GOUT AND ITS HOMEOPATHIC MANAGEMENT

                                                                         GOUT

DEFINITION:-

        Gout is caused by an inborn error of purine metabolism resulting in raised level of serum uric acid and deposition of monosodium urate crystals in joints and other tissues. First of all, there is recurrent acute inflammation of the first metatarsophalangeal joint of the leg followed by chronic polyarthritis, formation of tophi at other sites, urolithiasis and nephropathy.

AETIOLOGY (OR) CAUSES:-

        The exact cause of gout is still unknown. Some predisposing factors are below.

1.       Heredity.

2.       Age – usually above 40 years.

3.       Sex- occurs mostly in males (95%).

4.       Diet – excess consumption of items contains more purine, such as meat, beer or red wine, tea and coffee.

5.       Other factors – trauma, infection, mental stress and certain drugs (e.g. thiazides) can precipitate gout.

PATHOLOGY:-

        The serum uric acid level usually exceeds 7 mg percent (normal range between 2-5 mg percent).crystals of monourate are deposited in cartilages (inside or outside the joints), tendons and ligaments. Tophi (which are commonly known as “chalky stones”) are formed by localized deposition of urate crystals over the ear cartilage, bursae and tendon sheaths. Inside the affected joint, deposition of crystals brings about inflammatory changes in the synovial membrane and later destroys the cartilage and the concerning bones. Arthritic changes occur in joints and localized atrophic changes occur in adjoining bones (which appear as punches out areas in X-ray pictures). Deposition of urate crystals in the renal parenchyma causes damage to kidneys (uric acid nephropathy). Uric acid stones may form in urinary passages. In such cases hyperuricaemia is often associated with atherosclerosis and hypertension.

SYMPTOMS:-

      Depends upon the symptoms it has 2 types. A. acute, b. chronic.

a.       Acute:-

-          Onset is sudden.

-          Severe pain and burning sensation in either of the first metatarsophalangeal joints.

-          Joint is swollen, red, hot and tender.

-          Malaise, dyspepsia and headache.

-          Pain is more on right great toe.

-          The attack usually lasts in some five days.

b.      Chronic:-

-          Onset is slow.

-          Chalky deposits gradually appear, deforming the joints and causes stiffness on joints.

-          Disease attacks feet first, then the hands.

-          Tophi appear over the cartilage of the ears, eyelids, and nose or around the affected joints.

-          When tophus is pricked with a needle, white chalky material comes out of it. A tophi underneath the skin may ulcerate.

COMPLICATIONS:-

-          Interstitial nephritis.

-          Artero-sclerosis with hypertrophy of the heart.

-          Chronic bronchitis.

-          Pyogenic ulcerations.

-          Renal colic.

DIAGNOSIS OR INVESTIGATIONS:

-          Examination of synovial fluid.

-          X-ray – in acute it doesn't shows any abnormality. But in chronic shows punched out areas of bony destruction seen in adjoining bones.

DIET:-

-          Pure vegetarian.

-          Mainly fruits, vegetables and milk.

-          Avoid starches rich food and saccharine foods.

-          Avoid liquors.

-          Avoid cigarette smoking.

-          Fish, eggs and oysters are allowable.

TREATMENT:-

           The patient and the affected joint should be given complete rest. Plenty of water should be taken. The best drug for acute gout is colchicines 1-2 tablets given every 2 to 6 hours till the symptoms subside. The drug should not give in empty stomach.ibuprofen; diclofenac can give TID for 7-10 days. If results are not satisfactory, prednisolone is added.

HOMEOPATHIC DRUGS:-

1.       ARNICA:-

     It is good remedy for gout. Onset is sudden, great fear of being touched or approached. Pain in back and limbs, as if bruised or beaten. Sprained and dislocated feeling. Soreness after overexertion. Everything on which he lies seems too hard. Cannot walk erect, on account of bruised pain in pelvic region. Rheumatism begins low down and works up. [Ledum.]

2.       BENZOICUM ACIDUM:-

       Joints crack on motion. Gouty deposits. Rheumatic gout; nodes very painful. Ganglion; swelling of the wrist. Pain and swelling in knees. Tearing pain in great toe. Tearing with stitches. Pain in tendo Achillis. Cold hands, feet, back, knees. Worse; in open air; by uncovering. Gouty and asthmatic. Omits words in writing.

3.      BRYONIA ALBA:-

        Aching in every muscle. The general character of the pain here produced is a stitching,

tearing; worse by motion, better rest. Mucus membranes are all dry. Delirium; wants to go home; talks of business. Knees stiff and painful. Hot swelling of feet. Joints red, swollen, hot, with stitches and tearing; worse on least movement. Every spot is painful on pressure. Constant motion of left arm and leg. [Helleb.]

4.       BUFO RANA:-

        Pains in loins, numbness of limbs, cramps, staggering gait, feeling as if

a peg were driven in joints; swelling of bones. Effects of onanism. Ulceration of cervix. Striking rheumatic symptoms. Anxious about health. Sensation of heart swimming in water.

5.       CALCAREA CARB:-

        Rheumatoid pains, as after exposure to wet. Sharp sticking, as if parts were wrenched or sprained. Cold knees cramps in calves. Weakness of extremities. Swelling of joints, especially knee. Feet feel cold and dead at night. Tearing in muscles. Burning of soles of feet. Worse; from exertion, mental or physical; ascending; cold in every form; water, washing, moist air, wet weather; during full moon; standing. Better; dry climate and weather; lying on painful side; Sneezing (pain in head and nape).

6.      COLCHICUM:-

        Affects markedly the muscular tissues, periosteum, and synovial membranes of joints. Dreams of mice. Tearing in limbs during warm weather, stinging during cold. Pain worse in evening and warm weather. Inflammation of great toe, gout in heel, cannot bear to have it

touched or moved. Joints stiff and feverish; shifting rheumatism; pains worse at night. Oedematous swelling and coldness of legs and feet. Knees strike together, can hardly walk.

7.       LYCOPODIUM:-

      Painful callosities on soles; toes and fingers contracted. Pain in heel on treading as from a pebble. Chronic gout, with chalky deposits in joints. Tearing in shoulder and elbow joints. Cannot lie on painful side. Right foot hot, left cold. Cramps in claves and toes at night in bed.

8.       MAG CARB:-

      Tearing in shoulders as if dislocated. Right shoulder painful, cannot raise it. [Sang.]. Whole body feels tired and painful, especially legs and feet. Swelling in bend of knee. Worse; warmth of bed; change of temperature; cold wind or weather; every three weeks; rest. Better; warm air; walking in open air.

9.       NUX VOMICA:-

      Arms and hands go to sleep. Sensation of sudden loss of power of arms and legs in the morning. Cracking in knee-joints during motion. Partial paralysis, from overexertion or getting soaked. [Rhus.]. Drags his feet when walking. Legs numb; feel paralyzed; cramps in calves and soles.

10.   RHODODENDRON:-

       Rheumatic and gouty symptoms well marked. Rheumatism in the hot season. Joints swollen. Gouty inflammation of great toe-joint. Rheumatic tearing in all limbs, especially right side; worse, at rest and in stormy weather. Stiffness of neck. Pains in bones in spots, and reappear by change of weather. Cannot sleep unless legs are crossed.

11.   SULPHUR:-

      Hot, sweaty hands. Rheumatic pain in left shoulder. Rheumatic gout, with itching. Burning in soles and hands at night. Sweat in armpits, smelling like garlic. Stiffness of knees and ankles. Cannot walk erect; stoop-shouldered. Drawing and tearing in arms and hands. Ganglion. Trembling of hands.. hot pt.

Some of other drugs are antimonium crudum, ars album, baptisia, causticum, iodum, kali iodum, nat sulph, pulsatilla, Sabina, sarasaparilla, silicea etc….