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Gout symptoms and therapy
contents
- definition
- symptoms
- Chronic course
- causes
- risk factors
- diagnosis
- therapy
- nutrition
- Naturopathic therapy
- Herbalists
- hydrotherapy
- homeopathy
definition
Gout is often understood as a joint disease, but is actually a metabolic disease, the consequences of which can manifest not only in the joints, but also in the area of the internal organs (especially the kidneys). Due to malfunctions in the purine-uric acid metabolism, excessive uric acid accumulates in the organism (hyperuricemia) and uric acid crystals form, which are deposited in the joints and cause inflammation there. The kidneys are damaged in the long term by the hyperuricemia, which in the worst case can lead to a life-threatening kidney failure.
An acute attack of gout manifests itself as stinging joint pain, which often affects the metatarsophalangeal joint of the big toe. (Image: ThamKC / fotolia.com) symptoms
Characteristic of the disease is a relapsing course, the acute phases are also referred to as gout attack, gout attack and acute gouty arthritis. Such a seizure usually occurs relatively abruptly and is manifested above all by an inflammation of the joints, which is caused by deposits of uric acid crystals. Recent research has shown that the crystals trigger the mechanism of direct "crystal-mediated cell death" and corresponding necrosis in the tissue. This in turn is the cause of the inflammation.
The arthritis in turn is accompanied by swelling, overheating, redness and pain. In this case, the inflammation can theoretically manifest in every joint of the body. However, especially the big toe base joints, jumps and wrists are particularly frequently affected. As a visible sign of the acute attack is a "highly inflamed joint that feels very hot and crimson to bluish colored, thick swollen and extremely sensitive to touch," explains the German Rheumatism League. In addition, accompanying symptoms such as fever, headache, palpitations and nausea can sometimes be observed. Left untreated, the acute disease episode can last up to ten days.
Chronic course
If no treatment of the disease, the attacks are observed at ever shorter intervals, causing the affected joints irreversibly damaged in the long run. Bone destruction and joint deformations are typical consequences. In the further course of the disease goes into a chronic stage after a few months to years. "The joints are then destroyed so much that the patient often suffers from constant movement pain or swelling," reports the German Rheumatism League. The uric acid salt crystals can also deposit in the kidneys and lead to the formation of kidney stones, for example. As a result, the kidney function is permanently impaired, which makes this form of the disease for the patients far more dangerous than the articular gout. Last but not least deposits of uric acid crystals under the skin threaten, for example, on the ears, in bursa or tendons. In many patients, a so-called gout node (Gichttophus) forms, which is visible as a significant thickening externally.
The finger joints are also increasingly affected by gout, and in the long term, considerable deformations of the joints are imminent. (Photo: Karin Bangwa) causes
Regarding the causes of the disease, it can be stated that most of the patients have a genetic predisposition, so that the disease is at least partially inheritable. In the further course, the symptoms are caused by an impairment of the purine-uric acid metabolism, which is characterized by an excessive formation of uric acid and / or by an insufficient excretion via the kidney. Ultimately, an excessive proportion of uric acid remains in the organism, the level of uric acid in the blood rises (hyperuricemia) and urinary crystals begin to deposit at various sites. First complaints are often after a particularly rich food (with much meat and / or fish), excessive consumption of alcohol, an infectious disease or unusually strong physical stress, as this increases uric acid accumulates in the body. The disturbance of the purine-uric acid metabolism itself is due to impairment of renal function in many patients, but it can also be caused by diseases of the blood-forming system and other rare diseases.
risk factors
Many factors can cause the occurrence of a gout attack, with high consumption of meat, fish and alcohol in particular being an often underestimated risk. The contained purines are metabolized to uric acid, which increases their concentration. But also fasting and diets in combination with diuretics are to be mentioned as risk factors. Furthermore, the consumption of lemonade and fruit juice drinks is also linked to the disease, such as excessive consumption of fresh peas, raisins, tomatoes or tofu. Also some medicines are known as potential triggers. For example, caution should be used with antihypertensive drugs if there are already problems with the purine-uric acid metabolism.
In the case of gout, diet plays a decisive role and some foods can trigger an acute disease spurt. (Image: ThamKC / fotolia.com) diagnosis
The increased uric acid level in the blood can be detected relatively easily by means of a uric acid test. In healthy people, uric acid levels of three to six milligrams per 100 milliliters of blood serum are normal. Men usually have a slightly higher value than women. Increases to more than seven milligrams per 100 milliliters, this may indicate a gout disease. The test for uric acid is still the most important instrument for early diagnosis. An examination of the synovial fluid for the presence of uric acid crystals can also provide important clues for the diagnosis later on. Ultimately, however, the decisive clinical picture of the complaints is decisive for the diagnostic evaluation.
X-ray examinations can only make a contribution to the diagnosis in the later stage of the disease, when more and more uric acid crystals have accumulated in the joints. They are also used for follow-up, as changes in the bone substance and deformities of the joints are generally easily recognizable. If necessary, damage to the kidneys can be determined by means of a laboratory examination of the urine and imaging techniques such as ultrasound examinations, computed tomography and magnetic resonance tomography.
therapy
The aim of the treatment is basically a normalization of the uric acid level. For this purpose, two different drug groups are available, which either inhibit the formation of uric acid or promote their excretion. "Benzbromaron is the active ingredient that enhances uric acid excretion by the kidneys" and "the active ingredient allopurinol reduces the formation of uric acid in the body," explains the German Rheumatism League. The acute attacks are also usually treated with so-called non-steroidal anti-inflammatory drugs NSAIDs, which develop an anti-inflammatory and analgesic effect. Even the poison of the Herbstzeitlosen, the active ingredient colchicine, is used to treat the acute symptoms - but due to the threat of side effects, however, today much less common than before. Last but not least, the use of cortisone as a means of drug treatment of an acute episode of illness should be mentioned.
Luscious food with lots of meat and beer is to be evaluated as a risk factor for a current gout attack. Overall, the diet can have a massive impact on the symptoms. (Image: Dar1930 / fotolia.com) nutrition
Generally, diet plays a major role in gout, as dietary purines in the body are metabolized to uric acid. According to the German Society for Nutrition (DGE), a permanent change in diet is the basis for long-term successful treatment. "Consistently implemented nutritional therapy helps to save medicines and can even make a drug treatment superfluous," according to the DGE. The emergence of new relapses can be effectively counteracted by adhering to a special nutritional plan. This should, according to DGE "a purinarme diet with plenty of cereal products, potatoes, selected vegetables, salad and fresh fruit, low-fat milk and dairy products, eggs in moderation and sufficient fluid and low alcohol, especially little beer" include. Existing overweight should be reduced as much as possible, however, fasting is counterproductive, since during fasting increased protein is degraded, which increases the uric acid level. In this way, even an acute attack can be provoked. More detailed information can be found in the DGE information center "Eating and drinking at Gicht".
Naturopathic therapy
Nutritional therapy is also an important factor in the naturopathic treatment of gout diseases. By adhering to special diets, the formation of uric acid is to be reduced or its excretion promoted. In addition, however, naturopathy knows various other treatment approaches, with which a drug therapy - especially in milder forms of disease - is often completely avoidable. Also naturopathic procedures can be used for the relief of acute complaints. Especially herbal medicine and hydrotherapy are considered to have very convincing effects. But also homeopathy and other procedures are used against metabolic disease.
Overall, naturopathy offers numerous starting points for alleviating the symptoms and last but not least plays in the naturopathic treatment in the sense of prevention, a regulation of the acid-base balance often a significant role. Base-rich diet is to avoid hyperacidity of the organism and thus counteract the occurrence of an acute attack of gout. Which naturopathic procedures are used, in the end strongly dependent on the individual symptoms of the patient and the methods presented below are only a part of the spectrum of possible treatment approaches.
In particular dandelion and stinging nettles are known as medicinal plants for the treatment of gout. But nature also has many other helpers on hand. (Image: shibanuk / fotolia.com) Herbalists
Various medicinal plants combined with consistent nutritional therapy can contribute to the normalization of the level of uric acid, so that a drug therapy may be completely unnecessary under certain circumstances. Even with a serious illness, the amount of required medicines can often be significantly reduced with the help of medicinal plants, report Professor Dr. med. med. Wolfgang Exel and colleagues in their book "Naturopathy Correctly Use". Through the medicinal plants let the activity of the urinary organs stimulate and promote the excretion of uric acid. Accompanying a lot of water should be drunk. Patients with impaired kidney function, however, must be careful here and should only resort to appropriate medicinal plants in consultation with the doctor.
As a herbal treatment methods that show a particularly promising effect in the metabolic disease, calls Maria Treben in her work "Health from the pharmacy of God" in addition to full baths with nettle addition and the consumption of fresh dandelion stem (five to six per day), and tea from Bärlapp, Ehrenpreis, corn beard, cowslip or coltsfoot. The tea blends can also be used well as a home remedy for the disease.
Blood cleansing tea blend according to Maria Treben:
50 grams of cowslips
50 grams of young shot of elderberry
15 grams of nettle leaves
15 grams of dandelion roots
From the tea mixture a heaped teaspoon is brewed with 250 milliliters of boiling water and the infusion should then pull for about three minutes. Two cups of tea are drunk in the course of the day.
Other noteworthy medicinal plants are juniper, birch leaves, goldenrod and field horsetail, which are mostly used for the preparation of herbal mixtures, but can also be consumed on their own (for example juniper) or processed into special tinctures.
hydrotherapy
Kneipp treatments are a particularly promising method for relieving pain and controlling inflammation as a special method of hydrotherapy for acute attacks of gout. Especially cold Kneipp treatments are fast acting against the pain. The most suitable is, according to Professor. med. Wolfgang Exel and colleagues the cold partial bath, where the water should be cooled down as much as possible by the enclosed ice cubes. Then the patients immerse the affected joint in the cold water for about 30 seconds. This can be repeated several times after a short break. However, there are some contraindications for the cold Kneipp treatments. For example, the cold partial bath should absolutely be avoided in case of circulatory disorders. Care should also be taken with cardiovascular diseases such as high blood pressure and a doctor should be consulted before using hydrotherapy.
homeopathy
In the field of homeopathy, various remedies have been proven in the treatment of the symptoms. Especially with Ledum palustre and Bryonia as a follow-up, the acute symptoms of a gout attack can be alleviated. Other homeopathic remedies promise improvement, but the choice should be reserved for experienced therapists or doctors. The same applies to the use of the Schüssler salt therapy. For example, Schüssler salts # 8 (sodium chloratum), # 9 (sodium phosphoricum), or # 11 (silicea) may be used. (Fp)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)