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Sunday, 5 February 2012

Why does uric acid build up? BY Dr Izharul Hasan

What is gout?
Gout is a metabolic disease, often familial, associated with hyperuricemia (high uric acid in blood) leading to acute arthritis, usually inflammation of the big toe, but may also effect other joints. Hyperuricemia can be because of over production or under excretion of uric acid, sometimes both.
Note : Some people have a high level of uric acid but do not form crystals or have gout. Also, rarely some peopel with a normal level or uric acid get gout attacks. However as a rule the higher the level of uric acid, the greater the chance of developing gout.

Why does uric acid build up?
It is often familial. Alcohol and certain medicines are important secondary causes. Alcohol ingestion promotes hyperuricemia by increasing urate production and decreasing the renal excretion of uric acid. Certain foods may tip the balance to raise your uric acid higher than normal. In particular, if you eat a lot of heart, herring, sardines, yeast extracts or mussles it may increase the level of uric acid. Some medicines such as diuretics and aspirin may raise the level of uric acid. People with certain other conditions such as obesity, kidney damage, diabetes, mellitus, bone marrow disorders and lipid disorders have an increased risk of developing gout?

How common is gout and who gets it?
Gout affects about 1 in 200 adults
Men are more commonly affected than women. Six out of 1,000 men develop gout, compared with one out of 1,000 women.
A first attack of gout typically develops in middle age, but it sometimes occurs in younger people. The first attack of gout in men most often occur between the age of 30 and 50. In women, it is rare for gout to occur until after menopause.
It tends to run in some families as there is family history of gout in about 1 in 5 cases. The genetic make up that you inherit from your family may be a factor in becoming an ‘under-excreter' of uric acid.

What are the symptoms of gout?
Gout usually occurs in ‘attacks'. An attack typically develops quickly over a few hours. Acute gouty arthritis is characterized by its sudden onset, frequently nocturnal, either without apparent precipitating cause or following rapid fluctuations in serum urate levels. Either increase or decrease in the serum urate level can precipitate a gouty attack. Common precipitants are alcohol excess (particularly beer), changes in medication that affect urate metabolism and fasting in hospitalized patients before medical procedures.

How is gout diagnosed?
Gout is usually diagnosed if you have the typical symptoms and a raised blood level or uric acid. If you think you have gout, see your general physician. He or she will ask about your symptoms and examine you, He or she may also ask about your medical history, especially family history. A blood test will measure the levels of urate in your blood but the level may also be high in healthy people who don't have gout. Fluid may be removed from your swollen joint with a needle. This usually causes no more discomfort than a blood test. If urate crystals can be seen in the fluid under a microscope, you have gout. If calcium crystals are seen, you have a similar condition called pseudo gout. An x-ray of your affected joint may be taken to rule out other medical conditions. It is also important to screen the kidneys in all cases with gount. Uric acid kidney stones are present in 5-10% of patients with gouty arthritis. Hyperurecemia correlates highly with the likelihood of developing stones, with the risk of stone formation receding 50% in patients with a serum urate level above 13 mg/dl. This and associated risk factors like hypertension, alcohol use and diabetes can lead to renal failure. Once diagnosed as a case of gout your base line uric acid should be maintained at 5 mg/dl and below.

What the complications of gout?
Kidney damage
Arthritis and joint immobility
Urinary stones-increased risk
Is gout serious?
A gout attack can be very painful. However, other effects from gout are uncommon. Joint damage may occur if you have recurring attacks. In a few people, uric acid cystals form kidney stones or may cause some kidney damage. Sometimes the crystals form bumps (tophi) under the skin. These are usually harmless and painless but sometimes form in awkward places such as the end of fingers. Tophi occasionally become infected.

Will obesity and consumption of certain foods lead to gout?
Obesity is common cause for gout according to current research. At least half of all gout sufferers are overweight, if not obese. The obese body puts a heavy load on the kidneys, above and beyond what they were meant to handle.
Research is also showing that it is not the protein that adds to the gout problem, but actually "purine rich foods". These include beans, peas, anchovies, liver, brains and (ironically enough) kidneys. Beer is also purine rich. It is the breakdown of the purine that causes uric acid to be formed. If the extra uric acid cannot be flushed from the system, they crystallize and lodge in joints, causing gout.

How Unani experts can help you manage your condition?
Unani experts propose the following measures for people with gout.
Weight loss : if you are overweight. This will quickly reduce the load on your kidneys and help ease the gout.

Dietary advise : A high uric acid level may be lowered by avoiding a high protein intake and foods rich in purines such as organ meats, sea food, yeast/yeast extracts, beer, other alcoholic beverages, beans, peas, lentils, oatmeal, spinach, asparagus, cauliflower and mushrooms. If you drink a lot of sugar-sweetened soft drinks, especially those containing fructose, it may help to reduce the number or cut them out altogether. Avoid dehydration by drinking plenty of water (upto 2 litres/day). If you drink a lot of alcohol, reduction in the amount you drink, may help. Avoiding binge drinking and keep to within the recommended levels of alcohol which is 21 units/week for men and 14 units/week for women.

Medication : If you are taking any medicines, check whether they are cause of gout. An alternative medicine may be available. Your doctor will advise to have your blood pressure checked at least once a year. High blood pressure is more common in people with gout.

Physical activity : The risk of gout is lower in men who are more physically active. The physiotherapists and fitness experts at Unani can help to formulate a customized physical activity pattern based on your fitness level, lifestyle and health condition.
With the help of the above lifestyle changes, many people only have an attack of gout every now and then. All you may need is to have some anti-inflammatory pain killers on ‘standby' to treat each attack. For some people, attacks occur more often. In this situation, you can take a medicine prescribed by your doctor to prevent attacks.

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