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Painful, swollen joints - gout, or part of my fibromyalgia?

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By Dr. Kristi Wrightson, ND, MS, RD • www.ProHealth.com • October 13, 2009

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Q: My right hand swelled up the size of a boxing glove over night, and was very painful. My doctor said she thought it was gout. I took all the tests for gout and they were all negative… Now I wake up with my hand & arm stiff, painful & swollen. The only thing I can do is put them under very hot water and the pain and swelling go down. If the tests I took were negative for gout, could this be part of my FM?

Dr. Wrightson answers: Although your symptoms are not typical of fibromyalgia, there is not a definitive answer to your questions of whether they are related to the FM. Most likely, though, your pain and swollen joints are related to the gout that your doctor diagnosed. Although your laboratory tests did not show any findings that are indicative of gout, this condition is often diagnosed through clinical symptoms alone.

Gout is an inflammatory arthritis that is characterized by swollen joints due to an increase of uric acid accumulation in the body. This build-up of uric acid can often occur with an excessive intake of food and/or alcohol, after surgery, or during physical or emotional stress.

Typical symptoms of gout include the following:

• Pain and swelling in a single joint, with the big toe being the most often affected, although other joints can be affected.

• Joint is purple-red, hot, inflamed.

• Pain occurs abruptly, with symptoms lasting a few days to weeks, and can re-occur spontaneously.

• Lumps of uric acid crystals can be found (called tophi) under the skin in recurrent attacks, and are often found in the arm, hands, feet, elbow or knee.

Lifestyle and dietary changes can often assist in decreasing or eliminating the recurrence of gout. Here are some tips to ensure that you do not have recurrent attacks:

Maintain a healthy weight through balanced nutrition.

Drink plenty of water each day to help the kidneys flush out excess uric acid. Goal is 64 ounces per day.

Eat a diet that is relatively free from foods containing purines, which can increase the amount of uric acid accumulation.
- High purine foods include: beef, goose, organ meats, sweetbreads, mussels, anchovies, herring, mackerel, and yeast.
- Foods with a moderate amount of purines include meats, poultry, fish, and shellfish not listed above.
- Spinach, asparagus, beans, lentils, mushrooms, and dried peas also contain moderate amounts of purines.

Quercetin is an anti-oxidant that can help to decrease the amount of uric acid in your body. It is typically taken with Bromelain, an anti-inflammatory enzyme. They can both be taken at dosages between 200-300 mg/day.

EPA (omega-3 essential fatty acids) from fish oils are anti-inflammatory and can help to reduce the inflammation that is caused by gout. Dosages of 1500 mg per day are useful. (Note that purines are found in the meat of some fish, but not in purified fish oil, where liquid oil is separated from the tissues by a process known as molecular distillation.)

Again, though your symptoms are not typical of fibromyalgia, there is not a definitive answer to your questions of whether they are related to the FM. The condition that you described sounds like it is an inflammatory condition that is related to gout or arthritis.

If your symptoms persist with no relief from dietary changes or supplements, you may want to consult another physician for further testing.

- Dr. Kristi Lou Wrightson, ND, MS, RD

____
Note: This information has not been evaluated by the FDA. It is not meant to prevent, diagnose, treat or cure any illness, condition or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.



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