What is Gout

Gout is a very commonly encountered problem all over the world today. It is observed generally in the elderly population, especially those who have been suffering for a long time from arthritis. Gout is a common painful type of arthritis.

The severest problem with gout is that it often comes on suddenly without any warning. Within a single night, an apparently hale and hearty joint can develop the painful swelling of gout; the painful symptoms take less than a day to appear completely.

Today, gout is considered to be primarily a male disease. It affects men four times more commonly that women. Also, men can be affected with gout much earlier in their lives. Men who have crossed 30 years of age are vulnerable to gout. But women are affected with gout only after they have completed their menopause. While in men, especially in the Southern Hemisphere, the incidences of gout have been found to be as high as 10%. New Zealand is the single country with the highest number of gout cases.

What is Gout

Gout is a type of arthritis also known as metabolic arthritis. It is characterized by painful swelling of the joints and the tenderness and redness in the affected areas. The pains of gout are felt in periodic episodes known as attacks. Gout pains are usually developed in the joints of the legs, especially the big toe. About 75% of all gout pains originate in the big toe. The pains are felt in one toe at a time. Apart from the big toe, other joints such as the ankle, instep, toes, heels, hand, wrists and elbows can also be affected.

The pains of gout are extremely severe. The severity is quite acute when the region is accidentally touched. Even a simple act as putting a blanket on the affected area can give rise to extreme excruciating pain.

When gout becomes prolonged, it can cause a painful swelling in the affected area, which appears quite reddened. This swelling is called as a tophus (tophi in plural). Tophi are actually crystalline deposits of uric acid in the affected regions. Over time the tophi become quite big in size, and need to be surgically removed. Sometimes the uric acid crystals can deposit in the kidneys and form one of the several types of kidney stones.

The name given in Sanskrit to gout is vata rakta roga. This is a combination of three words – vata which means the ‘wind’, rakta which means ‘blood’ and roga which means ‘disease’. Hence gout is considered by Ayurveda to be a disease of the vata dosha that makes its prevalence felt in the blood circulation of the body.

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Purine is one of the nitrogen bases in the human body. Purines are components of the DNA. The two purines in the human body are adenine and guanine. Both these purines need to be metabolized properly in the body. The enzyme xanthine oxidase is responsible for converting the purines into uric acid, which is eliminated through urination. However, sometimes there is an excess deposit of uric acid which is not voided. This excess deposit of uric acid is what causes gout. Excess deposit of uric acid in the bloodstream is called as hyperuricemia.

When there is an excess of uric acid in the body which is not eliminated in the body, it deposits in several parts of the body, especially the joints. The deposition of uric acid in the joints, or the tophi, is an important characteristic of the painful condition of gout.

According to Ayurveda, gout is a disorder found predominantly in people with the vata dosha. Vata is the air element which governs the internal metabolism of the body. This includes the circulation of the blood and the various enzymatic actions that take place within the body. People in whom the vata dosha is vitiated are susceptible to conditions of gout.

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Some people are more probable to get gout than others. Some of the important risk factors of gout are as follows:-

Men over 30 years, and mostly in the range of 40 to 50 years are more susceptible to gout. Women can get gout only after their menopause up to the age of 60 years.

People who have gout histories in their families are more at risk.

Obesity is an important precipitating factor for gout. Excessive fat reduces the metabolism of purines in the blood.

Also, alcoholism is directly related to gout as it deters the proper utilization of purines in the body.

People who take a diet rich in purines are more at risk.

Some drugs contain high purine content, especially the ones that are used in the treatment of hypertension.

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Gout is a disease that makes its appearance in stages. There are four very distinct stages in which vata rakta roga makes its appearance in humans. The four stages are described below:-

(i) Asymptomatic Stage of Gout

In this stage, no symptoms are shown. This is the stage when there is a buildup of uric acid in the bloodstream, i.e. hyperuricemia is beginning. However, there is no pain or any other external symptom shown. Most people at this stage do not even realize that they are heading towards having gout.

(ii) Acute Stage of Gout

The acute stage of gout is the first stage when the symptoms begin showing. The symptoms are first observed as an acute pain in some of the joints. In almost 75% of the cases, the pain starts in the big toe. The pain may alternate between the toes, but is always experienced in some of the joints.

This is the stage when the hyperuricemia has gone beyond limit and now the crystals have accumulated in the joints to drastic levels. The pains experienced at this stage could last for days or even weeks at a stretch. Gout is generally diagnosed at this stage.

(iii) Intercritical Stage of Gout

The intercritical stage of gout is normally a transition stage from the acute stage to the more dangerous chronic stage. At the intercritical stage, no symptoms are felt. The uric acid deposits do build up though, and the initial tophi may make their appearance. The intercritical stage lasts up to two to six months. During the intercritical stage, several people get confused and think that their gout has healed itself in some miraculous manner and stop their treatment.

(iv) Chronic Stage of Gout

Once the intercritical stage lasting from two to six months is past, the chronic stage of gout sets in. This is the most severe of all the stages. Large tophi make their appearance, and there is tremendous pain in the affected joints. There is redness and swelling in most of the major joints. At this stage, usually surgery is needed to correct the situation by removing the tophi.

The chronic stage of gout can lead to several major complications. Hence, medical attention is extremely important.

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The gout symptoms can be divided into stages according to the manner in which it makes its appearance. The following are some warning signs of gout:-

There is a sudden occurrence of pain in joints (almost overnight), without any explanation. The pain is most commonly originated in the big toe.

There is swelling or redness in joints, which is quite tender to the touch and reddened in appearance. The swelling is extremely sensitive to touch and application of any external pressure.

When the gout becomes more advanced, the following gout symptoms are shown:-

• The pain becomes more acute. A single attack can last up to ten days or more.
• There is inflammation of the joints.
• In the chronic stage, huge red swellings make their appearance in the areas of the joints, which are known as the tophi.

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Gout if left untreated can develop some major complications.

• One of the most frequent complications of gout is kidney stones. Since gout is caused due to hyperuricemia, i.e. excess of uric acid; these crystals may also deposit within the kidney giving rise to a kind of kidney stones.
• Due to prolonged inability of the kidneys to filter out uric acid, there may be a permanent damage of the kidneys. This may cause several excretory problems.
• Gout is also known to cause hypertension, i.e. high blood pressure, in its victims. Hypertension is a major complication in elderly people who suffer from gout.

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Gout is a non communicable disease. Hence, there is no fear of an infection. However, it is a hereditary disease. People with histories of gout in their families must take more precautions.

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The prevention of gout can be easily done by having a diet that is low in purine content, since excessive purines can lead to gout. The following foods must be avoided as they have high purine content:-

• Sea foods, especially shell fish, scallops, prawns, crabs, sardines and anchovies
• Offal meats such as livers, hearts, gizzards, tongues and kidneys
• Coffee and cocoa
• Tea
• Extracts of meats
• Vegetables such as spinach, peas and beans
• Sweetbreads
• Alcohols, especially beer
• Tofu

The following foods must be increased in the diet as they can lower the content of uric acid:-

• Celery
• Strawberries and blueberries
• Cherries

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