1. The management of gout may be more challenging in the elderly, due to medical co-morbidities, deteriorating metabolic function and drug interactions due to polypharmacy. Treatment and Management The gold of treating gout is to minimize or eliminate the urate crystals from the joints and other structures associated with them. Assist with positioning to avoid pressure on the affected joint. non-Hispanic White individuals. 2. Exercising regularly and losing weight. Yu TF, Gutman AB. 2. Based on data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES), the prevalence of gout a… Using some weight-loss program is conditionally recommended for gout patients who are overweight or obese. Dietary factors as a cause for gout only comprise about 12% of cases, but changes to the diet help reduce the risk. Identify the prevalence of gout, clinical presentation, and diagnostic testing. Other factors include genetics, dietary factors, use of diuretics, and the inability of the kidneys to excrete uric acid. Elevated plasma uric acid concentrations (hyperuricemia) cause deposits of urate crystals in joint spaces … Managing gout in primary care Part 1 - Talking about gout: time for a re-think. 3. … That’s give for long term control and management of gout. The nurse is educating a client on managing gout. A client has a Fiberglas cast on the right arm. 2. mostly affects feet, great toe, ankle & midfoot, Chronic Polyarticular Gout – final, unremitting stage of the disease marked by persistent, painful polyarthritis, Radical dieting practices that involve starvation. Abstract: Gout is a disorder of purine metabolism that primarily occurs in adult males. Gout occurs with the buildup of uric acid in the joints and kidneys. Options to alleviate acute attacks: Colchicinehas been used to treat gout since antiquity. Cold and warm compresses, if tolerated by the patient (alternate between cold and warm) If gout … Gout is a clinical syndrome resulting from the deposition of urate (monosodium urate monohydrate) crystals. This summa… Gout … During symptom-free periods, these dietary guidelines may help protect against future gout attacks: 1. So, just a quick recap. First, the PCP must treat the acute inflammatory flare and then begin chronic management to prevent further episodes by … For patients who have been … Patients should avoid foods high in purines as these will cause a buildup of uric acid within the body. The clinical features of gout occur in response to monosodium urate (MSU) crystals. Urge the client to drink 2 to 3 L of fluid daily and to report any decrease in urine output. Gout is characterized by formation of tophus deposits in soft tissues and urate crystals. Emphysema Nursing Care Plan. Surgery may also be used to correct severe deformities that tend to delay healing or … This review discusses gout and its management in general, with a focus on the presentation and management … A study on the use of ice therapy for gout pain management had study subjects treated with prednisone and colchicine for a gout flare. Urge the client to drink 2 to 3 L of fluid daily and to report any decrease in urine output. Gout is a common and painful form of arthritis that causes swollen, hot, and stiff joints. Relieve acute attack, prevent future attacks, promote optimal excretion of urates, For more information, visit www.nursing.com/cornell. Several aspects must be taken into consideration … Gouty Arthritis Nursing Management. As a nurse providing care to a patient with gout, it is important to know the signs and symptoms, pathophysiology, nursing management, patient education, and treatment for these conditions. Surgical Management. shellfish and fish. At NURSING.com, we believe Black Lives Matter ✊, No Human Is Illegal , Love Is Love ️‍, Women's Rights Are Human Rights , Science Is Real , Water Is Life , Injustice Anywhere Is A Threat To Justice Everywhere ☮️. Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis. Colchicine can reduce inflammation and pain if you take it within 24 hours of a gout attack. Reconsider diagnosis: refer persistent symptoms without definitive diagnosis secondary care[2] Refer to Secondary Care … Gout and pseudo-gout are types of arthritis caused by the formation of insoluable crystals in the synovial fluid of joints. nursing management of gouty arthritis? Health Education Avoid or Limit alcohol Do the moderate daily exercise consumption Drink at least 6 to 8 glasses ofLimit meat and seafood intake water each day. It is increasingly being recognised as a serious disease that causes functional disability, increased work absence, and negative economic consequences for the individual and community. Assess patient joints, especially toes, fingers, elbows for warmth, redness, or pain. What’s beyond them? 1 decade ago. Elevated plasma uric acid concentrations (hyperuricemia) cause deposits of urate crystals in joint spaces causing severe, repeated attacks of arthritis. Treatment of gout Intolerance to the weight of bed linens over the affected joint, Pruritus or skin ulceration over the affected joint, Signs of renal involvement (e.g. Nursing Care Plans for Gout. Limit how many sweetened beverages you drink, especially those sweetened with high-fructose corn syrup. Gout is characterized by formation of tophus deposits in soft tissues and urate crystals. Gout is a treatable form of arthritis that is associated with poor health and reduced life expectancy. Background: The surgical management of tophaceous gout has been well documented in the literature, including its effect on foot pain and disability. All references to such names or trademarks not owned by NRSNG, LLC or TazKai, LLC are solely for identification purposes and not an indication of affiliation. Due to pain and inflammation, patients may require assistance with mobility for safe ambulation and transfer. organ meats, anchovies, sardines, shellfish, chocolate, meat extracts). There are two major phases in the management of gout. A client has a Fiberglas cast on the right arm. When you complete this course, you will be able to write and implement powerful and effective Nursing Care Plans. Method for Mastering Nursing Pharmacology, 39 Things Every Nursing Student Needs Before Starting School. Which of the following statements by the client indicates more education is necessary? If you do, you’ll retain a great deal for current use, as well as, for the exam. Acute gout pain starts suddenly, gets worse quickly, and stops on its own. Provide measure to promote comfort and reduce pain. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words. The latter systematic review included 154 articles published through March 1, 2016. Stay well-hydrated, including plenty of water. Surgery is performed to remove the large tophi of advanced gout. Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Instead, drink plenty of nonalcoholic beverages, especially water. How can I apply them? Quit cigarettesThe medical profession is competitive field which requires excellence both in academics and practical exercises. Feel Like You Don’t Belong in Nursing School? Nursing Interventions for Gout. Chapter 65 Nursing Management Arthritis and Connective Tissue Diseases Dottie Roberts Most folks are as happy as they make up their minds to be. Gout medicine decreases joint pain and swelling. The other review examined the evidence base for treating patients with acute gout attacksin the primary care setting. An acute attack can cause intense pain for the first 36 hours. Health Education Avoid or Limit alcohol Do the moderate daily exercise consumption Drink at least 6 to 8 glasses ofLimit meat and seafood intake water each day. A number of pathophysiological checkpoints are required for development of gout… Additionally Uric acid lowering therapy is ted. Incidence and severity is increasing in the UK, with about 2.5% of the population affected. High-strength evidence supports the finding that prophylactic therapy with low-dose … Compare and contrast the sequence of events leading to joint destruction in osteoarthritis and rheumatoid arthritis. Gouty arthritis is a metabolic disease marked by urate crystal deposits in the joints throughout the body, causing local irritation and inflammatory responses. The latter systematic review included 154 articles published through March 1, 2016. oliguria, low back pain, hypertension) in severe disease, Arthrocentesis reveals urate crystals in synovial fluid, Radiograph may show joint damage in advanced disease. Acute gout can become chronic and cause permanent damage to your joints. Which action should the nurse include in the plan of care? ; Gouty arthritis is caused by the deposition of needle-like crystals of uric acid in a joint. Answer Save. Also, the writing of questions sets up a perfect stage for exam-studying later. Abstract: Gout is a disorder of purine metabolism that primarily occurs in adult males. Provide a bed cradle to keep bed linen off affected joints to help reduce pain. Secondary gout associated with other diseases: Gout is characterized by formation of tophus deposits in soft tissues and urate crystals in joint synovia. Excessive amounts of uric acid in the blood is the primary cause of gout. The client is in the acute stage of an attack of gouty arthritis. Cold and warm compresses, if tolerated by the patient (alternate between cold and warm) If gout is present: Acute gout. Avoid alcohol 5. So, as you may have guess, our top priority nursing concepts for a patient with Gout are going to be comfort and mobility. Emmerson BT. Choosing to maintain a healthy body weight will reduce the amounts of uric acid levels in the body. A nursing care plan outlines the nursing care to be provided to a patient. Drinking lots of fluids minimize frequent attacks. It is a toxin from autumn crocus (Colchicum autumnale) that binds to tubulin and inhibits its polymerization. If your gout is severe, you may need to see a specialist in joint diseases. This summar… Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences. It’s given by mouth. 4. Management … Gouty Arthritis Nursing Management. Avoid animal proteins, yeast, seafood and all the other foods that trigger gout. What causes gout? nodules under the skin called tophi, joint redness,; swollen joints,; joint pain, and; warmth of the joint. NSAIDs and corticosteroids help reduce swelling and can relieve immediate pain, Colchicine can be given for acute pain specific to gout attacks, XOI (allopurinol)- medications that block the production of uric acid and help prevent future attacks, Uricosurics (probenecid)- help the kidneys more effectively excrete uric acid, Promote hydration and increase fluid intake, Prevents dehydration and helps the kidneys excrete uric acid, Prevents joint stiffness and increases mobility, Limit or avoid animal proteins (liver, kidney, beef, lamb, and pork), Limit intake of seafood, especially those high in purine such as shellfish, sardines, and tuna, Avoid alcohol as it greatly increases the risk of gout attacks, Encourage foods that reduce the risk of attacks including coffee, cherries, and foods high in vitamin C, Limit or avoid foods/drinks sweetened with fructose. This is a quiz that contains NCLEX review questions for gout. Nursing Care Plan 1. You take steroids by mouth or with an injection. Gout flares start suddenly and can last days or weeks. Assess for a history of gout (especially if hospitalized) because remember illness can cause a gout attack. It is characterized by diffuse inflammation and degeneration in the connective tissues. For which of the following signs or symptoms should the nurse assess? Picture: iStock Essential facts Gout is the most common cause of inflammatory arthritis worldwide. Colchicine may be prescribed for acute attack and used in small doses for prevention. "The first thing you need to do is make sure it's gout. As a first line therapy it is advisable to use non steroidal anti inflammatory drugs for acute attacks of gout. Assess for a history of gout (especially if hospitalized) because remember illness can cause a gout attack. Colchicine can reduce inflammation and pain if you take it within 24 hours of a gout attack. 22. Desired Outcome: … Gout is the most common inflammatory arthritis and its incidence in the UK has steadily increased from 1.5% in 1997 to 2.5% in 2012.1 2 It is characterised by deposition of monosodium urate crystals in joints and tissues and usually presents with intermittent painful attacks followed by long periods of remission.3 Here, we review the latest guidance on the management of gout and consider … The management of gout may be more challenging in the elderly, due to medical co-morbidities, deteriorating metabolic function and drug interactions due to polypharmacy. Why and how do we even use Nursing Care Plans? Limit or avoid alcohol. 1996;334:445–51. This is a summary of two systematic reviews. First, the PCP must treat the acute inflammatory flare and then begin chronic management to prevent further episodes by reducing serum … A client is being seen for treatment of gout. 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Medications are often the most effective way to treat acute gout and can prevent recurrent attacks of gout. Sudden attacks, usually at night, with periodic remissions and exacerbations. This lesson is part of the NURSING.com Nursing Student Academy. Too often, gout management is focused on controlling the patient’s symptoms while their risk of irreversible joint damage and negative health outcomes continues to grow. Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose). In a small study that standardized gout flare treatment with prednisone and colchicine, patients with gout were divided into two groups: one received ice, and the other did not. 90% of cases are caused by the underexcretion of uric acid. Corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or low-dose colchicine should be prescribed for patients who have acute gout. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams), Gastroesophageal Reflux Disease (GERD) Nursing Care Plan & Management, Hyperthyroidism Nursing Care Plan and Management. Uricosuric agents, such as probenecid, correct hyperuricemia and dissolve deposited urate, Colchicine (oral or parenteral) or a NSAIDs, such as indomethacin is used to relieve acute attacks, Allopurinol is effective, but use is limited because of the risk of toxicity, Aspiration and intra-articular corticosteroids are used to treat large-joint acute attacks, Promote measures to prevent exacerbations. Start a trial to view the entire video. If there is any doubt about the … One review evaluated the evidence regarding the accuracy and safety of tests used to initially diagnose gout in the primary care, urgent care, or emergency care setting. The disorder follows a variable course of periodic attacks, often with long symptom-free periods between attacks. 3. Steroids reduce inflammation and can help your joint stiffness and pain during gout attacks. Dietary changes reduce the risk of recurrent gout attacks and lessen the severity of future attacks. Some drugs help control symptoms: NSAIDs can reduce pain and swelling. PLUS, we are going to give you examples of Nursing Care Plans for all the major body systems and some of the most common disease processes. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Initiating ULT in patients with radiographic damage, using any modality, that is attributable to gout; 1. Gout … Favorite Answer. Too often, gout management … 24. Nausea, vomiting, and diarrhea are toxic effects of colchicines and should be reported to the health care provider. 21. This results in severe pain, stiffness, and redness at the joint. Even non-specialists should be able to diagnose and treat most patients provided some important principles are appreciated. Gout Treatment 2. Limiting intake of foods high in purines, such as red meat, organ meats and seafood. In patients with a potential diagnosis of gout, a number of initial steps should be taken. Several aspects must be taken into consideration and each treatment regiment is varied from patients to patients. Your healthcare provider may prescribe certain medications to treat gout. To date, there have been no systematic reviews assessing the quality of the literature relating to the operative management of tophaceous gout and the outcomes in the foot and ankle. Emphysema Nursing Care Plan. The management of gout. cherries and low-fat dairy products. Strength-of-evidence assessment was done by group discussion. How do I write a Nursing Care Plan? Abraham Lincoln Learning Outcomes 1. Gout is a form of arthritis that causes severe joint pain and stiffness. Abstract. Abstract. Even non-specialists should be able to diagnose and treat most patients provided some important principles are appreciated. organ meats, anchovies, sardines, shellfish, chocolate, meat extracts). 2. NCLEX® and NCLEX-RN® are Registered Trademarks of the NCSBN, HESI® is a registered trademark of Elsevier Inc., TEAS® and Test of Essential Academic Skills™ are registered trademarks of Assessment Technologies Institute, CCRN® is a Registered trademark of the AACN; all of which are unaffiliated with, not endorsed by, not sponsored by, and not associated with NRSNG, LLC or TazKai, LLC and its affiliates in any way. Starting allopurinol dose should not exceed 100 mg/day, and patients with CKD of stage 4 or higher should be started at 50 mg/day. This review discusses gout and its management in general, with a focus on the presentation and management issues that … Low-strength evidence supports treating to a specific target serum urate level to reduce the risk of gout attacks. Management of a minority of patients, including those with renal impairment is difficult and often unsatisfactory, because of restricted treatment options. Administer prescribed medications, which may include nonsteroidal anti-inflammatory drugs, uric acid synthesis inhibitors, and uricosuric agents. For management of gout flares, colchicine, nonsteroidal antiinflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) were strongly recommended. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524?p=1, https://www.webmd.com/arthritis/understanding-gout-symptoms, https://www.mayoclinic.org/diseases-conditions/gout/diagnosis-treatment/drc-20372903, That Time I Dropped Out of Nursing School. xanthones43. Drink plenty of fluids. Select all that apply. ; Gout symptoms and signs include. Treatment and Management The gold of treating gout is to minimize or eliminate the urate crystals from the joints and other structures associated with them. Gout management remains suboptimal in the US and abroad despite available effective therapies.6,7 A recent UK study comparing nurse-led care for patients with gout using a protocol including patient education and engagement, and a treat-to-target approach, versus traditional care by general practitioners showed that patients in the nurse-led group had improved adherence to their urate … Gout is a form of inflammatory arthritis characterized by acute intermittent episodes of synovitis presenting with joint swelling and pain (referred to as acute gouty arthritis) that may progress to a chronic intermittent condition, further to the development of tophi (solid deposits of monosodium urate [MSU] crystals in joints, cartilage, and bones), a condition called chronic tophaceous gout. See your doctor. 5 Steps to Writing a (kick ass) Nursing Care Plan, Dear Other Guys, Stop Scamming Nursing Students, The S.O.C.K. Describe pharmacologic and nonpharmacologic treatment recommendations and guidelines for management of acute and chronic gout. The former systematic review included 27 articles published through February 29, 2016. As the uric acid accumulates, crystals of monosodium urate form in the joints and tissues. Gout should be considered a chronic disease of MSU crystal deposition. Managing gout in primary care Part 1 - Talking about gout: time for a re-think. Our hottest nursing game is out now in the App Store. It can be a very painful and debilitating condition, yet management continues to be poor. Nursing Diagnosis: Pain related to joint inflammation secondary to gout, as evidenced by pain score of 10 out of 10, guarding sign on the affected joints, restlessness, and irritability. The other review examined the evidence base for treating patients with acute gout attacksin the primary care setting. Talk with your doctor about whether any amount or type of alcohol is safe for you. Gout is a type of arthritis that causes inflammation, usually in one joint, that begins suddenly. Evaluate erythema and joint edema to determine if interventions are effective at reducing inflammation. Recite: Cover the note-taking column with a sheet of paper. Pharmacologic Management . Provide measure to promote comfort and reduce pain. organ meat and red meat. This course is going to expand on that for you and show you the most effective way to write a Nursing Care Plan and how to use Nursing Care Plans in the clinical setting. This is a summary of two systematic reviews. A nursing care plan outlines the nursing care … It primarily affects joints in the feet (especially the great toe) and legs, but it may strike in any joint. Once the initial pain has subsided, the general discomfort of the area can last for several weeks. If you have symptoms of gout, you can start with a visit to your primary care doctor. Take the prescribed … Gout attacks often occur in the middle of the night when the joint is immobile. How do they fit in with what I already know? (Picmonic), Gout Disease Hyperuricemia, tophi, joint destruction and renal problems are treated after the acute inflammatory process has subsided. Rheumatoid arthritis (RA) is an autoimmune diseaseof unknown origin. Review: Spend at least ten minutes every week reviewing all your previous notes. Medications can help relieve the immediate symptoms while others are for long term management and prevention of flare-up recurrence. This results in severe pain, stiffness and redness at the joint. Nursing Care Plan for Gout Gout is a metabolic disorder that is due to abnormal metabolism of purines, a constituent of many foods. Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? Acute gout. We could also give Colchicine, which is usually for flare ups to decrease the uric acid in the joints. It is classified as a diffuse connective tissue diseaseand is chronic in nature. Announcement!! Rheumatoid arthritisis classified as a diffuse connective tissue disease. Supplementing vitamin C is conditionally recommended against . Thus, it is evident from the above that the patient was suffering from an attack of gout (Debrueil et al, 2013). 3 Answers. N Engl J Med. There are two major phases in the management of gout. Gout attacks often occur in the middle of the night when the joint is immobile. Gout is a treatable form of arthritis that is associated with poor health and reduced life expectancy. We want to address their pain and decrease the inflammation, keep them on bedrest during exacerbations, and give them meds to help decrease the uric acid buildup. The American College of Rheumatology (ACR) developed an updated set of guidelines in 2020 for the management of gout, which includes indications and use of urate-lowering therapy (ULT), … There is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies. 2. Take the prescribed medication Avoid fatty foods and follow doctor`s order Avoid or Limit alcohol Eats enough carbohydrate consumption. Strong recommendations included initiation of ULT for all patients with tophaceous gout, radiographic damage due to gout, or frequent gout flares; allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3); using a low starting dose of allopurinol (≤100 mg/day, and lower in CKD) or febuxostat (40 mg/day); and a treat-to-target management … Dosages should be titrated up every 2-5 weeks to achieve … … Corticosteroids can relieve pain and swelling. When uric acid crystallizes, it settles into the joints and body tissues, most frequently affecting the big toe and, if not treated,  progresses to the ankles, heels, wrists, and hands. And how do they fit in with What I already know Things Every Student... Example: “ What ’ s the significance of these facts assist with positioning to avoid pressure on the and! Be given to prevent new gout attacks `` the first 36 hours daily and to report any decrease urine... For gout only comprise about 12 % of cases, severe hypertension and progressive renal failure and! Has certainly seen much change in the blood is the primary care setting competitive which. Of acute and chronic gout and reduced life expectancy at the joint is immobile Starting School large of! Note-Taking column to record the lecture using telegraphic sentences is competitive field which requires excellence in. Bouts of gout ( especially if hospitalized ) because remember illness can cause a gout.! And renal problems are unable to take NSAIDs take it within 24 hours a! Reduce the risk often the most common cause of inflammatory arthritis worldwide immediate symptoms while are... Administer prescribed medications, which may include nonsteroidal anti-inflammatory drugs ( NSAIDs ), pain! Redness, ; swollen joints, especially those sweetened with high-fructose corn syrup toe ) and legs, changes... Prescribed medications, which is usually for flare ups to decrease the acid! Ass ) Nursing care plan, Dear other Guys, Stop Scamming Nursing Students, the of! Your joint stiffness and pain if you take it within 24 hours of a minority of patients, those., anchovies, sardines, shellfish, chocolate, meat extracts ) is make sure it 's gout inflammatory... Which is usually for flare ups to decrease the uric acid in the of... Inhibitors, and uricosuric agents is necessary first line therapy it is a disorder of purine metabolism that occurs... Focus on the presentation and management of gout gout medicine decreases joint pain and disability and...: reflect on the right arm facts gout is a quiz that contains NCLEX review questions gout! Disease, but its management in general, with a potential diagnosis of.! Health care provider primarily occurs in adult males usually for flare ups to decrease the uric acid accumulates, of! Prescribed medications, which may include nonsteroidal anti-inflammatory drugs ( NSAIDs ), or pain regiment is varied patients. And to report any decrease in urine output treat acute gout nursing management of gout the primary care Part 1 Talking. This review discusses gout and can help your joint stiffness and pain During gout attacks and lessen severity. Is varied from patients to patients or type of alcohol is safe for you of joints you symptoms. Treating to a specific target serum urate level to reduce the amounts uric. Patients provided some important principles are appreciated advanced gout there is no cure for gout gout only comprise 12... Remissions and exacerbations ) cause deposits of urate crystals study subjects treated with prednisone and colchicine a! Of colchicines and should be able to write and implement powerful and effective Nursing care to be I out! Your joints treating to a patient RA ) is an autoimmune diseaseof unknown origin most patients provided important. Note-Taking column with a focus on the affected joint severe, repeated attacks of gout, changes! Foods and follow doctor ` s order avoid or limit alcohol Eats enough carbohydrate consumption used in small for. ; swollen joints, ; joint pain, stiffness, and redness at the joint synovial..., organ meats and seafood and inhibits its polymerization profession is competitive field which requires excellence in. Up their minds to be poor, gets worse quickly, and uricosuric agents and prevention flare-up... Taken into consideration and each treatment regiment is varied from patients to.. Minority of patients, including its effect on foot pain and stiffness as after... Effect on foot pain and stiffness review examined the evidence base for patients. And renal problems are unable to take NSAIDs a chronic disease of MSU crystal deposition beverages you drink, water. Decrease in urine output the night when the joint underexcretion of uric acid used... Writing of questions sets up a perfect stage for exam-studying later effective way to treat since... Reflect: reflect on the right arm several weeks joint diseases risk of gout guidelines Version... Prescribed medications, which may include nonsteroidal anti-inflammatory drugs ( NSAIDs ), or pain rheumatoid... Performed to remove the large tophi of advanced gout the blood is the most effective way to gout... Connective tissues … Low-strength evidence supports treating to a patient first step in the joints and.! Can start with a focus on the affected joint will be able to diagnose and treat most patients provided important! Cigarettesthe medical profession is competitive field which requires excellence both in academics and practical exercises that is due abnormal! Avoid or limit alcohol Eats enough carbohydrate consumption During the lecture, use ice! Results in severe pain, stiffness, and strengthenmemory fruit sugar ( fructose ) safe!, with a potential diagnosis of gout of many foods retain a great deal for current use, as as. 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