GOUT

                                               GOUT

                                    (Hyperuricemia, Crystal arthropathy, गठिया ,वात रक्त )

     
                                                        "Dangers of high Uric Acid"

Gout is a metabolic disorder which results in the deposition of urate crystals in joints. It is a disease caused by protein rich foods and chiefly affects middle aged men. Women after menopause are also sometimes affected by this disease.Gout was initially called  hyperurecemia  because of excess of uric acid in blood. Uric acid is a product in the body during the breakdown of Purine, a chemical compound that are found in high amount in certain foods such as meat, poultry and sea food.

Gout is a kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation.. Gout was known to the physicians of ancient Greece and Rome.The classical description was written in 1663 by Syndenham, himself a life-long sufferer. It was recognized in the 18th century that large enjoyable meals and the consumption of alcoholic drinks were often the prelude to an attack of gout. This disease affected many famous men in history, including Alexander the Great, Luther, Newton, Milton, Dr Johnson, Franklin and Louis XIV.

                  "Uric Acid : A normal constituent of blood and protein metabolism."

Introduction

When uric acid crystals deposit in  joints it causes Gouty arthritis. In soft tissue gout causes tophi and tenosynovitis. Gout also causes kidney stones.. The major crystal associated with arthritis are monosodium urate monohydrate (urate gout), calcium phosphate dihydrate (CPPD gout), hydroxyapatite (apatite gout).

When breaking down of Purines, the body produces uric acid. Uric acid is an end product of the protein metabolism that is body's chemical processes. This uric acid usually remained dissolved in the blood. But when the blood becomes too full of it, uric acid forms needle-shaped crystals in the joints which bring about attacks of gout.Those affected by gout have a higher level of uric acid than normal.
either due to formation of increased uric acid or due to reduced amount of  uric acid being passed out by the kidneys in the urine.

High Uric acid level is usually diagnosed incidentally while undergoing blood test for any other conditions. It’s becoming a common yet abnormal finding in a routine test.Ayurveda views this condition as vitiation of vata and rakta.

                                         "Gout gets worst at night and early morning hours".

Signs & Symptoms

* Pain, swelling and extreame tenderness in the joints in the joints, usually a big toe joint. This symptom is called podagra.
* Onset is abrupt usually occurs at night.
* Very red or purplish skin around the affected joint. The joint may be infected.
* Limited movement in the affected joint.
* Peeling and itching of skin around the affected joint as the gout gets better.
* Gout may lead to inflammation of the fluid sac (bursa) that cushion the tissues, particularly in the  elbows (olecrnon bursitis) and knee (prepatellar bursitis).
* Gout can also affect the joints of the feet,ankle,knees,wrists,fingers and elbows.

* Symptoms may occur after an illness or surgery.
* Chronic Tophaceous gout present chronic pain and stiffness with irregular swelling.
Tophi in cartilage of ear, nose or eyelids.
* The acute attack generally last for a week or so. During this period the patient may run a slight fever and feel disinclined to eat.
* In chronic gout the joint generally becomes damaged by arthritis. In which chalky lumps of uric acid crystals remain in the joint and also formed under the skin.
* Joint erosion and disruption may cause chronic disability, associated with soft tissue deposit of urate (tophi) in the pinna,(outer ear) bursae and tendons.
* Kidney stones made of uric acid is another serious complication of gout. It causes severe colic pains in the stomach.
* In some cases  the kidneys become damaged and do not function properly. This is a serious condition as the poisonous waste  products which are normally removed by the kidneys are accumulate in the blood.

                                                     "Gout is associated with obesity".

Causes

* High protein diet. meat, poultry and sea food.( राजसिक आहार) or rich diet.
* Taking the drugs such as Cyclosporine.
* Diuretics (lasix) medication for high blood pressure, leg swelling (edema) or heart failure can precipitate gout attack.
*  Dehydration.
* Obesity,
* Under functioning thyroid, and high levels of cholesterol can also increase the chances of developing gout
* Genetic disorders, can lead to high Uric acid levels.
* Heredity, certain races are prone to gout.
* Excessive intake of alcoholic drinks.
* Lack of proper exercise.
* Excess production of uric acid or under excretion of uric acid due to kidney element.
* Stress
*Ayurveda : According to Ayurveda, Gout is caused due to vitiation of  vata & rakta. Blood skin and muscles are afflicted.


                                                    "Acute attack last for 3-10 days".

Diagnosis

*  Blood test: Normal Uric acid  levels are 6.0 mg / 100 ml in females and 7.0 mg /100 ml in males. Asymptomatic high uric acid levels greater than 8 mg/dl warrant further investigations.

* Synovial fluid microscopy:  analysis is the best way to confirm the diagnosis. Neutrophil are present. Monosodium urate monohydrate crystals are long thin needle-shaped.

                                             
                                         
-X-ray are normal in acute gout, but pinched out erosion and joints disorganization is seen in chronic gout.

Complications

* High Uric acid levels are associated with kidney diseases and put one at a higher risk of heart diseases,
* High blood pressure
* Chronic kidney disease
* Metabolic syndrome (combination of obesity, high blood pressure and difficult to control diabetes.

Lifestyle

*   Relax, as stress can aggravate gout.
*   Fresh air and outdoor exercise are essential.
*   Lose weight if obese.
*   Reduce alcohol intake.
*   Adequate water throughout the day. Water helps in flushing out toxins from the body including excess presence of uric acid. So have at least 8-10 glasses of water every day.
*  Regularly exercise. Consider swimming, if one has arthritis.
*  Patient should be instructed to maintain high fluid intake to reduce chances of nephrolithiasis .

Mudra

Vayu Mudra
                     
                                                           

• Gout is cured with continuous practice of Vayu mudra followed by Prana mudra

Prana Mudra

Meditation

The best way to get rid of stress. Chanting of "OUM, ॐ " or practicing Udgeet Pranayama.

Diet 

* Diet low in purines and fat.
* Fruit, vegetables, whole grains, low fat dairy products lowers uric acid.
* Bananas. As bananas are low in purines and high in vitamin C, which makes them good food to eat if you have gout.
* Vegetables like cabbage, red bell pepper and beetroot. cucumber juice is beneficial.
* Fruits such as orange papaya, cherries, pineapple and crane berry juice are beneficial.

* Sprouted moongh. moth, gram, methi
* Apples should be consumed in the diet.
* Cherries is considered effective remedy for gout. Fresh cherries are best. Canned cherries can also be used. Cherry have anti-inflammatory substance referred to as anthocyanins, it helps in reducing uric acid levels. They also prevent uric acid from crystallizing, and getting deposited in joints. Another reason you should have cherries is they neutralize the acids and help in preventing inflammation and pain.
is considered an effective remedy for gout.
* Berries are good for gout especially strawberries and blueberries. Enriched with anti-inflammatory properties.
* Celery and celery seeds.  One of the most popular home remedies to treat high uric acid levels is by consuming celery seeds.
* Foods high in potassium such as potatoes, banana,leafy green vegetables, beans.
* Raw vegetable juices are protective against gout.  Drink  carrot, beetroot and cucumber juice. This is an effective remedy to treat high uric acid in blood. Raw potato juice, Juice of french beans
* Vitamin C enriched food: These foods disintegrate uric acid and flushes it out of the body. Include food such as amla, guava, kiwi,oranges,tomato and green leafy vegetables. Lime : As lime juice contains citric acid, a solvent of uricacid, adding it to your diet is helpful in preventing high uric acid levels. Squeeze half a lime juice in a glass of water and have it every day.
* Olive oil : Cook your foods with cold pressed olive oil.This is a healthy start as it contains anti-oxidants and anti-inflammatory properties.
*Consume low fat dairy milk and curd.
* High fiber food helps in lowering uric acid levels in blood. They absorb uric acid from the bloodstream and helps in eliminating excess uric acid from your body through kidneys. If you have been diagnosed with high uric acid, increase the consumption of dietary soluble fibers such as oats, apples, oranges, broccoli, pears, strawberries, blueberries, cucumbers, celery, carrots and barley.

Avoid

* All purines  : High purine content: Liver, kidney, brain, meat extracts, gravies sardine,lobster,
* Uric acid producing foods such as Meat, poultry (egg), fish, shellfish,sardines,mackerel,scallops,trout  and sea food. Glandular meat are especially harmful.
* No alcohol and sweet sodas.
* Avoid peas, lentils, chana,(chickpea) rajma, lobia,Soy and its products,.
* Avoid all intoxicating liquors,
* Tea, coffee.
* Sugar, white flour (Maida) and its products kachori,samosa, namak pare.
* All canned and processed foods.
* Spices and salts should be used as little as possible.
* Avoid excess of salt as it interferes with elimination of uric acid.

Treatment

Allopathic
                      Do not start uricosuric drugs until acute attack has subsided completely.
For Hyperuricemia
* Drug of choice : Tab Allopurinol (Zyloric or Ciploric) 100 mg, 200-300 mg daily.
* Tab Febuxostat 40 mg OD. If serum uric acid is less 6 mg/dl after 2-4 weeks increase dose to 120mg/day.
Uricosuric drug
* Probenecid if intolerant to Allopurinol.
* Anti-inflammatory medication : As soon as possible. Tab Ibuprofen, Neproxen sodium, Indomethacine, Celecoxib.
* Tab Etoricoxib 90-120 mg bd (twice a day). Advantage of less gastro-intestinal .side effects.
* Tab Indomethacin 50 mg tds (three times a day).
* Tab Neproxen 250-500 mg bd.
* Tab Colchicine (0.5 mg per tab), 2 tab stst followed by one tab 2 hourly till attack subsides.
                                    No Aspirin because it causes uric acid retention.
* Corticosteroids : Tab Prednesolone 40 mg/day tapered off.
* Joint aspiration or intra-articular steroids.
* Inj Triamcinolone 60 mg/day.
* Ice and elevation of joint.
                                                       Diuretics are contraindicated.

* The feet should be bathed in Epsom salt foot baths twice daily. Half to one pound of salt may be added to a foot bath of hot water.
* Cold pack at night, applied to affected joints will be beneficial





* Lithotripsy For renal calculi.

Ayurveda
-Guduchisatva
-Guduchisvarasa with guggulu
-External therapy : Pindataila

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* Medicine as suggested above should only be taken under the consultation and supervision of registered medical practitioner.