Gouty Arthritis

Gout-Podagra

Severe gouty arthritis with tophi

Podagra refers to  gout of the foot, particularly the metatarsophalangeal joint of the big toe. In severe cases the metatarsal-phalangeal and tarsal joints are involved. Gouty  arthritis is a metabolic disorder which results in the body's loss of ability to control uric acid production and excretion,  uric acid is a byproduct of  purine metabolism, two thirds of uric acid is excreted via the kidneys, and the remainder via the gut.Sadly, humans are the only mammals that lack an enzyme to breakdown purines. 

These prolonged high uric levels in the blood, (hyperuricemia) result in the deposition of uric acid deposits in the joints, kidneys, and subcutaneous tissues.The uric acid deposits crystallize and form insoluble precipitates, somewhat like shards of broken glass, causing inflammation, swelling and severe pain.Tophaceous Gout

Hyperuricemia is by no means an indication of a gouty state, for many people with this condition do not have gout, and many of those with gout do not have hyperuricemia, so it would appear that there are many other factors at work here.Because the gouty condition may present with similar symptoms as that of pseudogout, and infective arthritis, it is essential that joint aspiration be the deciding diagnostic test.Pseudo Gout

Gout attacks most commonly occur in males over 40, less than 5% of gout suffers are females.The usual incidence of gout in females occurs some 10 plus years after menopause, however, it may occur in younger females who have misused diuretics, and in others who have inborn errors of metabolism.Gout in males

Recent research has put paid to the old idea that gout was a disease of the wealthy who dined on rich fatty food and fine wines. This study found that:" the only major dietary difference between 61 men with gout, and another group of men who didn't have it was that 41 per cent of the gout group drank more than a dozen cans of beer-two and a half litres- a day".

Approximately 95% of gout victims have primary gout, which is due to the overproduction of uric acid. This has been blamed on inherited enzyme defects, however, while this may be the case in some individuals, there appear to be many other factors involved.

The fact that females with low estrogen levels in their 60s are more likely to develop gout, and that older males in their 80s are less likely to develop gout appears to indicate that hormones  play a significant role.Gout in females

There is also very strong evidence that diet plays a huge role in the development of gout, many gout victims have observed that a gouty attack may often be triggered by consumption of a particular food, or over indulgence in alcohol.

Secondary gout can occur in both males and females between the ages of 30 and 50, and is often due to drugs or disorders that promote hyperuricemia. The drugs most often implicated are diuretics which decrease the renal tubular excretion of urate.Renal disease, hypertension, malnutrition, cancer and hemolytic disorders can cause secondary gout to occur.

Read more: Gout in females

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References: White, B Linda & Foster Steven The Herbal Drugstore Published Rodale 2000

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