Christopher Columbus, Isaac Newton, Benjamin Franklin, Thomas Jefferson, Samuel Johnson, Karl Marx, Jeff Mullis, Wilkie Collins, Henry James, John Calvin, Alexander Hamilton and many more……Could you think of one common thing among these people apart from being famous personalities…..Yes there is one similarity among these great souls ……….Every one of these important thinkers, politicians or scientists suffered from Gout!!!!!
The term Gout is derived from the Latin word gutta which means a drop of discharge. Gout, or crystal induced synovitis as it often called among physicians and other health professionals is the result of deposition of micro crystals in the joints, specifically at the peri articular tissues. The inflammation in these affected regions is caused by the phagocytosis of crystals by neutrophils (cells in charge of devouring foreing particles such as bacteria, viruses or other infectious agents) and secretion of chemo tactic factors and enzymes.
Like every Gout sufferer, the above mentioned famous personalities suffered from intense pain due to the following reasons: the crystals create intense pain as well as the inflammation also causes pain. In case of gout the micro crystals that get deposited are composed of mono sodium urate, a chemical compound that results from a series of normally occurring chemical reactions in the cells. The urate crystals look like small needle shaped objects during light microscopic examination. Did anyone notice that all the famous personalities listed above are men? This doesn’t mean that the males are more popular but instead it suggests that men are more often victims of this disease. The big toe is usually affected primarily in gout. The crystals are often referred to as tophi and are formed more easily in kidneys, subcutaneous tissues and joints. Gout advances through four stages namely hyperuricemia being the first one, acute arthritis being the second one an interval phase and lastly chronic arthritis. Asymptomatic hyperuricemia occurs when the serum uric levels increases. This means that a regular check up of the blood levels of uric acid is a very effective way of preventing further progression of the problem into more severe conditions. The incidence of gout attacks is higher during spring. Lifestyle plays an important role in gout development. Among obese people gout is more prevalent. Generally this disease is more common in such societies where the protein, fat and alcohol intake is more. The causes of high uric acid include heredity, protein, and fat and alcohol intake in large quantity.
The treatment of acute attacks in first choice is to reduce the pain. For this purpose indomethacin, NSAIDS, oral glucocorticoids, or intra articular glucocorticoids are administered by an injection in the joint. Ibuprofen should be given instead of aspirin as the latter can worsen the condition. Cryotherapy for example ice application over the affected region for 20 to 30 minutes daily is effective and produces no side effects. The use of diuretics (acetazolamide) is useful in some cases as it inhibits the action of carbonic anhydrase on the pct of kidneys, which results in alkalizing urine. But after two three days the effect of diuretics decreases so it should be prescribed for short term. |
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