Gout

Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint. Pain typically comes on rapidly in less than twelve hours.  The joint at the base of the big toe is affected in about half of cases. It may also result in tophi, kidney stones, or urate nephropathy.

Gout is due to persistently elevated levels of uric acid in the blood. This occurs due to a combination of diet and genetic factors. At high levels, uric acid crystallizes and the crystals deposit in joints, tendons, and surrounding tissues, resulting in an attack of gout. Gout occurs more commonly in those who regularly eat meat or seafood, drink beer, or are overweight. Diagnosis of gout may be confirmed by the presence of crystals in the joint fluidor in a deposit outside the joint.Blood uric acid levels may be normal during an attack.

Symptoms

Gout can present in multiple ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). The metatarsal-phalangeal joint at the base of the big toe is affected most often, accounting for half of cases.Other joints, such as the heels, knees, wrists, and fingers, may also be affected.Joint pain usually begins over 2–4 hours and during the night. This is mainly due to lower body temperature. Other symptoms may rarely occur along with the joint pain, including fatigue and a high fever.

Long-standing elevated uric acid levels (hyperuricemia) may result in other symptoms, including hard, painless deposits of uric acid crystals known as tophi. Extensive tophi may lead to chronic arthritis due to bone erosion. Elevated levels of uric acid may also lead to crystals precipitating in the kidneys, resulting in stoneformation and subsequent urate nephropathy.

Causes

The crystallization of uric acid, often related to relatively high levels in the blood, is the underlying cause of gout. This can occur because of diet, genetic predisposition, or underexcretion of urate, the salts of uric acid. Underexcretion of uric acid by the kidney is the primary cause of hyperuricemia in about 90% of cases, while overproduction is the cause in less than 10%. About 10% of people with hyperuricemia develop gout at some point in their lifetimes.[ The risk, however, varies depending on the degree of hyperuricemia.

Treatment

The most reliable test for gout is finding uric acid crystals in a sample of the joint fluid obtained by joint aspiration.

Blood uria is the commonest blood test to estimate the level of Uric acid. Other blood tests commonly performed are white blood cell count, electrolytes, renal function, and erythrocyte sedimentation rate (ESR).

X-rays can sometimes be helpful and may show tophi-crystal deposits and bone damage as a result of repeated bouts of inflammation.

Ayurveda Management

Vata Rakta or Aadya Vata is a classical description of Gout in Ayurveda. Vata dosha, Pitta dosha and Rakta Dhatu are specially vitiated to cause Vatarakta.

Several causes are listed in Ayurveda, which causes Vatarakta are excessive intake of Lavana (salty), Amla (Sour), Katu (pungent), Tikta (bitter), Kshara (alkaline), Snigdha (Too oily), and Ushna (Too hot) foods, eating dried & preserved or spoiled fish/meat, Ulavalu (Horsegram), Blackgram, Nishpava (anumulu, a bean variety), sour curd or buttermilk, incompatible foods like fish with milk products, drinking alcohol, daytime sleep, staying awake in the night, anger etc.

Based on the seat of the disease, Vatarakta is classified into 2 types.

1. Uttana (superficial) – This is located in the twak (skin) & mamsa (muscle).
2. Gambhira (deep) – This is located in the deeper dhatus and more severe in nature. Tophi or nodule formation occurs.

At Bhagwati Ayurveda, our treatment includes Ayurveda Panchakarma therapy along with internal medicines, diet & lifestyle modifications. Therapies like Snehapanam, Virechanam, Abhyanga swedam, Elakkizhi, Pizhichil, Vasti, Navarakizhi etc are very useful in treating or even curing Vatarakta.

In very severe cases, even Rakthamokshana therapy is also practiced for quicker and long lasting relief.

Prevention

Both lifestyle changes and medications can decrease uric acid levels. Dietary and lifestyle choices that are effective include reducing intake of purine-rich foods of animal origin such as meat and seafood, alcohol, and fructose (especially high fructose corn syrup). Eating dairy products, vitamin C, coffee, and cherries may help prevent gout attacks, as does losing weight. Gout may be secondary to sleep apnea via the release of purines from oxygen-starved cells. Treatment of apnea can lessen the occurrence of attacks.