Gout and Uric Acid

Gout is one of the most painful rheumatic diseases. It results from deposits of needle-like crystals of uric acid in the connective tissue, joint spaces, or both. These deposits lead to inflammatory arthritis, which causes swelling, redness, heat, pain, and stiffness in the joints. Gout accounts for about 5 percent of all cases of arthritis.

Pseudogout, also a crystal-induced arthritis, is a condition with similar symptoms that results from deposits of calcium pyrophosphate dihydrate crystals in the joints. It is sometimes called calcium pyrophosphate deposition disease, crystal deposition disease, or chondrocalcinosis.

Uric acid is a substance that results from the breakdown of purines or waste products in the body. Deposits of uric acid, called tophi, can appear as lumps under the skin around the joints and at the rim of the ear. In addition, uric acid crystals can also collect in the kidneys and cause kidney stones.

For many people, gout initially affects the joints in the big toe, a condition called podagra. Sometime during the course of the disease, gout will affect the big toe in about 75 percent of patients. Gout can also affect the instep, ankles, heels, knees, wrists, fingers, and elbows.

Gout can progress through four stages:
  1. Asymptomatic(without symptoms) hyperuricemia - In this stage, a person has elevated levels of uric acid in the blood but no other symptoms. The tendency to develop gout, however, is present.
  2. Acute gout, or acute gouty arthritis - In this stage, hyperuricemia has caused the deposit of uric acid crystals in joint spaces. This leads to a sudden onset of intense pain and swelling in the joints, which may also be warm and very tender. An acute gout attacks commonly occur at night and can be triggered by stressful events, alcohol or drugs, or another acute illness. Early attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not occur for months or even years. Over time, however, attacks can last longer and occur more frequently.
  3. Interval or intercritical gout - This is the period between acute attacks. In this stage, a person does not have any symptoms and has normal joint function.
  4. Chronic tophaceous gout - This is the most disabling stage of gout and usually develops over a long period, such as 10 years. In this stage, the disease has caused permanent damage to the affected joints and sometimes to the kidneys. With proper treatment, most people with gout do not progress to this advanced stage.

Gout Symptoms:

Symptoms of Gout are inflammation, swelling, rednesss and warmth over the joint, most commonly the big toe. It will be extremely tender and touching or moving it will be extremely painful. Gout attacks occur quickly, often during an 8 to 12 hour period rather than gradually and typically occur in only one joint at a time. The individual also may experience fever, chills, and fatigue. In some cases gout symptoms develop in two or three joints at the same time however it is extremely rare. If symptoms occur more widespread than that, it is probably not gout. Many gout sufferer say they first noticed pain in the middle of the night or upon arising in the morning.

Gout Treatment and Drug Negative Side Effects:

ALLOPURINOL (Zyloprim, Lopurin) this drug inhibits the production of uric acid and has been linked to skin eruptions, inflammation of the blood vessels, and liver toxicity not to mention, nausea, vomiting, diarrhea, numbness and a host of other side effects.

COLCHICINE (no brand name) this drug is used to alleviate attacks. It can cause serious side effects and toxicity as well as the other minor side effects of nausea, vomiting, diarrhea, numbness and sometimes bleeding or bruising. And the overdose rating on this one is HIGH!

INDOMETHACIN (Indocin, Indocin I. V., Indocin S. R.) This is a non-steroidal anti-inflammatory drug or NSAIDs. It also treats the attacks of gout but has it's side effects as well. Stomach pain, indigestion, headaches, dizziness nausea, and vomiting are among the most common problems. Used long term NSAIDs may also have significant toxicity.

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