Gout is one of those conditions that never really made sense to me until I learned that uric acid is an important antioxidant in the bloodstream. What this means is that if levels of other antioxidants fall low, then the body compensates for this by pushing out more uric acid. That is absolutely fine, but the trouble is that if the level of uric acid gets too high, then, being rather insoluble, it precipitates out as crystals in the joint to cause an acute attack of gout. This is very tiresome because acute gout is extremely painful! The immune system does not like these gritty crystals in the joints and produces lots of inflammation to get rid of it and it is this that causes the heat, pain, swelling, redness and loss of function.
The concentration of uric acid in the blood is increased with dehydration.
Furthermore uric acid is more likely to precipitate in joints when the blood is acidic - see Acid-Alkali balance
The diagnosis is made by the characteristic clinical picture of acute severe joint pain, but one can also get a low grade generalised arthritis from gout. Blood tests will show high serum uric acid and it is this that gives the game away. (URIC ACID TEST available from The Doctors' Laboratory - cost at present is £28.50 on a urine sample and £20 on a serum sample - please, contact the office for more details, this test is not listed on the website.)
In the acute phase the priority is to stop the inflammation. Non-steroidal anti-inflammatories such as diclofenac or indomethacin are highly effective. A drug which switches off inflammation in the immune system such as colchicine is also highly effective. Colchicine comes from the Autumn crocus.
PREVENTION OF ATTACKS
Knowing the mechanism of gout gives us a 3 pronged approach to prevention:
- improve the antioxidant status in the bloodstream (SEE Antioxidants) Improving antioxidant levels will bring the level of uric acid down
- keep the body alkali by taking magnesium carbonate 1-3 grams at night
- avoid dehydration
This also explains why gout and running a high uric acid is said to be a risk factor for arterial disease. Actually I believe it is the other way round. Having poor antioxidant status is a risk factor for arterial disease and serum uric acid is symptomatic of this.
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