Gout
3 Case Studies
2 Member Stories
12 Research

Gout is a common and complex type of arthritis that can affect anybody. Gout can't be cured, but it can be handled successfully. Prompt attention to diet and reducing uric acid levels will rectify a number of the issues associated with gout.

What is gout?

Gout is a common and complex type of arthritis that can affect anybody. It is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe. An attack of gout can occur suddenly, often waking you up in the middle of the night with the feeling your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it might seem excruciating.


Gout symptoms can come and go, but there are ways to manage symptoms and prevent flares.


Gout causes severe pain and swelling in the joints & is indeed a form of acute arthritis. It most commonly affects the big toe, but may also affect the heel, ankle, wrist, hand, or elbow. It also affects the spine and causes lower back pain. Gout is often a recurring illness. A gout attack can come suddenly and go after 5 - 10 days. Gout occurs when there are high levels of uric acid circulating in the bloodstream, and the acid crystallizes and settles in the body. According to the National Institutes of Health (NIH), gout accounts for about 5 percent of all cases of arthritis reported in the USA.

Gout seems to be on the rise in the American people. According to a study published in National Health and Nutrition Examination Survey (NHANES), acute gout, is the most common inflammatory arthritis in the United States (US), and affected 8.3 million Americans, based on data from the 2007–2008. Cases of gout doubled between 1969 and 1996, and then doubled again between 1990 and 2010.[1]

What causes gout?

Uric acid is formed in the blood when the body breaks down waste products, mainly those containing purines. Purines can be generated naturally by the body, and they may be ingested from these high-purine foods as meat. Normally, the kidneys filter uric acid particles from the blood and excrete it in the urine. If the body produces too much uric acid or the kidneys are not able to filter enough of it out, there's a buildup of uric acid in the bloodstream. This problem is called hyperuricemia.

Uric acid doesn't tend to stay dissolved in the bloodstream. Over the course of years, or even decades, hyperuricemia can cause deposits of crystallized uric acid through the body. Joints, tendons, ear tips, and kidneys are preferred sites. When the immune system becomes alerted to the urate crystals, it mounts an inflammatory response that contains the pain, redness, swelling, and damage to joint tissue which are the hallmarks of an acute gout attack.

In males, the body's uric acid production is likely to increase during puberty. Thus, it should come as no surprise that nine out of ten of those suffering from gout are men. As it may take up to 20 years of hyperuricemia to have gout symptoms, guys do not commonly develop gout until reaching their late 30s or early 40s. If a woman does develop gout, typically, it'll be later in her life. It is believed by researchers that this is because estrogen protects against hyperuricemia. It's not until estrogen levels start to fall during menopause which urate crystals can start to accumulate.


Hyperuricemia doesn't necessarily cause gout. The propensity to accumulate urate crystals could be attributed to hereditary factors, excessive weight, or overindulgence in the wrong sorts of food. Moreover, regular use of alcohol to excess, using diuretics, and the presence of high levels of triglycerides and cholesterol in the blood may increase the chance of developing the illness. Sometimes, an underlying disease such as lymphoma, leukemia, or hemolytic anemia may also result in gout.


The sequence is as follows:

1) Gout occurs when urate crystals collect in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have elevated levels of uric acid in your blood.

2) Your body produces uric acid when it breaks down purines -- chemicals which are found naturally in the human body.

Purines are also found in certain foods, such as beef, organ meats and fish. Other foods also encourage higher levels of uric acid, such as alcoholic beverages, particularly beer, and beverages sweetened with fruit sugar (fructose).

3) Normally, uric acid dissolves in your bloodstream and passes through your kidneys into your urine. But occasionally either your body produces too much uric acid or your kidneys excrete too little uric acid. At these times, uric acid can build up, forming sharp, needlelike urate crystals in a joint or surrounding tissue which cause pain, swelling and inflammation.


Signs & smptoms of gout

The signs and symptoms of gout nearly always happen suddenly, and often at night. They include:


• Intense joint pain. Though it can occur in any joint, gout usually affects the large joint of the big toe. Other commonly affected joints include the ankles, knees, wrists, elbows and fingers. The pain is very likely to be most acute within the first four to 12 hours after it starts.


• Lingering distress. Following the most acute pain subsides, some joint discomfort may last from a few days to a couple of weeks. Later attacks will likely last longer and influence more joints.


• Inflammation and redness. The affected joint or joints become swollen, tender, red and warm.


• Restricted range of motion. As gout grows, you might not have the ability to move your joints normally.



An acute episode of gout often starts without warning. The needle-like urate crystals may be present in the joints for quite a long time without causing symptoms. Then, there might be a triggering event such as a stubbed toe, an illness, surgery, stress, fatigue, or even a heavy drinking binge. Patients in intensive care units (ICUs) may have an acute flare-up of gout. Additionally, it's known that chronic occupational exposure to direct contributes to decreased excretion of urates and a higher chance of developing gout.

Oftentimes, the gout attack starts in the middle of the night. There's intense pain, which normally involves just one joint. Often it's the first joint of the big toe. The inflamed skin over the joint is hot, shiny, and reddish or purplish, and the pain is often so excruciating that the sufferer can't tolerate the strain of bedcovers. The inflammation may be accompanied by a fever.

Acute symptoms of gout usually resolve in about a week, and then vanish altogether for months or years at a time. Finally, however, the attacks may occur more often, last longer, and do more harm. The urate crystals can eventually settle into hard lumps under the skin around the joints, resulting in joint deformity and decreased range of movement. These hard lumps, called tophi, may also develop in the kidneys and other internal organs, under the skin of the ears, or in the elbow. Individuals with gout also face a heightened risk of kidney disease, and nearly 20 percent of people with gout develop kidney stones. The connection between gout and kidney stone formation is still not entirely understood.

Gout diagnosis

Doctors can diagnose gout based on the description of symptoms and a physical exam, X-ray & lab tests [2]. So as to detect hyperuricemia, physicians can administer a blood test to measure serum urate levels. However, higher urate levels only point to the potential for gout. Lots of people with hyperuricemia do not have urate crystal deposits. In addition, It has been shown that around 30 percent of gout sufferers have normal serum urate levels, even in the time of an acute gout attack. The most definitive way to diagnose gout is to have a sample of fluid from an affected joint and examine it to the existence of the urate crystals.

Gout treatments

The symptoms of gout will stop a week or so after an acute attack with no intervention. It's essential, nevertheless, to be identified and treated by a healthcare practitioner to be able to prevent attacks of increasing severity in the future and to prevent permanent damage to the joints, kidneys, and other organs. During an acute attack, treatment focuses on relieving the pain and inflammation. On a continuous basis, the focus is on keeping normal uric acid levels, fixing tissue damage, and promoting tissue healing.


Diet Therapy

Normally, gout is unheard of in vegetarians. It's a condition that responds favorably to improvements in nutrition and diet. Recurrent attacks can be prevented by maintaining a healthy weight and limiting the consumption of purinerich foods. A diet high in fiber and low in fat is also advised. Processed foods should be replaced by complex carbohydrates, such as whole grains. Protein consumption should be limited to below 0.8g/kg of body weight each day.


Nutritional supplements

Vitamin E and selenium are suggested to reduce the inflammation and tissue damage resulting from the accumulation of urates.


Folic acid has been shown to inhibit xanthine oxidase, the principal enzyme in uric acid production. The drug allopurinol (see below) is used for this same purpose in treating gout. The therapeutic use of folic acid for this condition ought to be prescribed and monitored under the supervision of a heath care practitioner. The recommended dose range is 400--800 micrograms every day.

The amino acids alanine, aspartic acid, glutamic acid, and glycine taken daily enhance the kidneys' ability to excrete uric acid. Bromelain, an enzyme found in pineapples, is a powerful anti inflammatory. It can be utilised as an alternative to NSAIDs and other prescription anti inflammatory drugs. It needs to be taken between meals in a dose of 200--300 mg, three times every day.

The bioflavonoid quercetin helps the body absorb bromelain. Additionally, it helps reduce uric acid production and prevents the inflammation that results in the severe symptoms of gout and the consequent tissue destruction. Quercetin should be taken at precisely the exact same time and dose as bromelain: 200--400 mg, between meals in a 3 times every day.


Herbs

Dark reddish-blue berries such as cherries, blackberries, hawthorn berries, and elderberries are extremely good sources of flavonoid compounds which have been found to help lower uric acid levels in the body. Flavonoids are effective in reducing inflammation and preventing and fixing the destruction of joint tissue. An amount of this fresh, frozen, dried, juiced, or expressed berries equivalent to half a pound (about 1 cup) fresh ought to be consumed daily.

Devil's claw, Harpagophytum procumbens, has been proven to be of advantage. It may be used to reduce uric acid levels and also to alleviate joint pain.

Gout represents a severe strain on the kidneys. The dried leaves of nettles, Urtica dioica, can be made into a nice tea and consumed throughout the day to increase fluid intake and to encourage kidney functions. But some people are allergic to nettles.


Holistic Therapies

- Colchicum is a general homeopathic remedy which may be used for pain relief in a gout attack. It's formulated by the same plant, autumn crocus, since the drug colchicine, used in the traditional treatment of gout.

- Gout could be improved by having a constitutional remedy prescribed which is based on the inclination to develop the illness and its symptoms.

- During the acute phase of gout, acupuncture may be helpful with pain relief.

- Ayurveda is also used in managing gout symptoms


Applications of cold or ice water can decrease pain and inflammation during acute attacks.

Expectations after treatment

Gout can't be cured, but it can be handled successfully. Prompt attention to diet and reducing uric acid levels will rectify a number of the issues associated with gout. Kidney problems may also be reversed or improved. Tophi can be dissolved or removed, and with all the tophi gone, joint mobility usually improves. Gout is generally more severe in people whose first symptoms appear before age 30. The coexistence of hypertension, diabetes, or kidney disease can result in a much more severe condition.

Gout prevention

For centuries, gout was called the "rich man's disease," a disease of overindulgence in food and beverage. Although this perspective is perhaps oversimplified, lifestyle factors certainly influence an individual's risk of developing gout. By way of instance, losing weight and limiting alcohol intake can help ward off gout. Since purines are broken down into urates from the body, consumption of foods high in purine ought to be limited. Foods which are particularly high in purines are red meat, organ meats, meat gravies, shellfish, sardines, anchovies, mushrooms, cooked spinach, rhubarb, yeast, asparagus, beer, and wine.

Dehydration promotes the formation of urate crystals, so people taking diuretics, or "water pills," might be better off turning to a different kind of blood pressure medicine. Increased intake of fluids will dilute the urine and promote excretion of uric acid. Therefore, six to eight glasses of water should be consumed every day, together with loads of herbal teas and diluted fruit juices.

Consumption of saturated fats impedes uric acid excretion, and consumption of refined carbohydrates, such as sugar and white bread and pasta, increases uric acid production. Both should be seriously restricted.

The use of vitamin C should be avoided by people with gout, as a result of high levels of acidity.


During symptom-free periods, these dietary guidelines might help protect against future gout attacks:

• Drink lots of fluids. Stay well-hydrated, including loads of water. Limit how many sweetened drinks you drink, particularly those sweetened with high-fructose corn syrup.

• Limit or avoid alcohol. Speak with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence indicates that beer might be particularly likely to raise the risk of gout symptoms, particularly in men.

• Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein resources.

• Limit your consumption of meat, poultry and fish. A small amount may be tolerable, but pay close attention to what kinds -- and how much -- appear to cause difficulties for you.

• Maintain a desirable body weight. Choose portions that enable you to keep a healthy weight. Losing weight may Decrease uric acid levels in the body. But avoid fasting or rapid weight loss, because doing so may temporarily increase uric acid levels.

Gout complications

People with gout can develop more-severe conditions, for example:


• Recurrent gout. Some people may never experience gout symptoms and signs again. Others may experience gout several times every year. Medications can help prevent gout attacks in people with recurrent gout. If left untreated, gout can lead to destruction and erosion of a joint.

• Advanced gout. Untreated gout can cause deposits of urate crystals to form beneath the skin in nodules called tophi. Tophi can develop in a number of areas like your fingers, hands, feet, elbows or Achilles tendons across the backs of your ankles. Tophi is usually not painful, but they can become swollen and tender during gout attacks.

• Kidney stones. Urate crystals can collect in the urinary tract of individuals with gout, causing kidney stones. Medications can help reduce the chance of kidney stones.

References

1. Thompson MD. Insights in Public Health: Hyperuricemia and Gout in Hawai'i. Hawaii J Med Public Health. 2018;77(5):121–124.

2. CDC, https://www.cdc.gov/arthritis/basics/gout.html

3. Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897

4. Gayle's encyclopedia of alternative medicine

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