Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected (~50% of cases). Other joints, such as the heels, knees, wrists and fingers, may also be affected. It may also present as tophi (collections of uric acid crystals), kidney stones, or urate nephropathy.
It is caused by elevated levels of uric acid in the blood which crystallize and are deposited in joints, tendons, and surrounding tissues. Gout was historically known as "the disease of kings" or "rich man's disease".
Hyperuricemia is the underlying cause of gout. This can occur for a number of reasons, including diet, genetic predisposition, or under excretion of urate (the salts of uric acid).
Dietary causes account for about 12% of gout, and include a strong association with the consumption of alcohol, fructose-sweetened drinks, meat, and seafood. Other triggers include physical trauma and surgery. (Ref: http://en.wikipedia.org/wiki/Gout)
Symptoms of acute gouty attacks:
- Symptoms develop suddenly and usually involve only one or a few joints. The big toe, knee, or ankle joints are most often affected.
- The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating.
- The joint appears warm and red. It is usually very tender (it hurts to lay a sheet or blanket over it).
- There may be a fever.
- The attack may go away in several days, but may return from time to time. Additional attacks usually last longer.
After a first gouty attack, people will have no symptoms. Some people will go months or even years between gouty attacks. Some people may develop chronic gouty arthritis, but others may have no further attacks. Those with chronic arthritis develop joint deformities and loss of motion in the joints. They will have joint pain and other symptoms most of the time. Tophi are lumps below the skin around joints or in other places. They may drain chalky material. Tophi usually develop only after a patient has had the disease for many years. After one gouty attack, more than half of people will have another attack.
It is more common in males, postmenopausal women, and people who drink alcohol.
Diagnosis is confirmed clinically by the visualization of the characteristic crystals in joint fluid. Tests that may be done include synovial fluid analysis (shows uric acid crystals), Uric acid – blood & urine, Joint x-rays (may be normal), Synovial biopsy.
Nidhana & Samprapthi
Excessive intake of food items that are salty, spicy, bitter, oily and hot in potency, incompatible food, anger, day sleep, night arousal causes the vitiation of both vata and raktha; then lodges in small joints causing vata raktha. If affecting skin & muscle layer, it is called as uttana vataraktha and if affecting the joints, it is gambhira vataraktha.
Treatment Principle includes Nidhana Parivarchana, internal & external treatment - Snehana, Swedhana, Mrdu virechana, Vasti karma, Rakthamokshana (in balavan rogi)
- Reduced uric acid levels in blood & urine
- Marked reduction in pain – tracked in pain scale
- Visible reduction in swelling, redness
- Increase in range of movements