GOUT

General Infomation
Definition: 

Gout is a common form for arthritis caused by an excessive concentration of uric acid in the body fluids. Uric acid is produced from the metabolism of purines, substances found in food. The uric acid crystallizes in joints, tendons, kidney and other tissues and causes inflammation, tissue damage and pain. Gout mostly affects men between the ages of forty to fifty.

The first attack is usually characterized by intense pain involving only a single joint. The first joint of the big toe is affected in nearly half of the first attacks, and is involved at some time over 90% of individuals with gout .as the attack progresses, the joint swells; the skin over the joint becomes red, tight, shiny, and sensitive to the touch; and fever and chills develop. First attacks usually occur at night and are usually preceded by a specific event such as eating too much red meat, drinking too much alcohol, or taking certain drugs and vitamins (including several forms of chemotherapy and overdoses on niacin). Obesity and crash dieting are also associated with gout.

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The first attack is seldom the last. Most people who suffer a first attack will have another attack within a year. Affected joints can become immobile. Uric acid crystals form lumps in the kidney, and some degree of kidney dysfunction occur in nearly 90% of people with gout. There is also a greatly increased risk of kidney stones.

Conventional treatment uses various drugs to reduce both inflammation and uric acid production. Fortunately, gout can be treated very successfully with diet and life style changes supported by herbal therapy.

Symptoms: 

The Signs and Symptoms of Gout

The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:

Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first 12 to 24 hours after it begins.

Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.

Inflammation and redness. The affected joint or joints become swollen, tender and red.

When to see a doctor
If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.
Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.

Causes & Complication
Causes: 

Gout occurs when urate crystals accumulate around your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body — as well as in certain foods, such as organ meats, anchovies, herring, asparagus and mushrooms.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Complications: 

People with gout can develop more-severe conditions, such as:
Recurrent gout. Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout.
Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fi). Tophi usually aren't painful, but they can become swollen and tender during gout attacks.
Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Tests
Tests and Diagnosis: 

Tests to help diagnose gout may include:
Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
Blood test. Your doctor may recommend a blood test to measure the uric acid level in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.

Medication & Prevention
Lifestyle and Home Remedies: 


DIET RECOMMENDATIONS

- Eat a diet as low in purines as possible. While purines are found in all foods, it is especially important to limit protein intake. Completely avoid anchovies, bakers and brewer’s yeast, herring, mackerel, sardines, and shellfish. Reduce consumption of other high protein foods, such as meat, poultry, dried beans, and fish. Generally speaking, for a person weighing 150 pounds (70kgs), protein consumption should be limited to one 3-ounce (100-gram) serving of protein food daily. Also avoid asparagus and spinach.

- Eat a diet that emphasizes whole, unprocessed foods, including beans (up to two servings a day), nuts and seeds, vegetables, and whole grains.

- Eat cherries or take cherry extract. Eating half pound (225 grams) of canned or fresh cherries a day has been shown to be very effective means of preventing gout attacks. When fresh cherries are out of season, use cherry extracts or concentrates in tablet or tincture form, available from many health –food stores.it is likely that cherries inhibit compounds that cause inflammation. This reduces inflammation after uric acid builds up in a joint.

- To flush uric acid from the body, drink not less than eight glasses of water daily.

- Avoid alcohol, since alcohol increases uric acid production.

- Do not take more than 50 milligrams of vitamin B3 (niacin) or 3,000 milligrams of vitamin C per day. In excess, these vitamins compete with uric acid for excretion into the urine, and cause uric acid to accumulate in the body.

- Do not take aspirin or diuretics (water pills).these drugs can trigger a gout attack.

- Do not take supplements containing the amino acid glycine. Glycine can be converted into uric acid more rapidly in people who suffer from gout.

- Maintain a normal body weight. Obesity increases the risk of repeat gout attacks.

CONSIDERATIONS
- Allopurinol (zyloprim)reduces uric acid formation.it is a highly effective drug but it can produce severe side effects, such as fever, generalized rashes breakdown of red blood cells, and liver kidney problems. Another drug, colchicine, derived from the herb autumn saffron, eases acute gout attack and prevents future attacks. While often quite effective, it too can have serious side effects.

- Gout can be a sign of lead poisoning. Make sure you are not using serving dishes or pitchers fired with a lead glaze for anything other than decorative purposes. When acid foods touch the lead glaze, toxic lead leaches out into the food, and can promote uric acid formation in the body. A home lead-testing kit is available from the lead tester.

Alternative Medicine: 

Beneficial herbs.
1. Bilberry - provides powerful antioxidant compounds
Form and dosage
Extract; take as directed on the label.

2. Bromelain - dissolves uric acid crystals. Brings relief to a joint also inflamed by injury.
Form and dosage
Tablets; take 250-500 mg 3 times daily between meals.

3. Celery seed - contains numerous anti- inflammatory compounds
Form and dosage
Take as directed on the label.

4. Devil’s claw - relieves short-term pain and inflammation
Form and dosage
Enteric-coated capsules; take 1,000-2,000 mg 3 times a day for up to 3 weeks.

5. Iporuru - stops acute inflammation
Form and dosage
Tincture; take as directed on the label.

6. Quercetin -keeps uric acid from forming
Form and dosage
Tablets; take 125-250 mg 3 times daily, between meals.

7. Sarparilla- reduces long term frequency of gout attack
Form and dosage
Capsules; take 3,000 mg 3 times daily.

Precautions for the use of herbs;
• People who are allergic to pineapple may develop a rash from bromelain.if itching develops, stop using it
• Devil’s claw can slow the heartbeat.do not use it if you have congestive heart failure.
• Do not use quercertin if you are taking cyclosporine (neoral, sandimunne) or nifedipine.

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By Anonymous on 25 April 2011

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