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Gout
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Gout is almost exclusively a disease of adult men and is rare in premenopausal women and prepubertal children. While hyperuricemia may indicate an increased risk of gout, the relationship between serum uric acid and arthritis is unclear. Many patients with hyperuricemia do not develop gout, while some patients with repeated gout attacks have normal or low uric acid levels. In addition to the first metatarsophalahgeal joint involved in podagra, gout can strike ankles, knees, wrists, fingers and elbows. These painful attacks usually subside in hours to days with or without treatment. Most patients with gout experience repeated attacks of arthritis over the years.
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Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. The four phases of gout include asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout and chronic tophaceous gout. The peak incidence occurs in patients 30 to 50 years old, and the condition is much more common in men than in women. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle. Acute gout most commonly affects the first metatarsal joint of the foot, but other joints are ... commonly involved. Definitive diagnosis requires joint aspiration with demonstration of birefringent crystals in the synovial fluid under a polarized light microscope.
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Gout has long had a reputation as a disease that results from eating too much rich food and drinking too much alcohol. In the past, people with the disease were advised to avoid foods containing purines, which are broken down by the body into uric acid. These foods include liver, sardines, anchovies, and dried peas.
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When treating Gout and Arthritis modern medicine has no cures, it simply tries to suppress the symptoms. Some established conventional treatments include the use of steroids, antibiotics, NSAIDs, cortisone therapy, antimalarials, strong anti-inflammatory drugs and gold salts. Some of these may have very serious side effects including low white blood cells, kidney dysfunction, allergic reactions and skin rashes.
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Gout usually begins with an acute attack of pain, inflammation, extreme tenderness, and redness in the affected joint—often the big toe and sometimes the ankle or knee. After repeated attacks the disease can cause the deposition of sodium urate crystals in the tissues about the joints, causing stiffness and deformity. The aim of treatment is to minimize the formation of uric acid crystals. A high liquid intake that increases daily urine output is usually recommended. An acute attack of gout is usually treated with nonsteroidal anti-inflammatory drugs, such as indomethecine or naproxen, or the corticosteroid prednisone. Colchicine, a preparation of the meadow saffron, used since 1763 for gout, is still used when symptoms are not controlled by other drugs.
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Gout affects an estimated one million Americans. It most commonly afflicts men (800,000 men versus 200,000 women). Uric-acid levels tend to increase in men at puberty, and, because it takes 20 years of hyperuricemia to cause gout symptoms, men commonly develop gout in their late 30s or early 40s. Women more typically develop gout later in life, starting in their 60s. According to some medical experts, estrogen protects against hyperuricemia, and when estrogen levels fall during menopause, urate crystals can begin to build up in the joints. Excess body weight, regular excessive alcohol intake, the use of blood pressure medications called diuretics, and high levels of certain fatty substances in the blood (serum triglycerides) associated with an increased risk of heart disease can all increase a person's risk of developing gout.
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