Gout is a disease in which there is crystal deposition occurs, it is a reaction of joint to the presence of monosodium urate monohydrate crystals (MSUM), these crystals deposit in peripheral connective tissues in and around synovial joints, this first favors lower limbs (as compared to upper limbs) and target the first metatarsophalangeal and small joints of feet and hands especially.
As time progresses, the deposition of crystals increases gradually and enlarge in size, there is progressive involvement of more joints which are proximal sites and the potential for cartilage and damage of bone, and secondary osteoarthritis developed. Monosodium urate monohydrate crystals (MSUM) take much time sometimes upto a year to grow to a detectable size.
Gout has a strong predominance in males, as compared to females, the prevalence of gout increases as age progresses, and the concentration of uric acid increases. Primary gout is especially found in the male and the most common cause of inflammatory arthritis found in males who are over 40 years of age. Secondary gout is the result of kidney problem or due to some medicines, this affects the person age 65 years and above and most commonly found in females.
Factors that predispose to Gout:
- Diminished renal excretion which may be due to renal failure, some medicines like low dose aspirin, thiazide, diuretics, lead toxicity, alcohol intake.
- Increased production of uric acid.
Cause of Primary Gout:
- One-third of body uric acid is derived from diet and rest of two-third from endogenous purine metabolism, the concentration of uric acid in the body fluids depends on the balance between synthesis and elimination of uric acid through kidney and gut.
- Other than hyperuricemia there are some other risk factors and associations with primary gout are dyslipidemia, insulin resistance, high alcohol intake.
Causes of secondary Gout:
- It is due to longstanding hyperuricemia which may be due to renal compromise or due to long term diuretic use. Gout which is induced by diuretics there is a risk of nodal generalized osteoarthritis, which is especially found in females.
- In almost all first attack of gout, only one distal joint is affected, other common sites are ankle> midfoot> knee> small joints of hands wrist elbow.
- Pain in gout is of rapid onset reaching its peak in 2-6 hours, which some times compelled the patient to wake up in the early morning.
- There is severe tenderness.
- There is obvious swelling along with red and shiny skin.
- The pain of gout is self-limiting may occur for 5-14 days but can return to normal.
- There may be fever, the general feeling of unwell, especially if a large joint is involved, there are itching and desquamation of skin occur after the attack is over.
What to eat and what to avoid:
- To eat Low purine and low protein foods in gout
- Vitamin C rich fruits like orange, papaya.
- Pineapple juice.
- Almond, walnut, cashew nut, flaxseeds.
- Bitter gourd.
- Apple and banana, grapes, pear, pineapple, avocados (only one per day/moderate intake).
- Milk thistle seeds, small nettle extract.
- Raw celery sticks, juice, extract, or seeds,
- Turmeric, ginger.
- Magnesium-rich food.
- Cherry juice, orange, tangerine.
- Low-fat dairy products, soy products, eggs(4 eggs per week).
- Plant oil like olive oil, flax oil, avocado oil, coconut oil.
- Pulses like beans and lentils, tofu, and vegetable proteins, nuts, peanuts.
- To avoid High purine and high protein foods in gout
- Tomatoes, raspberries.
- Whole-grain bread and whole-grain pasta (occasionally in moderate amount).
- Cauliflower, spinach, peas, asparagus.
- Red meat.
- Organ meat.
- Honey, brown sugar.
- Seafood like lobster, crab, shrimp, trout, herring, mussels, codfish, etc.
- Fish (Can be taken in moderate amount ): Tuna, anchovies, sardines, shellfish.
- Yeast, white bread.
- High fructose drink and food.
- Processed food, alcohol, artificial sweeteners.