Understanding Gout: Gout
Gout is considered a form of crystal deposition arthritis, hence 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 deposits into joints and certain subcutaneous spaces in the body. To understand the way that acute gouty attacks occur, let's use a simple example;
Treatment of recurrent attacks includes the modifications in diet as previously talked about as well as 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 address are things such as; diet, weight, way of life issues, hypertension, dehydration, etc. These, and more, could all assist trigger gout attacks. Take diet for example...
- Sometimes though, our kidneys aren't working to their fullest extent so that you end up with an excess of uric acid.
- Other times, the body is actually generating too much uric acid for your renal system to deal with, even working from 100% efficiency.
- In either case you can end up with high acid levels in the blood, eventually leading to gout attacks.
Acute Gouty Attacks Occur in Much the Same Manner
Most acute gouty attacks occur in the late hours of the night. As we sleep, our bodies often focus on the primary metabolic functions like 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 an acute gouty attack. Pain results from the crystals that form within a joint. Range of motion of the joint results in severe pain and inflammation.
Some new drugs with regard to the treatment of gout include febuxostat (Uloric) which has been available since 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 FDA approved pegloticase for treatment of gout patients who cannot tolerate or do not respond to conventional therapy. Peglioticase is actually given every two weeks by intravenous infusion. Nausea, vomiting and allergic reactions have been reported as side effects.
Understanding Gout Treatment
So, how can you get rid of gout? Well, you can go the mainstream route which would be to take anti-inflammatory drugs for the pain and irritation, 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 are as bad as, or even worse than, the pain of their gout.
- 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 dramatic results but carries severe side effects which include nausea as well as severe diarrhea.
- Colchicine is dosed once every 2 hours until the desired (or undesired) effects are achieved.
Differential Diagnosis: The differential diagnosis for this condition should include;- fracture osteoarthritis infection of the joint rheumatic fever
Individuals who have had acute gouty attacks should restrict their intake of these foods. This does not mean that they need to totally 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 to excrete uric acid. Factors that influence normal renal function may result in 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 tension, exhaustion, infection or the use of penicillin.
What are the symptoms of Gout? The symptoms 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 additional 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 high in purines such as 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 ate the most red meat or seafood elevated their risk of gout by as much as 50%. 6 Many gout attacks improve within a few days, even without treatment, and they may not recur for many months or years.
Gout occurs when too much uric acid builds up in the blood and uric acid crystals precipitate in the cooler parts of the body such as 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 concentration exceeds 7 mg/dL, crystals of monosodium urate start to form in the tissues. This condition is known as hyperuricemia.
- 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.
- Our kidneys normally process the excess uric acid and flushes it from the body by way of urine.
Allopurinol, probenecid, and 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 episodes 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 produced, but they may cause nausea or skin rashes as side effects.
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 medications, with their unpleasant side effects...
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 deposits come from? They're formed when you have higher-than-normal levels of uric acid in your blood vessels. This condition is called 'hyperuricemia.'
Food contains organic chemical compounds known as 'purines.' These also exist in our bodies and type a very important part of the metabolizing procedure. But as they breakdown during this process, they produce uric acid. So if you eat foods that are high in purines, the risk of gout is a lot higher.
Gout is a type of arthritis that causes recurrent 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). Data indicate that gout affects around 3.5 million people in the United States. Gout is commonly seen in those with ages 50 plus, rarely affecting young adults and children. Although gout can occur in both genders, the disease has the highest incidence in men.
Treatment of Gout and Gouty Arthritis
The most significant consideration in treatment is the frequency of attacks. Frequent episodes (more compared to 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 medication should be taken to lower levels of serum uric acid.
- Symptoms: The symptoms of gout usually appear through the night are available 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 described as crushing and excruciating.
- Attacks tend to last several days.
- And there are many 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 in order to go into here.
So next, to complete your understanding of gout so that you can prevent further attacks, please now go to http://gout-relief-today.blogspot.com where you will also discover a remarkably simple 2 hour gout remedy.
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.
Order to prevent the build up of uric crystals inside the body, gout sufferers are encouraged 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 by people who suffer from gout. Gout sufferers should also limit their intake of simple carbohydrates (sweets), as they also facilitate the progression of the disease.
Heavy red meats such as sausage liver, kidney, tongue, center and additional foods including nuts, alcoholic beverages, Dairy products including milk, ice cream and cottage cheese.
- Uric acid is measured in the serum (liquid) component of our blood.
- Normal levels for men are less that 7mg/dl of serum and somewhat less for nearly all women.
- This level tends to rise in women following menopause.
- The vast majority of gout patients are usually men.
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 dissolve. When the water was close to a boil and saturated with sugar, we'd remove it from the heat and allow the sugar to crystallize on a string as the water cooled.
- High levels 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 in the following foods;
Is it Gout Understanding Classification and Differential Diagnosis
Introduction to GOUT. More of this can be found at http://www.thegoutacademy.com/medicaltheaters.aspx.
Read more on Home remedies for Joint Pain and Home remedies for Sciatica and also visit on Baba Ramdev Medicines Corticosteroids, such as prednisone, are recommended for severe cases of gout. Even though 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 per year because of the side effects.
Gouty Arthritis can be Visualize on 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 build up 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.
Understanding Natural Gout Remedies
One of the most important things to do is to avoid high purine foods. Typical foods to avoid are such things as red meat, game, organ meat, poultry, sea food, 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.
But it is very important to address the underlying issues, because recurring gout attacks can eventually lead to permanent joint harm as well as kidney problems, such as excruciating kidney stones...
- 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 due to under-excretion of uric acid on the premises of kidney dysfunctions.
- Nevertheless, the intake of purine-rich foods greatly plays a role in the development of gout as well.
- Thus, food regimens considerably effect the event and the progression of the disease.
Gout Diets 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 a minimum of two liters of pure water or perhaps unsweetened, non-alcoholic beverages each day.
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 ongoing treatment and need to respect a correct long-term meals regimen. It is important to note that which 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.
But, apart from that, drug-based therapy 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 thus gout attacks.
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How is Gout Diagnosed? Gout is identified based on family history, specific signs and 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.
How is Gout treated? Because gout episodes are so painful, patients demand 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 range from 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 medications can cause stomach pain, bleeding and ulcers, and beyond a certain dosage, they do not provide additional relief.
- Gout diet should contain complex carbohydrates (potatoes, rice, whole cereal products, pasta), green vegetables and fresh fruits.
- Low-fat milk products such as skim-milk as well as 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 recommended to all people affected by gout.