Understanding Gout: Gout
Gout is considered a form of crystal deposition arthritis, and so the name, gouty arthritis. Uric acid, a chemical that is found in the serum component of our blood, is the key to understanding gout. Excessively high amounts of uric acid lead to the deposition of monosodium urate crystals into joints and certain subcutaneous spaces in the body. To understand the way that acute gouty attacks occur, let's use a simple example;
But, apart from that, drug-based treatment only works whilst being taken. Once stopped, there is nothing to prevent recurring gout, unless you address the fundamental issues that can help trigger the conditions that give rise to high uric acid and so gout attacks.
Order to prevent gout you really need to understand gout. Here is a simple explanation of what it is and how you can stop recurring gout quite naturally, without resorting to drug-based drugs, with their unpleasant side effects...
Example - As children, we would make our own rock candy. We'd get a pot of water and begin to heat it on the stove. As the water warmed, we'd add sugar. The hotter the water became, the more sugar we could break down. When the water was close to a boil and saturated with sugar, we would remove it from the heat and allow the sugar to crystallize on a string as the water cooled.
Gouty Arthritis can be Visualize Upon X-Rays After Several Attacks
The bone adjacent to the joint becomes eroded with a characteristic punched out lesion referred to as a Martel's Sign or 'rat bite sign'. The erosion is very distinctive and represents a pocket of gouty tophi. Tophi would be the accumulation of monosodium uric acid crystals. Tophi are often found in joints but may also be found at extensor surface (back) of the elbow, the rim of the ear and at the back of the heel. When viewed surgically, tophi appear to have the same consistency of cottage cheese.
Order in order to prevent the build up of uric crystals inside the body, gout sufferers are advised to limit the intake of foods that contain high levels of purine. A gout diet should completely exclude organ meats (heart, liver, kidneys), and seafood (shrimps, mussels), as they are very rich in purines. Try to replace these foods with small portions of boiled, steamed, grilled or roasted white meat. It is essential in order to avoid frying your meals, as greasy foods are not well tolerated through people who have problems with gout. Gout sufferers should also limit their intake of simple carbohydrates (sweets), as they also facilitate the progression of the disease.
- Okay, so where does the uric acid come from then?
- Uric acid is found naturally in all of us and is actually a byproduct of our body's own metabolization process.
- The kidneys normally process the excess uric acid and flushes it from the body via urine.
- And there are lots of other natural ways to deal with gout symptoms.
- For example you can use herbs, specific fruits, natural supplements, homeopathic remedies, acupuncture, acupressure, and so on.
- There are just too many to go into here.
What are the symptoms of Gout? The the signs of gout are redness of a joint, associated with inflammation, stiffness, and intense pain. Many people experience their first gout attack in the big toe, but other joints such as the ankles, wrists, fingers, or elbows may be affected. The pain may be so severe in which even the pressure of bed sheets may be intolerable. A gout attack can be brought on by alcohol, or foods an excellent source of purines for example shellfish, caviar, sardines, anchovies, meats, or organ meats that are commonly used in sausages. A study over a 12-year period of 47,000 adult men revealed that those who consumed the most red meat or seafood elevated their risk of gout by as much as 50%. 6 Many gout attacks get better within a few days, even without treatment, and they may not recur for many months or years.
Differential Diagnosis: The differential diagnosis for this condition should include;- fracture osteoarthritis infection of the combined rheumatic fever
Understanding Gout Causes
The symptoms of gout are caused by urate crystals that have formed over time in your joints and associated tissue. So where do these types of deposits come from? They are formed when you have higher-than-normal levels of uric acid in your blood vessels. This condition is called 'hyperuricemia.'
Heavy red meats such as sausage liver, kidney, language, center and additional foods including nuts, alcoholic beverages, Dairy products including milk, ice cream and cottage cheese.
Food consists of organic chemical compounds called 'purines.' These also exist in our bodies and type a very important part of the metabolizing procedure. But as they breakdown throughout this, they produce uric acid. So if you eat foods that are high in purines, the chance of gout is a lot greater.
Gout Diet Programs Work on Multiple Levels
Their main goals are to lower serum uric acid levels and to reduce the dietary intake of purines. In order to reduce serum uric acid levels, gout sufferers need to help their organism excrete this substance from their system. Individuals with gout should drink at least two liters of pure water or perhaps unsweetened, non-alcoholic beverages each day.
Read more on Home remedies for Joint Pain and Home remedies for Sciatica and also visit on Baba Ramdev Medicines Corticosteroids, like prednisone, are recommended for severe cases of gout. Although these steroids can provide relief, they also have serious side effects, including thinning bones, poor wound healing, plus a weakened immune system. Cortisone injections into an impacted joint are generally limited to no more than three each year because of the side effects.
Gout is a type of arthritis that causes repeated joint pain, inflammation and swelling. Although the symptoms of gout are usually perceived in the lower regions of the body (big toe, heels, ankles, knees), they may appear in regions of the upper body as well (shoulders, elbows, wrists and fingers). Statistics indicate that gout affects around 3.5 million people in the United States. Gout is commonly seen in those with ages 50 plus, hardly ever affecting young adults and children. Although gout can occur in both genders, the disease has the highest incidence in men.
- High amounts of uric acid result from high levels of consumption or low levels of excretion of purines.
- The inability to metabolize purines may be inherited or acquired.
- Purines are protein components in foods in which are simply commonly within the next foods;
Gout occurs when too much uric acid builds up in the blood and uric acid crystals precipitate in the cooler parts of the body like the joints of the hands or feet. High levels of uric acid may also build up as lumps under the skin known as tophi, or as kidney stones. Uric Acid is a waste product of the oxidation of purines which are constituents of nucleic acids such as Dna. Uric acid is normally excreted in the urine to maintain a concentration of uric acid in the blood vessels of around 4 mg/dL. When the focus exceeds 7 mg/dL, crystals of monosodium urate start to form in the tissues. This condition is known as hyperuricemia.
Individuals who have had severe gouty attacks should restrict their intake of these foods. This does not mean that they need to completely eliminate these from their diets, but rather consume them with moderation. The serum level of uric acid is also significantly influenced by the ability of the kidney in order to excrete uric acid. Factors that influence normal renal function may bring about limited excretion of uric acid. These factors include the use of thiazide diuretic therapy and renal failure. Other factors that may contribute to the onset of gout range from the stress of surgery, emotional stress, exhaustion, infection or the use of penicillin.
How is Gout treated? Because gout episodes are so painful, patients need some kind of gout treatment, despite the fact that the treatments for gout are not very effective and have undesirable side effects. The most common treatments include the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, indomethacin and naproxen. Aspirin is not used because it aggravates hyperuricemia by improving uric acid retention. 17 These types of drugs can cause stomach pain, bleeding and ulcers, and over and above a certain dosage, they do not provide additional relief.
Treatment of acute attacks includes the use of non-steroidal anti-inflammatory medications such as Indocin or Clinoril. Control of pain may require a mild narcotic such as codeine. Other treatment may include Colchicine which yields spectacular results but carries severe side effects which include nausea as well as severe diarrhea. Colchicine is dosed once every two hours until the desired (or undesired) effects are achieved.
- Symptoms: The symptoms of gout usually seem through the night and come on like a freight train.
- The weight of the bed sheets is often intolerable.
- One joint or several may be involved.
- The most common site is the initial metatarsal phalangeal joint (big toe joint).
- The pain is referred to as crushing and excruciating.
- Attacks have a tendency to last a number of days.
Some brand new drugs with regard to the treatment of gout include febuxostat (Uloric) which was introduced in 2009 for the chronic management of hyperuricemia in patients with gout. It is a xanthine oxidase inhibitor that works by decreasing the amount of uric acid made in the body. Febuxostat must be taken daily and it may take several months before it begins to prevent gout attacks. As a side effect, febuxostat may cause increased levels of liver enzymes in the blood that may be a sign of liver damage.
Pegloticase (Krystexxa) is a urate oxidase enzyme that catalyzes the conversion of uric acid to be able to allantoin which is five to ten times more soluble than uric acid. In 2010, the actual FDA approved pegloticase for treatment of gout patients who can not endure or do not respond to conventional therapy. Peglioticase is actually administered every two weeks by intravenous infusion. Nausea, vomiting and allergic reactions have been reported as side effects.
But it is very important to address the underlying issues, because recurring gout attacks may eventually lead to permanent joint harm and even kidney problems, such as excruciating kidney stones...
Acute Gouty Attacks Occur in Much the Same Manner
Most acute gouty episodes occur in the late hours of the night. As we sleep, our bodies often focus on the primary metabolic functions such as digestion, breathing, etc. The extremities, such as the feet tend to cool as a result of this 'lack of attention'. As they cool, and also if the dissolved amount of uric acid is high sufficient, the result is actually an acute gouty strike. Discomfort results from the crystals that form within a joint. Range of motion of the joint results in severe pain and inflammation.
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How is actually Gout Diagnosed? Gout is identified based on family history, specific symptoms, and laboratory tests. Diagnosis of gout is confirmed by the determination of high levels of uric acid in the blood, monosodium urate crystals in the fluid of an inflamed joint, more than one attack of acute arthritis, and the involvement of only one joint such as the bottom, ankle, or knee.
Understanding Natural Gout Remedies
One of the most important things to do is to avoid high purine foods. Typical foods to prevent are such things as red meat, game, organ meat, poultry, seafood, legumes, etc. Typical food you can eat are things like; green leafy vegetables, fruit, foods high in vitamin C, essential fatty acids, complex carbohydrates, and so forth. And drink plenty of water in order to stay hydrated.
Allopurinol, probenecid, as well as colchicine are sometimes prescribed in daily doses to reduce the risk or lessen the severity of future episodes. Allopurinol blocks the formation of uric acid, probenecid decreases the regularity of attacks of gout by increasing the kidney's excretion of uric acid, and colchicine may relieve swelling and help alleviate problems with the frequency of gout attacks. These drugs speed the elimination of uric acid from the body, as well as they also slow down the rate at which it is created, nevertheless they may cause nausea or skin rashes as side effects.
Understanding Gout Treatment
So, how can you get rid of gout? Well, you can go the well known route which is to take anti-inflammatory drugs for the pain and inflammation, plus, drugs to reduce the uric acid if so prescribed by your doctor. These can work for a few people, but others discover that their nasty side effects tend to be as bad as, or worse than, the pain of their gout.
- The main cause of gout is the accumulation and deposition of uric crystals at the level of the joints and adjacent soft tissues.
- Uric acid is a waste product that results from purine metabolism.
- Most cases of gout occur because of under-excretion of uric acid on the premises of kidney dysfunctions.
- Nevertheless, the intake of purine-rich foods greatly contributes to the development of gout as well.
- Thus, food regimens considerably effect the event and the progression of the disease.
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Corroborated with an appropriate medical treatment, a healthy diet can reverse the undesirable effects of gout, also minimizing the risk of relapse. Due to the pronounced chronic character of the disease, gout sufferers require continuing treatment and need to respect a correct long-term meals regimen. It is important to note that that gout diets alone can't overcome the disease completely. In order to achieve a complete recovery, people affected by gout also need to make lifestyle improvements. If necessary, gout victims should take measures in slimming down, getting more physical exercise and reducing stressful conditions.
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- Uric acid is measured in the serum (liquid) component of our blood.
- Normal levels for men are much less that 7mg/dl of serum and somewhat less for most women.
- This level tends to rise in women following menopause.
- The vast majority of gout patients are usually men.
- Sometimes though, our kidneys aren't working to their fullest extent so that you end up with an excess of uric acid.
- In other cases, the body is actually producing too much uric acid for your renal system to deal with, even working from 100% efficiency.
- Either way you can end up with high acid levels in the blood vessels, eventually leading to gout episodes.
Treatment of repeated attacks includes the modifications in diet as previously talked about and the use of Allopurinal, an inhibitor of uric acid synthesis. Probenecid and sulfinpyrazone are also used to increase the output of uric acid by the kidney. Dosing and combination therapy depends upon the level of serum uric acid which is assessed periodically throughout therapy. Individuals prone to gouty attacks should also maintain a high fluid intake to promote the excretion of uric acid and decrease the tendency to form uric acid stones in the kidney and bladder.
Understanding the Underlying Issues
Typical issues that these drugs don't tackle are things such as; diet, weight, way of life issues, hypertension, dehydration, etc. These, and more, could all assist trigger gout attacks. Take diet plan for example...
About the author:Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.
Treatment of Gout and Gouty Arthritis
The most significant thing to consider in treatment is the frequency of attacks. Frequent episodes (more than one a year) will result in progressive erosion of the joint, leading to painful persistent arthritis. Isolated attacks (less that one a year) lead to small destruction of the joint. The frequency of gouty attacks determines whether treatment is merely for each attack, or whether daily medicine should be taken to lower levels of serum uric acid.
- Gout diet should contain complex carbohydrates (potatoes, rice, entire cereal products, pasta), green vegetables and fresh fruits.
- Low-fat milk products such as skim-milk and light yogurt can be safely included in any gout diet.
- By drinking two glasses of skim-milk each day, one can greatly reduce the frequency and the intensity of gout attacks.
- Low-fat dairy food can normalize serum uric acid concentration and therefore they are suggested to be able to all people affected by gout.