Gout results in an inflammation of the joint. This is due deposition of uric acid crystals in the joint spaces and or in the connective tissue of the joints.
Gout has four distinct stages:
Asymptomatic: High levels of Uric acid in blood but no joint complaints
- Acute phase: Acute complaints pain and swelling occur for a brief period
Intercritical phase: There is no pain or swelling of joints in this phase, the patient is relatively symptom-free.
- Chronic: Gout attacks may become frequent during this phase and the condition may affect many joints at a time (polyarticular). Tophi formation may also be seen.
Pathology:
Gout is a disorder of purine metabolism, and occurs when its final metabolite, uric acid, crystallizes in the form of monosodium urate, precipitating in joints, on tendons, and in the surrounding tissues. These crystals then trigger a local immune-mediated inflammatory reaction, with one of the key proteins in the inflammatory cascade being interleukin 1?.
Causes:
If parents have gout, then children have a 20% chance of developing it.
Intake of alcoholic beverages, especially beer, increases the risk for gout.
Diets rich in red meats, internal organs, yeast, and oily fish increase the risk for gout.
Uric acid levels increase at puberty in men and at menopause in women, so men first develop gout at an earlier age (after puberty) than do women (after menopause).
Attacks of gouty arthritis can be precipitated when there is a sudden change in uric acid levels, which may be caused by
overindulgence in alcohol and red meats,
trauma,
starvation and dehydration,
IV contrast dyes,
chemotherapy,
medications,
diuretics and some other anti-hypertensive medications,
aspirin (Bayer, Ecotrin),
nicotinic acid (B-3-50, B3-500-Gr, Niacin SR, Niacor, Niaspan ER, Slo-Niacin),
Cyclosporin A,
allopurinol (Zyloprim) and probenecid (Benemid),
Medical conditions such as Metabolic syndrome, a combination of abdominal obesity, hypertension, insulin resistance, and abnormal lipid levels, occurs in nearly 75% of cases
Sign and symptom
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.
Complication
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. Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the back of your ankle. 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
Treatment for gout
Drugs used to treat acute attacks and prevent future attacks include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs may control inflammation and pain in people with gout. Doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks. NSAIDs carry risks of stomach pain, bleeding and ulcers.
Colchicine
If one is unable to take NSAIDs, doctor may recommend colchicine (Colcrys), a type of pain reliever that effectively reduces gout pain — especially when started soon after symptoms appear. The drug’s effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea.
After an acute gout attack resolves, doctor may prescribe a low daily dose of colchicine to prevent future attacks.
Corticosteroids
Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into joint. Doctor might inject a corticosteroid medication during the same visit as a joint fluid test — where he or she withdraws (aspirates) fluid from joint with a needle. Corticosteroids are generally reserved for people who can’t take either NSAIDs or colchicine.
Side effects of corticosteroids may include thinning bones, poor wound healing and a decreased ability to fight infection.
Homeopathic medicines for gout
Benzoic acid:
This is used for gout, especially of the knee or big toe. Tearing and stitching pain in the affected joint, for acute rheumatism and gout with stiffness, swelling and lameness. Also, symptoms of gout associated with highly colored and offensive urine. Symptoms are worse in open air and from uncovering the affected parts.
Berberis vulgaris:
This remedy is indicated when there are sudden twinges of pain — stitching pains in gouty joints, which are worse from motion. The pains often radiate out from the affected part or move to a different area all together. The person has a tendency towards kidney stones and may ache all over. –
Urtica urens:
This remedy helps in the elimination of uric acid from the body. The patient has a tendency to gout and uric acid formations. The joint symptoms are associated with hive-like eruptions. There is pain in the shoulders (deltoid region), wrists and ankles. The patient is worse from exposure to cool moist air, snow-air, water and touch.Select the remedy that most closely matches the symptoms.
Colchicum:
Gout in the big toe or heel so painful that the person cannot bear to have it touched or moved. Joints are red, hot and swollen. The pain is often worse in the evening and at night. Pains are worse in cold, damp weather and flare-ups may occur with weather changes or in the spring. The person often has a feeling of internal coldness
Ledum:
This remedy is indicated when the gouty pains shoot through the foot, limb and joints – especially the small joints. The foot and ankle are extremely swollen. Cold or ice cold applications relieve the pain and swelling. –
Lycopodium:
This remedy is for chronic gout, with chalky deposits in the joints. There is a pain in the heels on treading, as from a pebble. One foot feels hot and the other cold. The urine is slow to produce and has heavy, red sediment. There may be a backache, which is relieved by passing urine. The right side of the body is particularly affected and all the complaints seem to be worse, especially between 4pm and 8pm.
Rhododendron:
This remedy can be useful for gouty swelling of the big toe joint that flares up before a storm. Other joints may ache and swell, especially on the right side of the body. Pain usually is worse toward early morning and after staying still too long. The person may feel better from warmth and after eating.
Calcarea fluorica:
When this remedy is indicated, the finger joints may become enlarged because of gout, and the knees and toes may be involved. Stabbing pain is experienced, and the joints may make a cracking sound on movement. Discomfort is worse during weather changes, and warmth may bring relief.
Belladonna
Symptoms that suggest this remedy are sudden onset. Joints are swollen, red, throbbing and extremely sensitive. It’s worse from touch and jarring. The person may feel restless, flushed and hot.
Arnica:
This remedy is used when the pain is sore and bruised, such as it hurts to walk. The person may be afraid to be touched or approached because of pain.
JAIN CLINIC
