GOUT - Learn About Gout

Gouty arthritis is a painful condition that results from crystals of uric acid depositing in joint tissues, causing attacks of joint inflammation (arthritis).

Gouty arthritis is a painful condition that results from crystals of uric acid depositing in joint tissues, causing attacks of joint inflammation (arthritis).

What Is Gout?

Gout is a condition that results from crystals of uric acid depositing in tissues of the body. Gout is characterized by an overload of uric acid in the body and recurring attacks of joint inflammation (arthritis). Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in processing uric acid can cause attacks of painful arthritis (gout attack), kidney stones, and blockage of the kidney filtering tubules with uric acid crystals, leading to kidney failure. Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history.

Approximately 6 million people in the United States suffer from attacks of gout.

 

Who Is Affected by Gout?

Gout is nine times more common in men than in women. It predominantly attacks males after puberty, with a peak age of 75. In women, gout attacks usually occur after menopause. Among the male population in the United States, approximately 10% have elevated blood uric acid levels, a condition known as hyperuricemia. However, only a small portion of those with hyperuricemia will actually develop gout. If your parents have gout, then you have a 20% chance of developing it.

 

Obesity, weight gain, alcohol intake, high blood pressure, abnormal kidney function, and certain drugs can promote the development of gout.

 

What Are the Risk Factors of Gout?

Risk factors for developing gout include obesity, excessive weight gain, especially in youth, moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function. Certain drugs and diseases can also cause elevated levels of uric acid. Interestingly, a recent study demonstrated an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.

Gouty arthritis is characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness.

Gouty arthritis is characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness.

What Are Symptoms of Gout?

The small joint at the base of the big toe is the most common site for a gout attack. Other joints that can be affected include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. In some people, the acute pain is so intense that even a bed sheet on the toe causes severe pain. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most patients with gout will experience repeated attacks of gouty arthritis over the years.

Gout (Big Toe)

The joint at the base of the big toe is the most common site of an acute gout attack. The joint at the base of the big toe is the most common site of an acute gout attack. Over time, it is not unusual for other joints to become involved, including the ankles, knees, and hands.

Severe gout in the fingers results in large, hard deposits of crystals of uric acid. These deposits are called tophi.

Gout (Fingers)

People may experience gout with deposits of uric acid crystals in their finger joints as well as many tissues of the body.

Gout (Elbow)

Gout can also attack joints such as the knees and the elbows, as well as tissues such as the elbow bursa shown here.

What Procedure Is Used to Diagnose Gouty Arthritis?

Gout is considered when a patient reports a history of repeated attacks of painful arthritis, especially at the base of the toes. Ankles and knees are the next most commonly involved joints in gout. The most reliable test for gout is detecting uric acid crystals in the joint fluid obtained by joint aspiration (arthrocentesis). Arthrocentesis is a common office procedure performed with topical local anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the inflamed joint with a syringe and needle.

How Is Gout Diagnosed?

Fluid is obtained from deposits in a patient with gout. The joint fluid is analyzed for uric acid crystals and for infection.

Bright, needle-like uric acid crystals are best viewed with a polarizing microscope (left). Needles of urate crystals under polarized microscopy are on the right.

What Do Uric Acid Crystals Look Like?

Bright, needle-like uric acid crystals are best viewed with a polarizing microscope.

How Are Gout Attacks Prevented?

Maintaining adequate fluid intake helps prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney stone formation in patients with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism and cause hyperuricemia. It causes gout by impeding (slowing down) the excretion of uric acid from the kidneys as well as by causing dehydration, which precipitates the crystals in the joints.

Additional Prevention Techniques

Dietary changes can help reduce uric acid levels in the blood. Since purine chemicals are converted by the body into uric acid, purine-rich foods are avoided. Examples of foods rich in purines include shellfish and organ meats, such as liver, brains, kidneys, and sweetbreads. Researchers have reported that meat or seafood consumption increases the risk of gout attacks, while dairy consumption and avoiding fructose seemed to reduce this risk. Weight reduction can be helpful in lowering the risk of recurrent attacks of gout. This is best accomplished by reducing dietary fat and caloric intake, combined with a regular aerobic exercise program.

What Are the Medical Treatments for Gout?

There are three aspects to the medication treatment of gout. First, pain relievers such as acetaminophen (Tylenol) or other more potent analgesics are used to manage pain. Secondly, antiinflammatory agents such as nonsteroidal antiinflammatory drugs (NSAIDS), colchicine, and corticosteroids are used to decrease joint inflammation. Finally, medications are considered for managing the underlying metabolic derangement that causes hyperuricemia and gout. These medicines decrease the elevated levels of uric acid in the blood.

What Does the Future Hold for Gout?

Active research is ongoing in a variety of fields related to gout and hyperuricemia. Scientists recently reported that high animal protein slightly increased the risk for gout. New drugs are being developed that may be more versatile and safe in treating the elevated uric acid levels in patients with chronic gout.

GOUT - Sugary drinks possible cause of gout

Sugary drinks possible cause of gout

September 13, 2013

Sugar raise uric acid in the blood due to processing in the liver and it also appears to directly interfere with excretion of uric acid from the kidney.

FEATURE

WELLINGTON: Sufferers of gout might soon be advised to add sugary drinks to the list of foods that can cause the painful and crippling affliction to flare up, according to a New Zealand study released yesterday.

Red meat, seafood and beer are already known to trigger high levels of uric acid that cause the arthritic ailment, but scientists at the universities of Otago and Auckland have also discovered a human gene variant that can “turn bad” when affected by sugary drinks, China’s Xinhua news agency reported.

The study showed that when the variant of the gene SLC2A9 behaved correctly, it helped transport uric acid out of the blood stream and facilitated its excretion through the kidney.

“But when people with this gene variant consume sugary drinks, it takes on Jekyll and Hyde characteristics; the apparent function of the gene variant reverses, such that we think uric acid is instead transported back into the blood stream and the risk of gout is increased,” Associate Professor Tony Merriman, of Otago’s Department of Biochemistry, said in a statement.

“So not only does sugar raise uric acid in the blood due to processing in the liver, but it also appears to directly interfere with excretion of uric acid from the kidney. This was a quite unpredictable interaction,” he said.

“Each daily 300-millilitre serving of sugar-sweetened drink increases the chance of gout by 13%.”

As a result of the research, he recommended that in addition to taking prescribed medicines, people with gout should avoid sugary drinks.

Gout is caused when uric acid in the blood crystallises in the joints, causing them to become inflamed. It is the most common form of arthritis in New Zealand, particularly among men, and has strong links with other metabolic diseases such as diabetes, heart and kidney disease.

- Reuters

HEALTH - Vitamin C may not treat gout

May 23, 2013

It's not that the vitamin C didn't reduce the uric acid level at all, it's just so small that it wouldn't make a difference from the patients' perspectives

NEW YORK: Daily vitamin C supplements don’t lower uric acid as much as drugs used to treat high levels of the acid that’s responsible for gout, says a new study from New Zealand.

“It’s not that the vitamin C didn’t reduce the uric acid level at all, it’s just so small that it wouldn’t make a difference from the patients’ perspectives,” said Dr. Lisa Stamp, the study’s lead author from the University of Otago in Christchurch.

Previous studies had found that people who eat the most vitamin C were at a decreased risk for developing gout, a form of arthritis caused by the crystallization of uric acid in joints. It’s believed the vitamin increases the amount of uric acid excreted through a person’s urine.

Few studies, however, have looked at whether vitamin C would lower uric acid levels in people already suffering with the pain and swelling of gout, or if it would lead to additional uric acid reductions in people who are already on medication.

For the new study, which was published in Arthritis & Rheumatism and funded by The Health Research Council of New Zealand, the researchers recruited 20 gout patients who were already on medicine and another 20 who were not.

The 20 participants who were on medication were taking allopurinol, which is marketed as Aloprim and Zyloprim. They were told to either increase their dose of the medicine or also take 500 milligrams of vitamin C supplements every day.

The 20 participants who were not already taking medication were either started on allopurinol or told to take a 500-milligram vitamin C supplement every day.

At the beginning of the eight-week study, the amount of uric acid in the participants’ blood was 9 milligrams per deciliter on average. The researchers said a healthy uric acid level falls below 6.5 milligrams per deciliter.

In both cases, participants who started taking vitamin C – with or without medication – did not see a significant decrease in uric acid levels.

There was, however, a significant decrease in the uric acid levels of people who started on allopurinol – about 3 milligrams per deciliter – and in those who were on the drug but increased their doses – about a 1.6 milligrams per deciliter decrease.

“It still appears you’re probably better off taking whatever uric acid lowering treatment your doctor would prescribe,” Stamp said.

Obesity and beer

She added that there could be a few reasons why they didn’t see an association between vitamin C and decreased uric acid levels.

“It may be that just in gout patients that the effect of vitamin C would be too weak,” she said.

But Dr. Tim Bongartz, a rheumatologist from the Mayo Clinic in Rochester, Minnesota, said it’s difficult to make any firm conclusions from the new study, because it would take about 200 participants in each group to see a difference.

“So the results of the study don’t tell you much,” said Bongartz, who was not involved with the new study.

He added that even if the study could reproduce the results of past studies of people without gout, it probably wouldn’t bring people’s uric acid levels below the threshold of 6.5 milligrams per deciliter. But it doesn’t mean medication is the only answer.

“It does not always have to be medication. There are many other measures that can help people drop uric acid levels. The most important one is in obese individuals to drop weight,” Bongartz said.

Another way, according to both Bongartz and Stamp, is to cut back on alcohol – especially beer.

- Reuters

HEALTH - Gout - What is Gout?

Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.

Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

An acute attack of gout can wake you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

Symptoms

The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:

• Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first 12 to 24 hours after it begins.
• Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness. The affected joint or joints become swollen, tender and red.

When to see a doctor
If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.

Seek medical care immediately if you have a fever and a joint is hot and inflamed, which can be a sign of infection.

Causes

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as organ meats, anchovies, herring, asparagus and mushrooms.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Risk factors

You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include:

• Lifestyle factors. Choices you make in your everyday life may increase your risk of gout. Excessive alcohol use — generally more than two drinks a day for men and more than one for women — increases the risk of gout.
• Medical conditions. Certain diseases and conditions make it more likely that you'll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
• Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
• Family history of gout. If other members of your family have had gout, you're more likely to develop the disease.
• Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop signs and symptoms after menopause.

Complications

People with gout can develop more-severe conditions, such as:

• Recurrent gout. Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout.
• Advanced gout. Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fi). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the back of your ankle. Tophi usually aren't painful, but they can become swollen and tender during gout attacks.
• Kidney stones. Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Tests and diagnosis

Tests to help diagnose gout may include:

• Joint fluid test. Your doctor may use a needle to draw fluid from your affected joint. When examined under the microscope, your joint fluid may reveal urate crystals.
• Blood test. Your doctor may recommend a blood test to measure the uric acid level in your blood. Blood test results can be misleading, though. Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.

Treatments and drugs

Treatment for gout usually involves medications. What medications you and your doctor choose will be based on your current health and your own preferences. Gout medications can be used to treat acute attacks and prevent future attacks as well as reduce your risk of complications from gout, such as the development of tophi from urate crystal deposits.

Medications to treat gout attacksDrugs used to treat acute attacks and prevent future attacks include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may control inflammation and pain in people with gout. Your doctor may prescribe a higher dose to stop an acute attack, followed by a lower daily dose to prevent future attacks.
  NSAIDs include over-the-counter options such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), as well as more-powerful prescription NSAIDs such as indomethacin (Indocin). NSAIDs carry risks of stomach pain, bleeding and ulcers.
• Colchicine. If you're unable to take NSAIDs, your doctor may recommend colchicine (Colcrys), a type of pain reliever that effectively reduces gout pain — especially when started soon after symptoms appear. The drug's effectiveness is offset in most cases, however, by intolerable side effects, such as nausea, vomiting and diarrhea.
  After an acute gout attack resolves, your doctor may prescribe a low daily dose of colchicine to prevent future attacks.
• Corticosteroids. Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids may be administered in pill form, or they can be injected into your joint. Your doctor might inject a corticosteroid medication during the same visit as a joint fluid test — where he or she withdraws (aspirates) fluid from your joint with a needle. Corticosteroids are generally reserved for people who can't take either NSAIDs or colchicine.
  Side effects of corticosteroids may include thinning bones, poor wound healing and a decreased ability to fight infection. To reduce the risk of these serious side effects, your doctor will try to find the lowest dose that controls your symptoms and prescribe steroids for the shortest possible time.

Medications to prevent gout complicationsIf you experience several gout attacks each year or if your gout attacks are less frequent but particularly painful, your doctor may recommend medication to reduce your risk of gout-related complications.

Options include:

• Medications that block uric acid production. Drugs called xanthine oxidase inhibitors, including allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric), limit the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout. Side effects of allopurinol include a rash and low blood counts. Febuxostat side effects include rash, nausea and reduced liver function.
  Xanthine oxidase inhibitors may trigger a new, acute attack if taken before a recent attack has totally resolved. Taking a short course of low-dose colchicine before starting a xanthine oxidase inhibitor has been found to significantly reduce this risk.
• Medication that improves uric acid removal. Probenecid (Probalan) improves your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased. Side effects include a rash, stomach pain and kidney stones.

Lifestyle and home remedies

Medications are the most proven, effective way to treat gout symptoms. However, making certain changes to your diet also may help.

The American Dietetic Association recommends following these guidelines during a gout attack:

• Drink 8 to 16 cups (about 2 to 4 liters) of fluid each day, with at least half being water.
• Avoid alcohol.
• Eat a moderate amount of protein, preferably from healthy sources, such as low-fat or fat-free dairy, tofu, eggs, and nut butters.
• Limit your daily intake of meat, fish and poultry to 4 to 6 ounces (113 to 170 grams).

Alternative medicine

If gout treatments aren't working as well as you'd hoped, you may be interested in trying an alternative approach. Before trying such a treatment on your own, talk with your doctor — to weigh the benefits and risks and learn whether the treatment might interfere with your gout medication. Because there isn't a lot of research on alternative therapies for gout, however, in some cases the risks aren't known.

Certain foods have been studied for their potential to lower uric acid levels, including:

• Coffee. Studies have found an association between coffee drinking — both regular and decaffeinated coffee — and lower uric acid levels, though no study has demonstrated how or why coffee may have such an effect. The available evidence isn't enough to encourage noncoffee drinkers to start, but it may give researchers clues to new ways of treating gout in the future.
• Vitamin C. Supplements containing vitamin C may reduce the levels of uric acid in your blood. However, vitamin C hasn't been studied as a treatment for gout. Don't assume that if a little vitamin C is good for you, then lots is better. Megadoses of vitamin C may increase your body's uric acid levels. Talk to your doctor about what a reasonable dose of vitamin C may be. And don't forget that you can increase your vitamin C intake by eating more fruits and vegetables, especially oranges.
• Cherries. Cherries have been associated with lower levels of uric acid in studies, but it isn't clear if they have any effect on gout signs and symptoms. Eating more cherries and other dark-colored fruits, such as blackberries, blueberries, purple grapes and raspberries, may be a safe way to supplement your gout treatment, but discuss it with your doctor first.

Other complementary and alternative medicine treatments may help you cope until your gout pain subsides or your medications take effect. For instance, relaxation techniques, such as deep-breathing exercises and meditation, may help take your mind off your pain.

Prevention

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

Keep your fluid intake high.Aim for 8 to 16 cups (about 2 to 4 liters) of fluid each day, with at least half being water. Limit how many sweetened beverages you drink, especially those sweetened with high fructose corn syrup.

Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.

Eat a balanced diet following the Dietary Guidelines for Americans. Your daily diet should emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk products.

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 sources.

Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.

Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.

HEALTH - Papaya For Uric Acid/Gout Problem

1.   First boil at least 3 liters of water. 

2.   Slice medium size green papaya and remove the 

      seeds.

3.   Cut into small cubes. 

4.   Place into the water and bring to boil.

5.   Add tea leaves (oolong) or green tea at least 5 

      bags similar to the tea making proces . . . this is 


This is a very effective treatment for gout. 



Frequent drinking of this formula will heal the pain 

you've been suffering for ages . . . skin of the papaya 

should be included . .!