What Is Gout And What Causes It
Gout causes attacks of painful inflammation in one or more joints. It is a type of arthritis . The pain of a gout attack can be severe.
Gout is caused by a chemical in the blood, called uric acid . Uric acid is usually harmless and is made in the body. Most is passed out with the urine and some from the gut with the stools . In people with gout the amount of uric acid in the blood builds up. From time to time the level may become too high and tiny grit-like crystals of uric acid may form. The crystals typically collect in a joint. The crystals irritate the tissues in the joint to cause inflammation, swelling and pain – a gout attack.
Note: some people have a high level of uric acid but do not form crystals or have gout. Also, rarely, some people with a normal level of uric acid have gout attacks. However, as a rule, the higher the level of uric acid, the greater the chance of developing gout.
Natural Remedies For Gout
A.Vogels Stinging Nettle tincture, made from the anti-inflammatory and slightly diuretic plant, has been successful in resolving excess uric acid, when 25 drops are taken with a little water, three times a day.
For general intestinal and digestive health Molkosan and Bio-Strath can help balance the bodys pH, maintain healthy intestinal flora and help with the digestion of nutrients and elimination of toxins such as uric acid.
Once an attack of gout is under control, a detox treatment can be useful in boosting the ability of the kidneys and intestines to flush out the toxins. A treatment using A.Vogels Boldocynara or Milk Thistle products, which are rich in herbs with choleretic, cholagogue, diuretic and toning effects, is recommended at least twice a year.
Gout is probably one of the easiest forms of arthritis to manage through a healthy lifestyle. And anything that promotes digestive health and aids the body in efficiently eliminating toxins can do nothing but help prevent or heal gout and optimize ones overall health.
Signs And Symptoms Of Gout
Any joint can be affected by gout, but it usually affects joints towards the ends of the limbs, such as the toes, ankles, knees and fingers.
Signs and symptoms of gout include:
- severe pain in one or more joints
- the joint feeling hot and very tender
- swelling in and around the affected joint
- red, shiny skin over the affected joint
Symptoms develop rapidly over a few hours and typically last three to 10 days. After this time the pain should pass and the joint should return to normal.
Almost everyone with gout will experience further attacks at some point, usually within a year.
Read more about the complications of gout.
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What Is Gout Its Causes
Gout is actually a type is arthritis that happens due to hyperuricemia, a condition where blood uric acid level increases more the normal level. So, what happens when uric acid increases in our body?
Uric acid present in the blood gets ionized into Monosodium Urate Crystal. Normally these urate crystal gets dissolved and its solubility is affected by:
- Synovial fluid pH,
- Electrolytes level, and
- Other synovial components such as proteoglycans and collagen.
But, when the level of uric acid increases the urate crystal starts deposition gets starts in the tissue around the joints leading to gout. There are two factors that causes the increase in the uric acid level one is overproduction of uric acid and second condition is when there is decreased excretion of uric acid from the body.
Joints Affected By Gout
Gout can affect any joint, but some joints are more likely to be affected than others. Joints commonly affected include the big toe, the foots instep, heel, ankle, and knee.2 Less often, gout affects the elbow, wrist, fingertips, or spine.2–7
Gout is acute, painful swelling in the joints from uric acid buildup. Common areas include the foot and big toe.
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Whats The Outlook For People With Gout
Untreated gout can lead to permanent joint damage. The buildup of uric acid in the joints and soft tissue is called tophus. Some people with gout can also develop other health problems, such as severe arthritis, kidney stones and heart disease. Its important to discuss your symptoms with a healthcare provider.
Research And Statistics: How Prevalent Is Gout In The United States
Research published in the journal Arthritis & Rheumatology found that gout rates in the United States have been climbing steadily over the past 50 years, likely because of increases in obesity and high blood pressure.
Gout is the most common type of inflammatory arthritis among men. Its more common in men than women. About 6 percent of men in the United States have gout, while only about 2 percent of women have it. Women rarely develop gout before reaching menopause.
Gout is rare in children and young adults.
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Who Is Affected By Gout
Gout can affect anyone. It usually occurs earlier in men than women. It generally occurs after menopause in women. Men can be three times more likely than women to get it because they have higher levels of uric acid most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
- Obesity, or a lot of extra weight.
You are also more likely to develop gout if you:
- Consume a diet high in animal proteins
- Consume a significant amount of alcohol
- Are on water pills .
Other Symptoms Of Acute Gout Or A Gout Attack
- Sudden crushing or throbbing pain in one or a few joints that may last for a few days
- Sometimes an acute gouty arthritis attack has a sudden onset at nighttime. The big toe joint pain may be so severe that even the weight of bedsheets causes discomfort.
- Joints that appear swollen and inflamed, with reddish-purple skin that may feel warm
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United States Unapproved Drugs Initiative
An unintended consequence of the 2006 U.S. safety program called the through which the FDA sought more rigorous testing of efficacy and safety of colchicine and other unapproved drugswas a price increase of 2000 percent for “a gout remedy so old that the ancient Greeks knew about its effects.” Under Unapproved Drugs Initiative small companies such as , a Philadelphia drugmaker, were rewarded with licenses for testing of medicines like colchicine. In 2009, the FDA reviewed a for colchicine submitted by URL Pharma. URL Pharma did the testing, gained FDA formal approval, and was granted rights over colchicine. With this monopoly pricing power, the price of colchicine increased.
In 2012, Asia’s biggest drugmaker, , acquired URL Pharma for $800 million including the rights to colchicine earning $1.2 billion in revenue by raising the price even more.
On 29 July 2009, colchicine won FDA approval in the United States as a stand-alone drug for the treatment of acute flares of gout and familial Mediterranean fever. It had previously been approved as an ingredient in an FDA-approved combination product for gout. The approval was based on a study in which two doses an hour apart were as effective as higher doses in combating the acute flare of gout.
What Happens At Your Appointment
The GP may ask about your diet and if you drink alcohol.
They may refer you to see a specialist and arrange a blood test and scan. Sometimes a thin needle is used to take a sample of fluid from inside the affected joint, to test it.
The blood test will find out how much of a chemical called uric acid there is in your blood.
Having too much uric acid in your blood can lead to crystals forming around your joints, which causes pain.
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Chronic Gout Signs And Symptoms
- Compared with the dramatic nature of acute gout pain, chronic gout pain is more of a soreness or persistent ache.
- Pain that tends to be a more continuous feeling of dull aching or soreness in the joints
- Hard white deposits or lumps under the skin, called tophi, found on the elbows, ears, or fingers.
What Can Trigger A Gout Attack
Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:
- a knock or injury to the joint
- an illness that may make you feverish
- having an operation
- having an unusually large meal, especially a fatty meal
- drinking too much alcohol
- starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.
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Do Gout Medications Have Any Side Effects
- Gout medications are well tolerated by most people. However, like other medications, they have potential side effects.
- Allopurinol is well tolerated by most people, but in some people, it can cause an allergicrash. Very severe rashes rarely can occur after taking allopurinol, and any allergic type rashes that develop while a patient is taking allopurinol are taken seriously.
- Colchicine can cause signs and symptoms such as nausea, diarrhea, and rarely muscle weakness and abnormal blood counts.
- Probenecid is generally well tolerated but should not be used in patients who have uric acid kidney stones, as it can worsen the kidney stones and potentially harm the kidneys in these patients.
Risk Factors For Gout: Have Some People More Risk Than Others
Yes. Most affected people are men between 30 and 50 years. This imbalance is explained by the level of uric acid in blood normally higher in men than in women. However, the onset of gout is possible in women from menopause and sometimes during pregnancy, we have to be so careful. Heredity also seems to be involved. A genetic or family predisposition would be at the origin of this metabolic disorder. Age is also a factor predisposing: the kidneys are less effective and eliminate less well the waste of the body. This promotes the elevation of uric acid in the blood. Gout affects essentially developed countries. It was called “the Royal disease”, because it’s due to a diet too rich, as that of the Kings.
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What Is Gout What Causes It
Gout is a type of arthritis that happens when you have too much uric acid in your blood and it forms sharp crystals in one or more of your joints. This usually happens in your big toe, but you also can have gout in your knee, ankle, foot, hand, wrist, or elbow.
Attacks are sudden and cause serious pain, often with redness and swelling around the joint. They usually last 3 to 10 days, but the first 36 hours are typically the most painful. After the first attack, some people dont have another one for months or maybe years.
How Will Gout Affect Me
Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.
Without medication attacks tend to happen more often and other joints can become affected.
Having high urate levels and gout for a long time can lead to other health problems, including:
- narrowing of the arteries – which can lead to an increased risk of stroke or heart attacks or other heart problems
- osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
- an increased risk of developing kidney disease or worsening of the condition if you already have it
- kidney stones
- an increased risk of some cancers, especially prostate cancer
- mental health problems, including depression
- underactive thyroid
- erectile dysfunction in men.
If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.
Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:
- treating the acute attack
- treatments to prevent future attacks.
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Decreased Excretion Of Uric Acid
Two thirds of urate excretion occurs in the kidneys while the rest is excreted through the gastrointestinal tract . Reduced secretory function of the transporter ABCG2 leads to decreased excretion of uric acid through the GIT resulting in rise of serum levels of uric acid and enhanced renal excretion .
What Is The Evolution Of The Gout
In general, the frequency and numbers of gout pain increased with time. After several years, in addition to joint pain, the disease may cause deposits of crystals under the skin called tophi. They are friable whitish or yellowish masses located on the outside edge of the ear, on the elbows or near the elbows, on fingers, on toes or close to the Achilles tendon. If these tophi is deposited in bone structures then we talk about gouty arthritis. Joints are gradually destroyed, and this is especially characteristic in the hands, wrists, feet… Crystals may also settle in the kidneys. In the absence of treatment, they will interfere with their functioning and ultimately lead to renal failure.
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S Of The Gout For Better Understanding
Heres few pictures of the gout!
If you have pain, swelling and redness at the base of the great toe then most likely it is due to gout. It not only affects this joint but initially it may affect small joints of fingers of hand and leg, in the later stage, it may also affect large joints such as the ankle, knee wrist and elbow joint.
Gout happens due to increased blood uric acid level. Pharmacological management focuses on controlling the blood uric acid level but being a physiotherapist I will also suggest few home tips and exercises that will prevent the joint swelling, pain and most important is joint stiffness.
So, lets get started.
Can Obesity Cause Gout
Obesity is a result of poor lifestyle choices that can lead to the development of insulin resistance which causes elevated triglycerides, high blood pressure, diabetes, stroke, chronic kidney disease, heart attacks and uric acid levels. The combination of these conditions alone makes an obese person more likely to develop gout among other health conditions.
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How Is Gout Diagnosed
Gout is diagnosed using a number of tests including:
- medical history
- physical examination
- blood test to measure urate levels although this cannot confirm gout
- removing a sample of fluid from the joint if you have gout, uric acid crystals can be seen under a microscope. This is the most definitive test
- ultrasound scan can identify early crystal formation in the fluid between your joints.
Early diagnosis and treatment is very important. The main goal for everyday management of gout is to reduce the level of uric acid in your blood so it cant form crystals in the tissues or joints and cause joint damage.
Treating A Gout Attack
Treating an attack of gout doesnt lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.
The most commonly used drug treatments for attacks of gout are:
Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration many people with gout quickly learn what works best for them.
In cases where one drug doesnt seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.
Non-steroidal anti-inflammatory drugs
Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.
If youve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.
The earlier you start treatment, the better.
NSAIDs arent suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.
Colchicine isnt a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.
Colchicine tablets can cause diarrhoea or stomach aches.
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The Role Of Uric Acid
Uric acid is produced when your body breaks down purines, which are substances naturally found in your body, as well as in protein-rich foods. At normal levels in your blood, uric acid is a powerful antioxidant and does not cause any damage. The body keeps uric acid at a set level by excreting it through the kidneys and in urine.
It is possible to have hyperuricemia and not develop gout. About two-thirds of people with elevated uric acid levels never have gout attacks. It is not known why some people do not react to abnormally high levels of uric acid.
What Are Gout Treatments And Home Remedies
When gout is mild, infrequent, and uncomplicated, it can be treated with diet and lifestyle changes. However, studies have shown that even the most rigorous diet does not lower the serum uric acid enough to control severe gout, and therefore medications are generally necessary. When attacks are frequent, uric acid kidney stones have occurred, tophi are present, or there is evidence of joint damage from gout attacks, medications are typically used to lower the uric acid blood level.
Medications for the treatment of gout generally fall into one of three categories: uric-acid-lowering medications, prophylactic medications , and rescue medications to provide immediate relief from gout pain.
Urate-lowering medications are the primary treatment for gout. These medications decrease the total amount of uric acid in the body and lower the serum uric acid level. For most patients, the goal of uric-acid-lowering medication is to achieve a serum uric acid level of less than 6 mg/dl. These medications also are effective treatments to decrease the size of tophi, with the ultimate goal of eradicating them. Uric-acid-lowering medications include allopurinol , , probenecid, and pegloticase .
Gout home remedies
Home remedies for an acute gout attack include drinking plenty of water. Over-the-counter NSAIDs , such as ibuprofen and naproxen sodium , can be used when there are no contra-indications, such as decreased kidney function or stomach ulcers.
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