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  Gout

Gout is a chronic, systemic disease that causes sudden and painful swelling, redness, inflammation and stiffness in joints, specifically the first joint of the big toe and the ankles.

Gout Joint pain
Gout


Cause
Gout is the result of excessive uric acid crystallizing into deposits (called tophi) that settle in joints. Uric acid is the result of liver processing of the organic compound purine. Purine is found in a variety of foods. Why there is an excess of purine is not exactly known. Either the liver is processing too much purine or the kidneys are not filtering enough from the blood stream.

Hyperuricemia is the medical term for too much uric acid in the body, specifically the blood stream. Hyperuricemia is considered a metabolic disorder, explaining the higher prevalence of gout in obese patients. Patients with chronic hyperuricemia may also have crystal deposits in other ears, including producing a kind of kidney stone.

High uric acid levels are not always present in individuals with gout – it is the settlement of the crystals in joints that causes a gout flare-up.

There is still a belief that gout is caused by excessive dietary indulgence and laziness. Many believe that gout is the result of several years of physical inactivity, a poor diet (lacking in purine neutralizing foods) and excessive alcohol consumption. Another theory is that individuals are genetically predisposed to gout, so regardless of their lifestyle – they will suffer from gout attacks.

Gout can also be a side effect or co-morbidity of other diseases. These diseases are including polycythaemia, leukaemia, intake of cytotoxics, obesity, diabetes, hypertension, renal disorders, and hemolytic anemia. Gout in this case is noted as secondary gout because the cause is a specific result of another condition.

Some diuretics have been blamed for bringing on gout attacks.

Stages

Gout has four distinct stages:

1. Asymptomatic,
2. Acute,
3. Inter-critical,
4. Chronic

During stage one blood levels of uric acid increase, but do not cause a Gout attack. Stage two is marked by a true gout attack, seventy-five percent of time it occurs in the big toe. The pain is so intense that the lightest of touch is excruciating. Severe attacks can last days or even weeks. The Inter-critical stage is the symptom-free period that can last years or months. Gout sufferers usually have their second attack between six to twenty-four months after the initial attack.

The chronic stage is when gout attacks occur frequently and in multiple joints at during the same attack. Large tophi or deposits can be found in more than one joint. In advance Gout cases, kidney damage, hypertension (high blood pressure) and kidney stones can also develop.

Diagnosis
Gout is diagnosed in a laboratory, with tests that will confirm the disease when it is suspected by a doctor or medical practitioner.

Hyperuricemia, elevated uric acid levels are a common feature to gout, though do not indicate that the individual will develop gout. Uric acid falls with in the normal range in two-thirds of gout patients. If gout is suspected uric acid levels are checked during the attack and repeated after the attack to compare levels. Other blood tests are usually ordered to rule out arthritis and specifically septic arthritis. These blood tests may include renal functioning, full blood count, electrolytes and ESR (erythrocyte sedimentation rate).

The absolute diagnosis of gout is determined from a microscopic observation of joint fluid sampled from the affected joint. It sometimes can be difficult to obtain fluid from the affected joint. A trained laboratory specialist will be able to recognize urate crystals in the joint fluid.

Treatment
Initial treatment for gout is pain management. Once a diagnosis has been made, drugs used to treat gout are non-steroidal anti-inflammatory drugs and intra articular glucocorticoids – via injection to the joint.

Because of the swelling, a gout patient may be tempted to apply ice, but this only increases the crystal concentration. Heat to the affected area will provide more relief because it will improve circulation.

Previously the drug of choice was colchicines, which impaired the mobility of uric acid granules and prevented the inflammation that begins with the gout attack. Colchicine is taken within the first twelve hours of the attack and relieves pain within the next forty-hours. Non-steroidal anti-inflammatory drugs that are purchased over the counter can provide temporary relieve to pain and swelling. Aspirin should not be used because it can worsen the condition. Anti-swelling hemorrhoid cream can be applied to swollen joints to reduce the swelling. Professional medical intervention is required for long term care of gout.

Prevention
For chronic gout, anti-hyperuricemic therapy is used. Dietary changes can reduce the levels of uric acid.

The dietary changes that are recommended are:

• Avoiding excessive alcohol consumption
• Avoiding high purine foods – meat, fish, dry beans (including peas and lentils), spinach, asparagus, cauliflower and mushrooms.
• Increasing fresh fruits and vegetables that neutralize purine in the digestive track such as cherries, strawberries and diluted celery juice.
• Drinking distilled water
• B-complex and C vitamins

One noted natural cure is a berry extract supplement that consists of blueberries, cherries or bilberries. The anthocyanides (which give the berries their bright colors) become anti-inflammatory.

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