleroderma
  
• Osteoporosis
  
• Inflammatory bowel disease
  
• Crohn’s disease
  
• Asthma
  

There are hundreds of different types of inflammatory diseases, each with diverse symptoms and treatment requirements. If you are experiencing the symptoms of inflammation, it is recommended that you speak to a rheumatologist - a doctor that specializes in the treatment of inflammatory and autoimmune disorders.

A rheumatologist will talk to you about your medical history, family history of autoimmune disorders, and what symptoms you are experiencing before conducting a physical examination. Physical exams are crucial in helping providers detect symptoms or signs of conditions such as lupus or rheumatoid arthritis.

Autoimmune conditions can be hard to diagnose in their early stages, so the rheumatologist may order follow-up testing to better determine the cause of your symptoms. These diagnostic tests include:

• X-ray scans
  
• Blood tests
  
• CT scans
  
• Ultrasound tests
  
• MRI scans
  

Once the rheumatologist has examined your test results, they will work with you to create a treatment plan that can help you manage your symptoms. If surgery is needed, they may recommend an orthopedic surgeon to correct any musculoskeletal damage causing you pain.

Your primary care provider may recommend that you see a rheumatology specialist if they suspect that you have an autoimmune disorder or a complex musculoskeletal condition that requires specialized treatment.

Additionally, if you have a family history of arthritis or other autoimmune disorders, you may want to ask your primary care provider about a recommendation for a rheumatologist. Genetics - conditions being passed down through your family - is the biggest risk factor for the development of these disorders.

Undiagnosed and untreated autoimmune disorders can lead to significant joint damage. Early detection of an autoimmune disorder can help avoid worsening symptoms, such as joint pain and mobility loss. If you are experiencing any of the symptoms detailed above, or if you have a family history of these disorders, talk to your primary care provider about a recommendation for a rheumatologist.

No. Rheumatologists can perform diagnostic tests and physical examinations to diagnose autoimmune conditions and musculoskeletal problems, but they are not surgeons. These specialists are able to prescribe medication, administer steroid injections, and refer you to other specialists if needed.

If after your examination your rheumatologist determines that you may benefit from surgery, they will refer you to an orthopedic surgeon - a specialist in surgery of the bones, joints, ligaments, tendons, and muscles.

Allopurinol (generic for Zyloprim) is a prescription medication that reduces uric acid concentrations in your body. Uric acid is a waste product in the blood created when the body breaks down purines. High uric acid levels can cause adverse conditions like gout and kidney stones. Allopurinol is also commonly prescribed to cancer patients, as chemotherapy often elevates uric acid levels.

Removing high levels of uric acid can help your kidneys function better. This medicine is only available with a doctor’s prescription and is taken orally, often once or twice a day. Before taking allopurinol it is important to tell your doctor if you are allergic to allopurinol or other medications, what prescription and nonprescription medicines you are taking, as well as if you have ever had liver disease, cardiovascular disease, or kidney disease, as these may affect the dosage.

Allopurinol is often prescribed to patients with kidney stones or gout. It is also commonly prescribed to patients receiving chemotherapy for cancer treatment.

Kidney stones occur when high levels of uric acid cause crystals to form in your kidneys (most often calcium compounds). They can result in severe pain in the side and back and a burning sensation while urinating. Like kidney stones, gout is also caused when high levels of uric acid accumulate in your body, causing urate crystals to gather in your joints. This condition causes intense joint pain and inflammation. Allopurinol is also used to reduce complications associated with cancer treatment. Chemotherapy medications can increase the level of uric acid in the body, as cancer cells release uric acid when they die, placing patients at risk of developing kidney stones or gout.

Allopurinol has also been proven to slow down renal disease progression in people with chronic kidney disease. It is not however recommended to treat asymptomatic hyperuricemia.

Yes! Talk to a provider on Sesame and get your online doctor prescription or refill ordered right away for fast and convenient pickup from a pharmacy of your choice.

Note that all prescriptions are at the discretion of your clinician.

Naproxen (generic for Naprosyn) is a prescription medication that is used to manage pain and symptoms relates to musculoskeletal conditions. These conditions include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis (arthritis that affects the spine), juvenile arthritis (arthritis in children), tendonitis, bursitis, and acute gout. Arthritis is a common condition caused by inflammation and swelling in your joints. More prevalent in older individuals, arthritis affects more than 54 million Americans.

Naproxen may also be prescribed to treat pain caused by menstruation. Non-prescription Naproxen is frequently used to treat colds, fevers, headaches, and other common non-urgent symptoms.

It should be noted that Naproxen does not cure these conditions. Instead, it helps to relieve symptoms and manage discomfort associated with these conditions.

Talk to your doctor about whether naproxen may be right for you.

Prescription-strength Naproxen is used to manage pain and relieve symptoms associated with:

Osteoarthritis (arthritis caused by the deterioration of the cartilage in the joints) Rheumatoid arthritis (chronic inflammation in the joints) Ankylosing spondylitis (arthritis that affects the spine) Juvenile arthritis (arthritis affecting children) Tendinitis (inflammation of the tendons that join muscle to bones) Bursitis (inflammation of the fluid-filled sacs, called bursae, that surround joints) Symptoms of gout (uric acid buildup that causes swelling and pain, usually in the foot)

While Naproxen doesn’t cure these conditions, it does help minimize symptoms and discomfort caused by these problems. It may be prescribed along with other methods of treatment to manage pain and reduce inflammation.

Yes! Talk to a provider on Sesame and get your online doctor prescription or refill ordered right away for fast and convenient pickup from a pharmacy of your choice.

Note that all prescriptions are at the discretion of your clinician.

It depends. Telehealth platforms like Sesame make it easier than ever to see a doctor online from the comfort of your home through virtual visits. These are real-time video chats with doctors and providers that are used to address symptoms, discuss prescriptions, and screen for health care conditions. Telehealth (also known as telemedicine) is a convenient way to see a health care provider without requiring the commute and waiting rooms of office visits.

In-person visits, however, are vital health services. Certain conditions and specialty care services cannot be diagnosed or performed via a telehealth visit. Lab testing, for instance, often requires an in-person appointment at a doctor's office. Similarly, some physical exams, chronic condition consultations, and urgent care needs require in-person care. Some patients feel more comfortable receiving their care through in-person doctor visits, and many telehealth services require in-person visits before a condition can be definitively diagnosed.

Health care marketplaces like Sesame offer both in-person and virtual care options. If you're unsure whether or not you need to see a provider face-to-face, we recommend that you book a video doctor visit to discuss your concerns and talk through any symptoms you may be experiencing. If an in-person doctor appointment is required, you can easily book a visit through Sesame's scheduling platform.