JOINT PAINS - A SILENT KILLER — Dr Naveen Varghese

JOINT PAINS - A SILENT KILLER

Gout is a common type of arthritis caused by excess uric acid in the bloodstream which results in intense pain, swelling, and stiffness in joints particularly it affects the joint in the big toe. The symptoms of gout are due to the formation of uric acid crystals in the joints and the body’s response to them. Gout attacks often occur without warning in the middle of the night.

Most gout cases are treated with specific medications.

Symptoms

The signs and symptoms of gout almost always occur suddenly, and often at night. Other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours after it begins. • Lingering discomfort-After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints. • Inflammation and redness-The affected joint or joints become swollen, tender, warm and red. • Limited range of motion-As gout progresses, you may not be able to move your joints normally.

Causes

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body. Purines are also found in certain foods, including red meat and organ meats, such as liver, seafoods including anchovies, sardines, mussels, scallops, trout and tuna. Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the formula C5H4N4O3. It forms ions and salts known as urates and acid urates, such as ammonium acid urate. Uric acid is a product of the metabolic breakdown of purine nucleotides, and it is a normal component of urine.

Risk factors

You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your body include: Diet: Eating a diet rich in red meat and shellfish and drinking beverages sweetened with fruit sugar (fructose) increase levels of uric acid, which increase your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout.

Weight: If you're overweight, your body produces more uric acid and your kidneys will take more difficult time to eliminate uric acid.

Medical Conditions: Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, obesity, metabolic syndrome, and heart and kidney diseases.

Certain Medications: Low-dose aspirin and some medications used to control hypertension — including thiazide diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta blockers — also can increase uric acid levels. Using of anti-rejection drugs prescribed for people who have undergone organ transplant can also triggers gout.

Family history: If other members of your family have had gout, you're more likely to develop the disease.

Age and Sex: Men are also more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women tend to have lower uric acid levels but after menopause.

Recent Surgery or Trauma: Experiencing recent surgery or trauma can sometimes trigger a gout attack. In some people, receiving a vaccination can trigger a gout flare.

Complications

People with gout can develop more-severe conditions, such as:

Recurrent Gout: Some people may never experience gout signs and symptoms again. Others may experience gout several times each year. Medications may Disease Colum: Joint Pains help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.

Advanced gout: Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas, such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren't painful, but they can become swollen and tender during gout attacks.

Kidney Stones: Urate crystals may collect in the urinary tracts of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Diagnosis

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).

Ayurvedic Outlook to Gout

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.

Uttana (superficial) – This is located in the twak (skin) & mamsa (muscle).Uttana Vatarakta presents with itching, burning, ache, pain on extension, pricking pain, throbbing pain, contraction and associated with brownish black, red or coppery discolouration of Skin.

Gambhira (Deep) – This is located in the deeper dhatus and more severe in nature. Tophi or nodule formation occurs. Gambhira Vatarakta present with oedema, stiffness, hardness, excruciating pain in the interior of the body, blackish brown, coppery discolouration of skin, burning sensation, pricking pain, twitching sensation and suppuration of joints.

Ayurvedic treatment for gout comprises of herbal medicines that help the body to eliminate uric acid, thereby reducing the inflammation. In Ayurveda a detailed description of Vatarakta chikitsa is discussed in all texts along with lines of treatment, being Shodhana (internal purification), Shaman (palliative medicine) and Bahyachikitsa (external treatments on body), which is a very effective treatment and is eventually the need of the hour.

Kokilaksha – (Asteracantha Longiflia) is one such herb which is very effective in providing relief to patients suffering from Gouty arthritis. The Ayurvedic therapies that are effective in relieving inflammation are Dhanyamla dhara (pouring fermented liquid over the inflamed joint), Podikkizhi (herbal powder massage), Ilakkizhi (Herbal leaves massage), and after the inflammation is relieved procedures like Tailadhara ( Pouring medicated oil) on the affected part and Nhavarakkizhi (Medicated rice massage) are advocated along with Ksheeravasthi (Medicated milk enema). All these treatments are very effective in protecting the joints affected by Gouty arthritis.

Foods to Avoid if You Have Gout

• Skip foods and drinks that are high in purines to help lower your chances of an attack. • Beer and grain liquors (like vodka and whiskey) • Red meat, lamb, and pork • Organ meats, such as liver, kidneys, and glandular meats like the thymus or pancreas (you may hear them called sweetbreads) • Seafood, especially shellfish like shrimp, lobster, mussels, anchovies, and sardines • High-fructose products like soda and some juices, cereal, ice cream, candy, and fast food

Best Foods for a Gout Diet

• Low-fat and non dairy fat products, such as yogurt and skimmed milk • Fresh fruits and vegetables • Nuts, peanut butter, and grains • Fat and oil • Potatoes, rice, bread, and pasta • Eggs (in moderation) • Meats like fish, chicken, and red meat are fine in moderation (around 4 to 6 ounces per day). • Vegetables: veggies like spinach and asparagus.

What Can You Drink if You Have Gout?

Foods aren’t the only thing that can affect uric acid. What you drink matters, too.

Dos

It’s a good idea to drink lots of fluids -- 8 to 16 cups a day. At least half of what you drink should be water. Vitamin C (think orange juice) also can help lower uric acid, but studies also show that the high fructose in OJ may boost uric acid levels, so drink it in moderation. Caffeinated coffee can cut uric acid, too, as long as you don’t overdo it.

Don’ts

Stay away from sugary drinks like soda and fruit juice. You also may need to limit or avoid alcohol as well. Talk with your doctor to find out what’s right for you.

While a healthy diet can help control how much uric acid is in your system, you may still need medicine to prevent future gouty attacks.

Dr. Naveen Varghese (BAMS, MD, CGO, CSD) Specialist Medical Officer, Punarnava Project for Rehabilitation of Stroke & it’s Management, Government Ayurveda District Hospital, Kottayam, Kerala.