Gout which may manifest as acute or chronic is an abnormality of uric acid metabolism which results in the precipitation of crystals of uric acid in the form of sodium urate on the articular cartilage of joints, on tendons & in the surrounding tissues.
Sex- Gout is predominantly a disease of men.
Age- It usually begins in middle life.
Causes-
(1) Primary or idiopathic- This type of gout has no cause. Most cases of gout belong to this type.
(2) Secondary- This type of gout has an underlying cause. In this type another disease like lymphoma, leukemia etc is the underlying cause of raised uric acid level in the body & the consequent result is the development of gout.
Risk factors-
(1) Diet- Diet comprising too much meat or fish increases the risk of gout as they are rich in purines.
(2) Life style factors-Excessive alcohol consumption increases the risk of gout.
(3) Certain medical conditions- Certain medical conditions like hypertension, diabetes, hyperlipidemia etc increase the risk of gout.
(4) Certain medications- Certain medications like thiazide diuretics used to treat hypertension increases the risk of gout by increasing the uric acid levels.
(5) Family history -Chance of developing gout increases if there is any family history of gout.
(6) Surgery, trauma, etc- Acute attacks of gout are provoked by surgery, trauma, etc.
Site of lesion - It is usually monoarticular & first metatarsophalangeal joint is the most common site of involvement. Ankle, Knee, wrist, fingers & elbow are other joints affected. Distal & lower extremity joints are involved more often.
Associated medical conditions- Gout may be associated with hypertension, obesity & atherosclerosis.
Pathophysiology- The biochemical abnormality in gout is hyperuricaemia resulting from overproduction of uric acid in the body or its under excretion via kidney. Uric acid is the end product of purine metabolism. It is the last step in the breakdown pathway of nucleoprotein & purines. Uric acid is completely filtered by the glomerulus of the kidney & then subsequent complete reabsorption by proximal tubules followed by secretion of its major portion by the distal tubules occurs, thus maintaining the normal uric acid level in the blood. In primary gout the major cause of the hyperuricaemia is increased urate production, but there is also impaired renal excretion. But it is to be mentioned that hyperuricaemia does not always cause manifestation of gout. When crystals of uric acid in the form of sodium urate precipitate on the articular cartilage of joints, on tendons & in the surrounding tissues, then only there is manifestation of gout.
Clinical Features- The signs & symptoms of gout are always acute & occur suddenly usually at night without any warning & consist of intense joint pain & swelling involving a single joint, most often in the feet, especially the big toe. The typical gouty joint is red, warm, swollen & exquisitely tender. Sometimes the inflammation is so gross that it may resemble cellulites. In later stages of the disease, there is presence of tophi in the ear lobules or around joints which provides a clue to the correct diagnosis.
Investigations-
(1) Routine blood test- Routine blood test may show leucocytosis & raised ESR.
(2) Analysis of joint fluid- Joint fluid from an affected joint examined under a polarizing microscope if reveals the presence of urate crystals, diagnosis is confirmed.
(3) Blood test for uric acid level estimation- Blood test reveals high uric acid levels. But it may be misleading as people with high uric acid levels may never experience gout whereas people with normal or slightly raised uric acid levels may have clinical features of gout.
(4) X-ray - X-ray is usually normal but it may show deposits of tophi & bone damage due to repeated inflammations. X-ray can also help in monitoring the effects of chronic gout on affected joints.
Differential Diagnosis- Gout may be confused with cellulites, rheumatoid arthritis, osteoarthritis, pseudogout, psoriatic arthritis, septic arthritis etc from which it has to be differentiated.
Complications- Of the various complications, the following are important:
(1) Tophi formation- If untreated, it may cause deposition of urate crystals under the skin forming nodules called tophi.
(2) Kidney stones- Urate crystals may collect in the urinary tract giving rise to kidney stones.
Treatment-
[A] General measures to be taken are-
(1) Cold compresses on painful joints.
(2) Complete rest.
[B] Homeopathic medicines to be used – There are a lot of homeopathic medicines which are used in the treatment of gout. Some of the commonly used medicines are Aconite, Ammonium Phosphoricum, Benzoicum acidum, Bryonia, Calcarea Fluorica, Colchicum, Cinchona Officinalis, Formica Rufa, Rhus toxicodendron (Rhus.tox) etc. Aconite is helpful especially when the joint is red, swollen & the inflammation is worse at night. Ammonium Phosphoricum is very useful for chronic gouty patients with nodes in joints. Benzoicum acidum is very useful for gouty deposits. Bryonia is particularly helpful when there is pain on pressure on any spot of the affected joint. Calcarea Fluorica is usually used in gouty enlargements of the joints of the fingers. Cinchona Officinalis is useful for cases of chronic gout. Colchicum works better in gout in heel & feet, especially when the great toe is affected & the inflamed joint is tender to touch or move. Formica Rufa is useful for cases of chronic gout & stiffness of joints. Rhus.tox is helpful for those who have hot, stiff & painful swelling of joints. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual along with type of gout whether it is acute or chronic. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine. If the acute stage is over & the disease passes to a chronic stage, the medicine should be changed according to the demand of the prevailing condition of the disease.
Causes-
(1) Primary or idiopathic- This type of gout has no cause. Most cases of gout belong to this type.
(2) Secondary- This type of gout has an underlying cause. In this type another disease like lymphoma, leukemia etc is the underlying cause of raised uric acid level in the body & the consequent result is the development of gout.
Risk factors-
(1) Diet- Diet comprising too much meat or fish increases the risk of gout as they are rich in purines.
(2) Life style factors-Excessive alcohol consumption increases the risk of gout.
(3) Certain medical conditions- Certain medical conditions like hypertension, diabetes, hyperlipidemia etc increase the risk of gout.
(4) Certain medications- Certain medications like thiazide diuretics used to treat hypertension increases the risk of gout by increasing the uric acid levels.
(5) Family history -Chance of developing gout increases if there is any family history of gout.
(6) Surgery, trauma, etc- Acute attacks of gout are provoked by surgery, trauma, etc.
Site of lesion - It is usually monoarticular & first metatarsophalangeal joint is the most common site of involvement. Ankle, Knee, wrist, fingers & elbow are other joints affected. Distal & lower extremity joints are involved more often.
Associated medical conditions- Gout may be associated with hypertension, obesity & atherosclerosis.
Pathophysiology- The biochemical abnormality in gout is hyperuricaemia resulting from overproduction of uric acid in the body or its under excretion via kidney. Uric acid is the end product of purine metabolism. It is the last step in the breakdown pathway of nucleoprotein & purines. Uric acid is completely filtered by the glomerulus of the kidney & then subsequent complete reabsorption by proximal tubules followed by secretion of its major portion by the distal tubules occurs, thus maintaining the normal uric acid level in the blood. In primary gout the major cause of the hyperuricaemia is increased urate production, but there is also impaired renal excretion. But it is to be mentioned that hyperuricaemia does not always cause manifestation of gout. When crystals of uric acid in the form of sodium urate precipitate on the articular cartilage of joints, on tendons & in the surrounding tissues, then only there is manifestation of gout.
Clinical Features- The signs & symptoms of gout are always acute & occur suddenly usually at night without any warning & consist of intense joint pain & swelling involving a single joint, most often in the feet, especially the big toe. The typical gouty joint is red, warm, swollen & exquisitely tender. Sometimes the inflammation is so gross that it may resemble cellulites. In later stages of the disease, there is presence of tophi in the ear lobules or around joints which provides a clue to the correct diagnosis.
Investigations-
(1) Routine blood test- Routine blood test may show leucocytosis & raised ESR.
(2) Analysis of joint fluid- Joint fluid from an affected joint examined under a polarizing microscope if reveals the presence of urate crystals, diagnosis is confirmed.
(3) Blood test for uric acid level estimation- Blood test reveals high uric acid levels. But it may be misleading as people with high uric acid levels may never experience gout whereas people with normal or slightly raised uric acid levels may have clinical features of gout.
(4) X-ray - X-ray is usually normal but it may show deposits of tophi & bone damage due to repeated inflammations. X-ray can also help in monitoring the effects of chronic gout on affected joints.
Differential Diagnosis- Gout may be confused with cellulites, rheumatoid arthritis, osteoarthritis, pseudogout, psoriatic arthritis, septic arthritis etc from which it has to be differentiated.
Complications- Of the various complications, the following are important:
(1) Tophi formation- If untreated, it may cause deposition of urate crystals under the skin forming nodules called tophi.
(2) Kidney stones- Urate crystals may collect in the urinary tract giving rise to kidney stones.
Treatment-
[A] General measures to be taken are-
(1) Cold compresses on painful joints.
(2) Complete rest.
[B] Homeopathic medicines to be used – There are a lot of homeopathic medicines which are used in the treatment of gout. Some of the commonly used medicines are Aconite, Ammonium Phosphoricum, Benzoicum acidum, Bryonia, Calcarea Fluorica, Colchicum, Cinchona Officinalis, Formica Rufa, Rhus toxicodendron (Rhus.tox) etc. Aconite is helpful especially when the joint is red, swollen & the inflammation is worse at night. Ammonium Phosphoricum is very useful for chronic gouty patients with nodes in joints. Benzoicum acidum is very useful for gouty deposits. Bryonia is particularly helpful when there is pain on pressure on any spot of the affected joint. Calcarea Fluorica is usually used in gouty enlargements of the joints of the fingers. Cinchona Officinalis is useful for cases of chronic gout. Colchicum works better in gout in heel & feet, especially when the great toe is affected & the inflamed joint is tender to touch or move. Formica Rufa is useful for cases of chronic gout & stiffness of joints. Rhus.tox is helpful for those who have hot, stiff & painful swelling of joints. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual along with type of gout whether it is acute or chronic. Lower potency is to be used at the beginning. If response is not satisfactory a second dose should be used. If desired effect is still not noticed, it is better to switch over to a new medicine. If the acute stage is over & the disease passes to a chronic stage, the medicine should be changed according to the demand of the prevailing condition of the disease.
Prevention-
(1) Intake of diets with fewer purines. Curtail in intake of excessive proteins.
(2) Reduction in alcohol consumption.
(3) Intake of more low-fat dairy products.
(4) Intake of more complex carbohydrates।
Prognosis - Mild attacks resolve spontaneously within 2 days, more severe attacks may last for 7-10 days. Most patients with gout will experience repeated attacks of arthritis over the years.
(1) Intake of diets with fewer purines. Curtail in intake of excessive proteins.
(2) Reduction in alcohol consumption.
(3) Intake of more low-fat dairy products.
(4) Intake of more complex carbohydrates।
Prognosis - Mild attacks resolve spontaneously within 2 days, more severe attacks may last for 7-10 days. Most patients with gout will experience repeated attacks of arthritis over the years.
In short, gout is manifested by intense joint pain & swelling involving a single joint, most often in the feet& is to be treated by Aconite, Ammonium Phosphoricum, Benzoicum acidum, Bryonia, Calcarea Fluorica, Colchicum, Cinchona Officinalis, Formica Rufa, Rhus.tox etc.
But in every case, a doctor should be consulted.
But in every case, a doctor should be consulted.
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