Gout (crystal arthritis) or Podagra (gout of the foot, especially the big toe) is surely an ancient and well-known disease. Also perhaps one of the most painful diseases known to mankind, especially when it is advanced enough to affect may joints together. Gallstones, Gout, Pseudogout and Renal calculi are four clinical conditions where products produced with the body form crystals, triggering a painful pathological progression. Of these, both gall stones or renal stones may be removed with some invasive procedures like surgery or lithotripsy etc, but uric acid concretions (tophi) in gout and calcium pyrophosphate concretions in pseudogout are rarely removed so readily by surgery, especially if the gouty arthritis has spread to more than one joint (mostly the big toe).
A full-blown episode of gout occurs when all of a sudden, consequent to a night-time pathogenesis (more often than not), tiny urate crystals (composed of uric acid, a product of protein catabolism normally excreted dissolved in urine) collect in the big toe joint, causing an intense inflammatory reaction. In some people with hereditary metabolic defect, uric acid builds up in the blood and other body fluids. Most people with this condition, called hyperuricemia, do not develop gout, but those who do experience recurring attacks in the affected joint, and may also suffer from kidney stone formation. It is occurrences such as these lets me hold our reptilian & avian species in awe, as they excrete uric acid (as we excrete urea via urine) from their bodies, and, at times, to conserve water, they excrete more or less solid pellets of uric acid ! These species apparently have the capacity to concentrate (solidify) uric acid from a dissolved state, whereas in us, the human, such crystallization becomes such a horrandous malaise.
Gout is primarily a male-dominant disease, and the big toe is the most common target for such affliction, although once the disease spreads, it may well affect other foot joints as well as the fingers, ankles, elbows, wrists & knees. During an attack, the joint become very sensitive, painful, red, swollen and hot to touch. Attacks come on suddenly, and may pass quickly too. The remission intervals between varies from a few days to few years, but it invariably returns, especially as long periods of remission embolden the person to indulge in dietary indiscretion far too regularly.
When gout goes untreated, attacks become increasing frequent and may eventually even damage the affected joint, and sometimes the kidneys and other internal organs as well. In addition, deposits of urate crystals, called tophi, may occur under the skin near the affected joint, over the elbow, or on the outside edge (pinna) of the ear. These may eventually break through the skin and may even get infected.
A combination of medical treatment and self-care can control gout more or less completely. Doctors usually recommend routine anti-inflammatory pain-killers (NSAIDs or non steroidal anti-inflammatory drugs). With most patients, acute attacks can be prevented with daily dosage of a uricosuric agent (one that assists uric acid excretion), such as sulfinpyrazone (Anturane, discontinued in the US) and/or probenicid, to improve the body’s elimination of uric acid, or allopurinol, which reduces uric acid production. If these drugs still don’t work somehow, the doctor may prescribe a low daily dosage of colchicine and closely monitor the person for side effects. Uric acid-lowering measures (diet & drugs) should be increased until serum uric acid levels are below 300–360 µmol/l (5.0–6.0 mg/dl) and continued for fairly long periods. If the required drugs are already being taken at the time of an attack, they better be continued. Serum uric acid levels that cannot be brought below 6.0 mg/dl in spite of all measures indicate a ‘refractory gout’ variety.
SELF TREATMENT & HOME CARE
Anyone with gout should keep himself very well hydrated daily with plain water or non-alcoholic beverages to dilute urine and prevent a buildup of uric acid. An overweight patient should shed excess pounds, since obesity aggravates gout, besides placing undue pressure on the leg & foot joints. However, one should refrain from going on a crash diet, as an abrupt loss in weight (body breakdown) can also precipitate an attack. Precisely for almost similar reason the patients being treated for cancer (killing the cancer cells of the body) may experience gout pain & attacks. Regular exercise helps keeping the joints mobile and flexible, but one should avoid stressing inflamed joints, which can sure lead to permanent damage. Sodium Bicarbonate, Baking Powder, Fruit Salt, Disodium Hydrogen Citrate, Lemon, Apple Cider Vinegar etc ares ome common alkalizers people use in gout malady.
Do identify and avoid the factors (especially your food/drink items) that tend to trigger gout flare-ups. Also note that some drugs, especially the diuretics (promoting excessive urination) used to treat hypertension, do cause gout sometimes as they( by increasing urinary output substantially) bring up the relative concentration of uric acid in our blood plasma.
Many specialists advise avoiding foods high in purine, a substance that raises uric acid level in blood. Such foods include organ meats (liver, kidneys, sweetbreads and brains), sardines, anchovies, meat extracts, dried peas, lentils, and other legumes. Red wine, beer, and other alcoholic beverages may also trigger an attack. Readymade food items containing ‘fructose’, as also all items containing HFCS (high fructose corn syrup) are advised against, as are some purine-rich vegetables like cauliflower, spinach, broccoli, peas, and even a fruit seemingly as innocent as an avocado.