Gout

Gout is a condition in which the level of uric acid increases in the body and crystals of urate get deposited in the joints resulting in joint inflammation.

gout

It is a chronic and progressive disease. Hard lumps of uric acid gets deposited in and around the joints in case of chronic gout and results in destruction of joint, decrease in kidney function and formation of kidney stone.

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Characteristic symptoms of gout are painful, swollen; red and hot joints especially big toe.
It is more common in men. Women get affected after menopause.

Basics:
In gout the uric acid gets accumulated in blood and tissues. The urate salts precipitate and form crystals.
Classification of Gout

• Asymptomatic hyper-uricemia:
Level of uric acid increases in blood but produces no symptoms.

• Acute gouty arthritis:
Uric acid crystals get deposited in the joint spaces and acute symptoms appear. Joint gets swollen with throbbing pain. Patient will develop fever with chill. The inflammation may travel into the ankle and underneath of the foot.

• Intercritical gout:
Acute symptoms subside with no pain or discomfort and joints function normally.

• Chronic tophaceous gout:
Permanent damage to affected joints as well as kidney damage occurs. Formation of tophi also occurs in joints.

Mortality of Gout

Acute attack of gout is a benign condition.

commonly seen in ?

It is prevalent between 30-60 years of age, males are at more risk.

Causes of Gout

There is a disturbance in Purine metabolism of the body. Uric acid is a waste product of the body, which is produced as a result of breakdown of Purine in the body. Most of the time uric acid dissolves and goes into the urine via the kidneys. However, if the body is producing too much uric acid, or if the kidneys are not excreting enough uric acid, it builds up. The accumulation results in sharp urate crystals which look like needles. They accumulate in the joints or surrounding tissue and cause pain, inflammation, and swelling.
Factors that increase the uric acid level in the body are:
• Obesity.
• Excess alcohol.
• Diet rich in purine foods, such as seafood and meat.
• Diets low in calories.
• Regular use of diuretic medicines.
• Medicines taken by transplant patients, such as cyclosporine.
• Rapid weight loss.
• Chronic kidney disease.
• Hypertension.
• Psoriasis.
• Tumors.
• Myeloma.
• Hemolytic anemia.
• Lead poisoning.
• Hypothyroidism.
• Surgery.

Signs and Symptoms of Gout

• Severe pain in the joints:
Pain in ankles, hands, wrists, knees or feet. Big toe is most commonly affected.

• Itchy and peeling skin:
After the symptoms of gout subside the skin around the affected area peel off and becomes itchy.
• Redness and inflammation of affected part.
• Fever.
• Loss of flexibility of the affected joint.

• Nodules – gout may first appear as tophi (nodules) in the elbows, hands, or ears.

Differential diagnosis of Gout

• Cellulitis.
• Tenosynovitis.
• Bursitis.
• Arthritis.
• Nephrolithiasis.
• Paronychia.

Investigations for Gout

Tests that help in diagnosis gout are:
• Joint fluid analysis. Fluid is drawn from the affected joint using a needle. When examined under the microscope, the fluid may reveal uric acid crystals.
• Blood test to check for uric acid level in blood.
• X-rays to see joint damage.

Treatment for Gout

• Nonsteroidal anti-inflammatory drugs.
• Colchicine.
• Corticosteroids.

Diet / management of Gout

• Keep the swollen joint elevated above chest as much as possible.
• Ice packs can be helpful in relieving pain and reducing inflammation.
• Adequate hydration should be maintained to minimize the frequency and intensity of attacks.
• Avoid alcohol.
• Have a moderate amount of protein.
• Limit your daily intake of meat, fish and poultry.
• Slow exercises.

Diet:
• Low fat containing dairy products.
• Fresh vegetables.
• Fresh fruits.
• Grains.
• Avoid alcohol, meat, seafood, junk food.
• Apples, banana, cucumber and garlic.
• Adding folic acid and vitamin C in diet.
• Drinking plenty of water.
• Avoiding drugs.

Prognosis of Gout

Treatment of acute attack gives good results. It can advance to chronic gout.

Complications of Gout

• Kidney stones.
• Gouty arthritis.
• Chronic kidney failure.

Homeopathic treatment for Gout

Actaea spicata
• Swelling of joints after slight fatigue.
• Pain as from paralytic weakness of hands.
• Great stiffness of joints after rest.
• Small joints swell after walking.

Arnica montana
• Inflamed joint shines, red and hard.
• Constant fear of being touched.
• Pains unbearable during night.
• Bed feels too hard.
• Sensation as if the foot were compressed by a hard body.

 Colchicum autumnale
• Shifting pain with burning and tearing.
• Aggravation from any external impression, noise, odor, touch or bright light.
• oedema and coldness of legs and feet, with weariness, heaviness and inability to move.
• Urine dark and scanty.

Kalium carbonicum
• Tearing pains in small articulations and in big toe.
• Migraine with nausea.
• Anorexia or bulimia.
• Urine red, smarting pain, with brick dust sediment.

Lycopodium clavatum
• Formation of tophi.
• Nocturnal pains, muscular contractions, drawing, tearing in the limbs at night and on alternate days.
• Muscles and joints rigid, painful, with numbness.
• Finger-joints inflamed; also with arthritic nodes, swelling of the dorsa of the feet.
• Frequent belching without relief.

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