Gout – a very small, acute affection of joint causing very big pain. Motion is life, as
earth do — Being immovable is more painful than any other.
Gout makes anyone disabled by crippling or locking the joints with its deposits. Arthritis is inflammation & pain in joints, which restricts movements. It is one of the most common sufferings, where the sufferers are made to live with pain throughout the life. Arthritis may be due to wear & tear mechanism, in case of age or due to deterioration of the cartilage pads or cartilage tear or formation of spurs or loss of lubricating fluids or muscle stiffness.
Every one likes to go on Life Miles, with Smiles towards ageing. But the major fear of life track. for aged persons is disability. Gout is one of that kind, which affects joints and mind i.e. a type of arthritis which affects persons of age below 50. It is mainly due to increased uric acid level in the body. Even though Gout seems to affect small joints, its pain is intolerable.
Gouty arthritis shares 7-9% of total arthritis cases.
Gout – is a metabolic, degenerative & crystal (monosodium urate) depositing disease of joints & connective tissues. It is also called as Rich man’s disease or King’s disease. It is one of the oldest diseases in the medical world. All the way, we learnt, man gets deviated from nature & gets diseases, whereas gout has been identified in older days itself, i.e. from the age of fruits or kings, where fruits are the major natural staple foods for man. The organic acids in the fruits, forms alkaline carbonates for alkalization of the body. Our body’s normal PH is 6.5-7.2. Many Nutritionists says that our food should be more alkaline than acidic. When our body becomes acidic- arthritis, stiffness, headaches, depression, ulcer stomach, sores, may occur. For that, alkaline foods like vegetables, juices & raw fruits should be taken which helps in eliminating toxic wastages.
Incidence - Males are more predominantly affected than females.
- Usually 30-50 age group is more commonly affected
- Mostly people of “O” blood group and hypertension have increased incidence.
- Gout more commonly occurs in people who have elevated serum uric acid levels
- Start up usually follows unusually heavy diet or citrus fruits or its juices or alcohol or drugs or starvation
- Even though complaints get aggravated, due to stiffness in cool climates, it attacks mostly in hot climates.
Pathology & Progress of the Gout – Uric acid is a waste end product of body metabolism, which occurs naturally. Uric acid results from the breakdown of purines, a compound that is found mostly in animal origin foods and human tissues. It is normally eliminated by kidneys through urine. If it is not eliminated properly, due to renal damage or excess production, it precipitates to form crystals and get deposited in the joints and connective tissues. These deposits can cause injury or abrasions and give rise to inflammation of the joints, causing pain, swelling, redness and tenderness.
The initial attack mostly occurs in one joint which will be for a week or more. It will mostly respond to anti-inflammatory type of medicines. Later after a silent period, it again rebounds within a year or more, but with more potential. This time it won’t respond easily to anti-inflammatory type of medicines. Even if it responds, it won’t go away completely. In due course, flare up occurs in more joints, most frequently and more violently, making the joint distorted and making the patient disabled.
Causes – The ultimate cause is unknown. The Main triggers are
- Familial – genetic predisposition
- Over weight – excess fat increases uric acid production
- Foods rich in purines- liver, kidney, sea foods, alcohol.
- Starvation or fasting- reduction in calories may precipitate the gout
- Multivitamins therapy especially when containing niacin
- Drugs- diuretics, hypertensive drugs, anti inflammatory drugs, chemo therapy.
- Trauma
- Stress
The rise in uric acid may be due to increased production or decreased elimination. The conditions mostly accompanied with are
- Increased uric acid level due to elimination defects — Renal failure, Drugs, Hyperparathyroidism, Down’s syndrome
- Increased uric acid level due to increased production of uric acids – Food, alcohol, obesity, diabetes, heart diseases, psoriasis, polycythemia, leukemias.
Types of Gout – Gout is classified mainly as primary or secondary gout
Primary Gout – where no other cause can be identified. Mostly this type are genetic.
Secondary gout – which may be due to high levels of uric acid, from over production as in case of foods, alcohol, psoriasis, obesity, diabetes.or reduced elimination of uric acid due to kidney damage. In relation to its intensity and period, gout can be further classified as
Acute gout – it is a very active stage of disease, where hyperuricemia causes deposits of uric acid crystals, in joint spaces which lead to sudden onset of intense pain and swelling in the joints. It commonly affects the first metatarsal joint of the foot, but other joints can also be commonly involved.
Chronic gout – As disease becomes older, the uric acid crystals deposited inside the joint and in the surrounding soft tissues, lead to destructive changes in the joint and cause persistent inflammation. Uric acid crystals deposited in soft tissues are known as ‘tophi.’ These appear as yellowish deposits under the skin, commonly occur in the fingers or toes, behind the heels or elbows, edges of the ears, etc. They can also form deposits in the kidney or urinary tract causing renal stones, in long course of time. With proper treatment, the disease won’t progress to this advanced stage.
Symptoms of Gout – Initial symptom of pain is usually followed by swelling, stiffness & restriction of movements. There are two set of symptoms. They are
Pre deposit symptoms- The start up pain usually subsides within a month and recurs in short or long time.
- Usually it gets started as acute and severe pain in toes and fingers
- Complaints starts mostly in single joint (great toe) but can occur in one or more joints
- Other common sites are knee, ankle and small joints of feet, hands, wrist & elbow. But the joints of the lower limbs have greater incidence than the upper limbs
- The inflamed joint is very painful, red, swollen, shiny and hot with dilated veins
- The inflamed joint cannot be moved or touched.
- Mostly aggravated in night
- It may be accompanied with fever with chills, raised ESR, leucocytosis, etc., complaints recurs on weeks or months intervals, weakness, fatigue, spasms.
- Sleeplessness
Post deposit symptoms or Complications- Persistent inflammation or recurrent attacks will produce degenerative changes, bony erosions, cartilage damage, deposition of monosodium bicarbonate crystals (chalky crystals –named Tophi) in joints, making the joint distorted or damaged, which are all, on the way to deformities and disability
- Crystals can get deposited in cartilage of ear, soft tissues & tendon sheath
- Renal stones and renal failure
- Eczema in the gouty joints or crystal deposited areas
Diagnosis & Investigations – It is better to evaluate the disease, with the history of complaints, physical examination and laboratory investigations to treat the disease, in initial period itself, since every disease responds very well in initial period. The main diagnostic tools in confirming the Gout are
- Blood tests for elevated serum uric acid level will mostly disclose the presence of elevated level in case of gout, but it is not confirmative, since there are lots of people who have this elevated level, without any symptoms. Like wise, even though it is mostly elevated in gout, there are exceptional cases where it seems to be very normal.
- The most confirmative diagnose is examination of synovial fluid (lubricating fluid of the joints) * Trace for needle shape uric acid crystals in synovial fluid
* For the presence of bacteria in synovial fluid - In advanced cases, X-ray may show joint distortion, with crystal deposition like crippling or spurs or erosions
Preventive measures – Prevention is the best defense against gout and its complications.
Avoid - Alcohol – it increases the uric acid level, by acting as a diuretic.
- Weight loss or starvation – increases the uric acid level, due to lactic acidosis
- Foods rich in purines- meat, liver, brain, kidney, cod liver oil, yeast, bread, sauces, beans, nuts and peas
- Acid foods- proteins-beans, dairy, fats, poultry, cooked grains, synthetic vitamins
- Diets which have rich fat content
- Fructose- i.e. fruit juices which increase uric acid level
- Drugs- Hypertensive drugs, diuretics.
- Overusing the joints during pain
Take - Foods which can be easily digested and eliminated
- Apples, bananas, mango, cucumber, garlic which often seems to give betterment
- Low purine diet such as fruits, breads, grains, cheese, eggs, milk products, sugar, spinach, green stuff vegetables, salads.
- Folic acid, Vit C sometimes helps in uric acid elimination. In some cases, it flares up the condition even with a small piece of lemon or tomato.
- Cherry and strawberry to neutralize the uric acid level
DOs- Drink plenty of water
- Slow movement or slow exercise to avoid fixation or immobility.
- Warm up the muscles with exercise
- Rest and elevation for the part inflammed
- Slowly increase habit of taking fruits since some cases & theories show that fresh and ripe grapes, oranges & sour fruits cure the condition after a flare up.
Treatment – Generally, Allopathy concentrates on the spot, and mostly treats the inflammatory conditions and manages the situation. For centuries, the treatment was related with diet. Some doctors ask the patients, to avoid fruits, and some other asks to take in plenty. Some doctors frame the life style with less stress, changing the diuretics drugs & drugs for hypertension with caution. The most commonly used drugs like anti-inflammatory drugs (NSAIDs) or Corticosteroids taken orally or in the form of injection into the affected joint, usually benumb the pain i.e. these drugs kill only the pain, but the production of the uric acid or its eliminating defect in the body is not at all interrupted or altered. If this condition is left untreated, affected joints may get damaged permanently, causing disability. In most cases, gout does not get treated properly, unless it occurs frequently and hurts much. Also, Pain killers cannot be taken by peptic ulcer patients. Sometimes these drugs itself can stir up the gouty condition.
– Treatment should be aimed at reducing serum urate level & its deposits than killing the pain. Pain is the indicator of presence of inflammation or uric acid crystals. If we put off the pain, we cannot judge the proceedings & presence of the disease. Even though the effect is seen only in great toe, it affects body wholly (its impact can be seen in other joints, kidneys, soft tissues, tendon sheaths & skin). Thus for cure, the disease must be treated, completely in a holistic manner internally, rather than with pain killers or applications which mask the complaints by causing a benumbing sensation Gout causes pain in many places. So it is more important to correct uric acid level i.e. hyperuricaemia, not just relieving the pain or its effects on the joints.
A piece of pickle or a sip of lime juice or a gulp of tomato soup can precipitate the condition like oil poured on fire. With mountain of difficulty, patients take precautions about food and restrict one by one and later correlate every thing with pain. Supplementation and restriction can work only for the time being.
The ultimate cause is UNKNOWN. So you cannot attack the enemy who is hiding. We should get strengthened, to withstand the situation or condition. Homeopathy protects us, by raising our body immunity. Homeopathy can also surely bring dramatic effects of cure, since it treats wholly.
Success of the treatment mainly depends upon the early diagnosis & early treatment. Since later on structural damage will occur with deposits. Usually functional damages can be corrected fully, whereas structural changes cannot be cured completely, & can only be managed. So, it is better to treat Gout on initial attack itself, otherwise it will take much time to eliminate it, from its root. The symptoms of gout usually wax and wane. Improvement on homeopathy treatment will be in a slow manner. Have patience, to get relief or be a life-long patient. So, for a safer & long-time protection, opt for homeopathy. Homeopathy shall provide complete cure for gout.
The results of homoeopathy treatment through my experiences in gout cases are far superior, to usual way of treatment with other system of medicines. The homeopathic medicines commonly used in cases of Gout are Aconite, Benzoic acid, Belladonna, Beri beri vul, Bryonia, Causticum, Cimicifuga, Colchicum, Kalmia, Ledum, Lithium carb, Lycopodium, Phosphorus, Rhus tox, Tarentula, Pulsatilla Urtica urens. These medicines should be taken under the advice and diagnosis of a Qualified Homoeopath.
for new hope
Dr. S. Chidambaranathan, BHMS, MD (Homeo)
Laxmi Homeo Clinic
24 E. New Mahalipatti Road
Madurai, TN 625 001
India
Tel: +91-452-233-8833 | +91-984-319-1011 (Mob)
Fax: +91-452-233-0196
E-mail: drcheena@yahoo.com
www.drcheena.com / www.drcheena.in
(Disclaimer - The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)
