Cure Gout Naturally

Definition
Gout is an inflammatory arthritis
associated with hyperuricaemia
Acute arthritis is the most frequent early clinical
manifestation of MSU gout.
Usually only one joint is affected initially
Polyarticular acute gout is also seen in male
hypertensive patients with ethanol abuse as well as
in postmenopausal women.

The metatarso phalangeal joint of the first toe is
often involved.
Ankles, and knees are also commonly affected.
In elderly patients, finger joints may be inflamed.

Epidemiology
—o—
Prevalence of hyperuricaemia 5%
Prevalence of Gout 0.2%
M:F ratio 10:1
Hyperuricaemia is defined as >2 SD from me
umol in males and 360 umol/1 in females.

Urate production varies with the purine content of
the diet and the rates of purine biosyntesis,
degradation and salvage.


Factors associated with High Uric acid
Increasing age
Obesity
High protein diet
High alcohol consumption
Combined hyperlipidemia
Diabetes mellitus
Ischaemic heart disease
Hypertension

Uric acid is the last step in purine breakdown
Conversion of hypoxnthine to xanthine and xanthine
to Uric acid is catalysed by Xanthine Oxidase


Causes of hyperuricemia
Primary
No recognized cause
Hypoxanthine
phosphoribosyltransferase
deficiency
Increased phosphoribosyl
pyrophosphatase activity.


Secondary
Hereditary fructose
intolerance
Myeloproliferative disease
Linfoproliferative disease
Hemolitic anemia
Drugs: Low-doses salicylate,
diuretis, pyrazinamide,
ethambutol, nicotinamide, etanol

Several events may precipitate acute gouty arthritis:
o Dietary excess
0 Trauma
o Surgery
o Excessive ethanol ingestion
o Glucocorticoid withdrawal

Uric acid excretion
UA is completely filtered by glomerulus
Almost 100% is reabsorbed by proximal tubule
50% is re-excreted by distal tubule
Low dose aspirin blocks secretion
High dose aspirin blocks reabsorption

Impaired excretion
Chronic renal failure
Drugs: thiazides, low dose aspirin
Hypertenion
Lead toxicity
Pr. Hyperparathroidism
Hypothyroidism
t lactic acid production: alcohol,
sxercise, starvation
G 6 PD deficiency


Increased production
Lesch Nyhan Syndrome (HGPRT deficiency
PRPP overactivity
G6 PD deficiency
Increased purine turnover
Myeloproliferative disorders eg Polycythemia
rubra vera
Lymphoproliferative disorders like leukemia
Carcinoma esp after chemo, severe psoriasis

Acute Gout
Sudden onset of severe agonizing pain, swelling of
1st MTP joint
Too painful to touch or move
Precipitated by food, exercise, alcohol or diuretic
Usually recovers in 7 days
Typically associated with desquamation of overlying
skin


Treatment
High Dose NSAIDs
Rapid response
Naproxen 750 mg initially then soomg bid
Diclofenac 75-100 mg intially then 50 mg bid or tid
Indomemethacin 75 mg initially the 50 mg bid or qid


Alternative treatments
Colchisine looomg initially then soomg bid to qid
((DIARRHOEA))
Corticosteroids ((intramuscular or intra articular))-
depot methylpredisolone