GOUT- A CHRONIC DISEASE

Hi everybody, the prevalence of gout is increasing day by day... yesterday an adorable lady, my suman aunty ask me to write something about gout... she was realy curious to know what this gout is???? What are the dietary recommendations??? And how we can diagnose this condition????

An awareness and nutritional education need to develop among the people of society as its prevalence and incidents are increasing in recent years... so here I am....

GOUT

Gout is a kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation. Gout is a chronic disease caused by an uncontrolled metabolic disorder, hyperuricemia, means too much uric acid in the blood, which leads to the deposition of monosodium urate crystals in tissue. Uric acid is the end metabolism product of purine, purine being the nitrogen-containing compound that occurs in nucleic acid. It is excreted out mainly by the kidneys, where it passes out in urine. Whenever the normal balance is disturbed by decreased excretion by the kidney or increased production, the blood level of uric acid increases and builds up in the fluid around the joints (synovial fluid), uric acid crystals form. These crystals cause the joint to swell up and become inflamed. There are two conditions of Gout, Acute gout is a painful condition that typically affects one joint. Chronic gout is repeated episodes of pain and inflammation, which may involve more than one joint.

PREVALENCE AND RISK FACTORS

Gout is the most prevalent form of inflammatory arthropathy. It is a true crystal deposition disease caused by formation of monosodium urate crystals in joints and other tissues. It is a common inflammatory arthritis that has increased in prevalence in recent decades. A number of epidemiological studies from a diverse range of countries suggest that gout has increased in prevalence and incidence in recent years and that the clinical pattern of gout is becoming more complex. In particular, the greatest increase has been observed in primary gout in older men. The incidence of gout varies in population with an overall prevalence of less than 1 to 15.3%. The Bhigwan COPCORD survey demonstrated low prevalence of Gout (0.12%) in rural India. In another Indian study gout prevalence was 2%. Gout once called the “disease of kings,” is also seen in women, especially after menopause. Gout affects more than 1% of adults in the USA, and it is the most common form of inflammatory arthritis among men.

Accumulating data support an increase in the prevalence of gout that is potentially attributable to recent shifts in diet and lifestyle, improved medical care, and increased longevity. Gout prevalence increases in direct association with age; the increased longevity of populations in industrialized nations may contribute to a higher prevalence of gout through the disorder's association with aging-related diseases such as metabolic syndrome and hypertension, and treatments for these diseases such as thiazide diuretics for hypertension. Robust epidemiological studies have established risk factors for gout including genetic factors, excess alcohol consumption, purine-rich diet, the metabolic syndrome (obesity, hypertension, hyperlipidemia and insulin resistance), use of diuretics and chronic renal failure. Trends in alcohol use, diet, obesity and the metabolic syndrome in the general population might explain changes in the prevalence and incidence of gout in the community.

The condition may also develop in people with:

• Diabetes

• Kidney disease

• Obesity

• Sickle cell anemia and other anemias

• Leukemia and other blood cancers

The condition may occur after taking medicines that interfere with the removal of uric acid from the body.

SYMPTOMS

Symptoms of acute gout:

• Symptoms usually involve only one or a few joints. The big toe, knee, or ankle joints are most often affected.

• The pain starts suddenly, often during the night

• The joint appears warm, red and are usually very tender. In some people, the acute pain is so intense that even a bed sheet on the toe causes severe pain.

• There may be a fever.

• The attack may go away in a few days, but may return from time to time. Additional attacks often last longer.

After a first gouty attack, people will have no symptoms. Half of patients have another attack.

Some people may develop chronic gout. Those with chronic arthritis develop joint damage and loss of motion in the joints. They will have joint pain and other symptoms most of the time.

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. Typically, these tophi are not painful but can be a valuable clue for the diagnosis as the crystals that form them can be removed with a small needle for microscopic examination. Microscopic evaluation of a tophus reveals a nest-like accumulation of uric acid crystals embedded with white blood cells of inflammation.

TREATMENT

Medicines should be taken as soon as possible if you have a sudden gout attack. Consult your physician as soon as possible. Along with specific prescribed medications, it is typically recommended that people with gout reduce their intake of purine-rich foods.

LIFESTYLE AND DIET MODIFICATION

• Avoid alcohol

• Reduce purine-rich foods. According to the American Medical Association, purine-containing foods include:

• Beer, other alcoholic beverages.
• Anchovies, sardines in oil, fish roes, herring.
• Yeast.
• Organ meat (liver, kidneys, sweetbreads). Even lamb, pork, beef, shrimp, scallops, mussles, lobster and canned fish are also harmful.
• Legumes (dried beans, peas).
• Meat extracts, consommé, gravies.
• Mushrooms, spinach, asparagus, cauliflower.

• Avoid fatty foods such as salad dressings, ice cream, and fried foods.

• According to the American Medical Association, a balanced diet for people with gout include foods:

• High in complex carbohydrates (whole grains, fruits, vegetables)
• Low in protein (15% of calories and sources should be soy, lean meats, poultry)
• No more than 30% of calories from fat (10% animal fat)

• Increase the intake of low fat dairy products which include skimmed milk, yogurt and such items which protect you against gout attacks. Research is suggesting that certain foods may also prevent gout. In a study published in the New England Journal of Medicine, scientists found that a high intake of low-fat dairy products reduces the risk of gout in men by half. The reason for this protective effect is not yet known. Another study examining the effects of vitamin C on uric acid suggests that it may be beneficial in the prevention and management of gout and other diseases that are associated with uric acid production.

FOODS MUST INCLUDED IN DIET

• Dark berries help in processing uric acid and hence lowering its levels inside the body. Cherries can lower plasma uric acid levels. They contain flavonoid compounds that may lower uric acid and reduce inflammation. Flavonoids called anthocyanins, often found in purple and blue colored berries, help to shut down the enzymes that cause tissue inflammation in the first place. Anthocyanins can therefore prevent and treat many kinds of pain. A study done at the University of California at Davis by Jacob et. al entitled "Consumption of Cherries Lowers Plasma Urate in Healthy Women" proved just that and also showed that there was a decrease in plasma urate after cherry consumption. Bilberry, hawthorn, and blueberries are also high in anthocyanosides

• Fish like salmon and flax seeds are also known to lower the levels of uric acid inside the body. Olive oil is also known to reduce inflammation and enhance the healing process of gout.

• Add Tofu to your daily diet routine instead of meat. A research done by Yamakita J, 1998, published in advances in experimental medicine and biology journal, suggest that tofu is a preferable source of protein, especially in gout patients with uric acid clearance > 6.0 mL/min.

OBESITY AND GOUT

Exercise regularly and maintain a healthy body weight. Lose weight if you are overweight, but avoid low-carbohydrate diets that are designed for quick weight loss. When carbohydrate intake is insufficient, your body can’t completely burn its own fat. As a consequence, substances called ketones form and are released into the bloodstream, resulting in a condition called ketosis. After a short time, ketosis can increase the level of uric acid in your blood. If you are losing weight, lose it slowly. Quick weight loss may cause uric acid kidney stones to form.

I HOPE THIS WILL HELP ALL OF YOU TO DIAGNOSE THIS CONDITION AND CREAT AWARENESS AMONG OTHERS TOO...

Content courtesy: http://www.niams.nih.gov/Health_Info/Gout/default.asp

http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gout.asp

http://www.ncbi.nlm.nih.gov/pubmed/21205285

http://www.ncbi.nlm.nih.gov/pubmed/17664951

http://www.ncbi.nlm.nih.gov/pubmed/19447779

http://www.ncbi.nlm.nih.gov/pubmed/16820041

http://www.ncbi.nlm.nih.gov/pubmed?term=tofu+and+uric+acid&TransSchema=title&cmd=detailssearch

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001459/

http://www.jkscience.org/archive/volume91/GOUT%20&%20MENOPAUSE.pdf

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