Gout

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           Gout is a form of acute arthritis that causes severe pain and swelling in the joints. It most commonly affects the big toe, but may also affect the heel, ankle, hand, wrist, or elbow. It affects the spine often enough to be a factor in lower back pain. Gout is often a recurring condition. An attack usually comes on suddenly and goes away after 5–10 days. Gout occurs when there are high levels of uric acid circulating in the blood, and the acid crystallizes and settles in the body.

Classification–

  1. Acute gout

It is a painful condition that typically affects one joint.

  1. Chronic gout

It is repeated episodes of pain and inflammation, which may involve more than one joint.

      CAUSES––

  1. Uric acid (High production and low excretion)
  2.  Hereditary (male gender)
  3. Alcohol(especially beer)
  4. Obesity
  5. Diets (red meats, internal organs, yeast, oily fish)
  6. Menopause(women)
  7.  Trauma
  8. Dehydration
  9. Starvation
  10. IV contrast dyes
  11. Chemotherapy
  12. Medications
    1. diuretics
    2. aspirin
    3. nicotinic acid
    4. cyclosporin A

      Symptoms And Signs–               

A.  Asymptomatic stage

  1. Urate levels rise in the blood
  2. No symptoms

B. Acute stage

      1. Symptoms usually lasting 5-10 days
      2. Sudden attack of joint pain
      3. Swelling
      4. Joints feel hot, tender
      5. Joint looks dusty red or bruised

C.  Inter-critical stage

  1. Symptom-free intervals between gout episodes.
  2. 2nd attack from 6 months- 10 years.(varies from person to person)

D.  Chronic stage

  1. Persistently painful joints with large urate deposits in the cartilage, membranes between the bones, tendons and soft tissues
  2. Skin over the deposits develop sores and release a white pus
  3. Joint stiffness
  4. Limited motion of affect joint

INVESTIGATIONS—

  1. Synovial fluid analysis
  2. Uric acid – blood
  3. Joint x-rays
  4. Synovial biopsy
  5. Uric acid – urine

TREATMENT—                    

  1. Nutritional supplements
    1. Vitamin E
    2. Selenium
    3. Folic acid (inhibit xanthine oxidase)
    4. Amino acids (daily)
    5. Bromelain(effective anti-inflammatory
    6. Quercetin(bioflavonoid)

2. Ayurvedic Medications

3. Surgery

         Required for un-dissolvable Tophi

COMPLICATIONS—

  1. Chronic gouty arthritis
  2. Kidney stones
  3. Chronic kidney failure

Prevention —

  1. Reduce weight
  2. Avoid alcohol(especially beer)        
  3. Switch over to another anti-hypertensive, if taking diuretics
  4. Avoid consumption of saturated fats and refined carbohydrates
  5. Drink 10 to 12 eight-ounce glasses of non-alcoholic fluids daily.
  6. Avoid Vitamin C
  7. Avoid or restrict foods high in purine
    1. Sardines
    2. Anchovies
    3. Brains
    4. Liver
    5. Kidneys
    6. Sweetbreads
    7. shellfish (mussels and oysters)
    8. fish roe
    9. scallops
    10. peas
    11. lentils
    12. beans
    13. Excessive amount of red meat.

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