HOMEOPATHY AND GOUT
GOUT : is the one of the common form of inflammatory arthritis ,more common in men above 40 yrs.It is a painful form of arthritis caused by excess amount of Uric acid in the blood (HYPERURICEMIA) .high uric acid levels in the blood lead to formation of monosodium urate crystals in the joints and other tissues.,causing inflammation ,swelling and pain in the joints.The acute episode is followed by recurrence.
Gouty Diathesis —
The dictionary defines Diathesis as, “A hereditary predisposition of the body to a disease, a group of diseases, an allergy, or another disorder.”Gouty diathesis is defined as High levels of uric acid in the urine which can cause either calcium or uric acid stone formation . The ph of urine in a gouty diathesis is usually below 5.5,while the normal urine ph is between 5.5- 6.5.
At a pH below 5.5, nearly 100% of uric acid exists in an undissociated form.However, persistently acidic urine (ie, pH < 5.5) is the most important factor observed in patients with uric acid stones.The cause for persistent acidic urine is not clearly understood,but recent studies suggest a association between diabetes mellitis and insulin resistance in patients with normal uric acid levels and acidic urine.Insulin resistance may lead in a mild defect in ammonium excretion which result in stone formation.
The primary risk factor for gout is elevated levels of a metabolic byproduct called uric acid in the blood; this condition is known as Hyperuricemia.
Hyperuricemia increases the risk of not only gout, but other diseases as well, including hypertension, kidney disease, and metabolic syndrome. Even during the asymptomatic periods between gout attacks, the body is exposed to periods of low-grade, chronic inflammation.
Causes : Uric acid is formed as we metabolise the food we eat and break down of
- Generation of too much Uric acid : comprising of approximately about 10 % people suffering from gout.
- Under excreters : 90 % people belong to this category.Kidneys do not work effectively to excrete the uric acid in the urine.
- Trauma or Joint injury
- Starvation and dehydration
- Diuretics and some other anti-hypertensive medications,
- aspirin (Bayer, Ecotrin),
- nicotinic acid (B-3-50, B3-500-Gr, Niacin SR, Niacor, Niaspan ER, Slo-Niacin),
- cyclosporin A,
- allopurinol (Zyloprim) and probenecid (Benemid),
- Nutrition – is not the cause but can trigger gout . Hence, alcohol ,obesity- excess of alcohol especially Beet,red meat and purine rich food can worsen the disease.
- Sudden onset of hot ,red swollen joint commonly the great toe but any joint can be affected ( knee,ankle, small joints of hands )
- An acute episode is usually followed by recurrence affecting the same or other joint.
- Uric acid crystals can form outside joints. Collections of these crystals, known as tophi, can be found in the earlobe, elbow, and Achilles tendon (back of the ankle),or in other tissues. These tophi are not painful but can be a valuable clue for the diagnosis .
- Kidney stones are more common in people with gout.
Diagnosis of GOUT : Mainly a clinical diagnosis.However,
- Joint aspiration :most important diagnostic test.A needle is inserted in the joint and a sample of the fluid is collected and checked for uric acid crystal.
- Blood test : serum uric acid levels , kidney functions.Unfortunately, the level of uric acid is not a reliable marker , as it may be normal in about 10 % of people suffering from a episode of gout. Otherwise is also true . in which elevated uric acid levels are present but without any joint swelling or pain.Interestingly,uric acid levels are lowered during an acute inflammatory episode,hence the best time to measure uric acid levels is after the acute episode is over.
- Xray : to assess underlying joint damage.
HOMOEOPATHIC TREATMENT OF GOUT :
- Acute pain management : Drugs like Colchicum, Ledum,Belladonna ,Bryonia ,Benzoic acid,urtica urens,Rhododendron and Formica Rufa .
- Managing Gout Long term – Decreasing the uric acid to less than 6mg/dl is the goal of managing gout long term.Here constitutional treatment will be indicated .Drugs like Lycopodium,Pulsatilla ,Ammonium Phos ( when crystals have formed),Antim crud, Staphysagria are few of the well indicated remedies.
Self Care tips at Home
- It may be helpful to keep the swollen joint elevated above your chest as much as possible.
- Ice packs can be helpful in relieving pain and reducing inflammation.
- Maintaining adequate hydration is key for minimizing the frequency and intensity of attacks.Drink plenty of liquids like water, Fluids like water help in removing the uric acid from body.
- Avoid foods that are high in purines (the biochemical in foods that is metabolized into uric acid),including shellfish,sardines,fish eggs and Meats such as pork,lamb,Beef and other organ meats ( such as liver,kidney ,brain) and also meat based gravies.Also avoid other purine rich vegetables like cauliflower,spinach and mushrooms and also lentils,peas and oatmeal
- Add low fat dairy products to your diet.This is said to reduce the risk of gout
- Lose weight. This can lower your uric acid levels. Losing weight too rapidly can occasionally precipitate gout attacks.Regular exercise is a must.
- Restrict your intake of alcohol, especially beer.
- Low purine foods like breads ,pasta,rice and cereals.Beverages like coffee,carbonated drinks ,milk and milk products, vegetables like Tomatoes and other greens and other foods like olives, cheese,eggs, chocolate and fruits are recommended.