Inflammatory Arthritis

Some Topics

Gout = Inflammatory Arthritis

Gout is a painful inflammatory arthritis caused by uric acid crystals forming in the joints. Attacks of gout often start suddenly during sleep and feel like a joint is "on fire."

Uric Acid Crystals Cause Inflammation

The pain and swelling of gout are caused by uric acid crystals that form in the joint. Uric acid is a waste product of purine metabolism. Uric acid is dissolved in the blood and is excreted through the kidneys into the urine. In people with gout, the uric acid level increases and uric acid crystals are deposited in joints and other tissues. These needle-shaped crystals trigger an immune response that produces intense local inflammation with severe pain, tenderness and swelling. After several years of increased serum uric acid, uric acid crystals can build up in the joint(s) and surrounding tissues. They form deposits that are sometimes apparent as firm lumps (tophi) under the skin. Tophi often are found in or near severely affected joints, on or near the elbow, over the fingers and toes, and in the outer edge of the ear. Uric acid crystals can also form stones in the kidneys, in the ureters and in the bladder. Stones form when the uric acid concentration in the urine is too high - this is cause by low water intake, diuretics, and overly acidic urine. A diet rich in purines may be the culprit.

Uric Acid Production

Uric acid substance is a product of the chemical breakdown of the purine bases that compose the genetic material, DNA and RNA. As cells die and release DNA from their chromosomes, purines are converted into uric acid which is excreted in the urine and, to a lesser extent, the intestinal tract. The concentration of uric acid in the blood is related to the balance between uric acid production and excretion. The normal level in children is  about 2 mg/dl. At puberty, the level increases in males by 1 mg/dl, but it does not increase in females; the normal range is 3 to 7 mg/dl in adult males and 2 to 6 mg/dl in adult females. At concentrations greater than 6.5 to 7.0 mg/dl in water, urate precipitates in the form of sodium urate crystals. When blood levels are above 10 mg/dl, the chance of an acute attack of gout is greater than 90 percent.

Only 10% of people with hyperuricemia are over-producers of uric acid caused by diseases of the blood and bone marrow, inherited enzyme abnormalities and metabolic alterations due to obesity. In patients who overproduce uric acid because of a deficiency of hypoxanthine-guanine phosphoribosyltransferase, gout attacks may begin before puberty.

Increased destruction of body cells leads to increased uric acid production; examples are malignancies, particularly lymphoreticular cancers, hemolytic anemia, polycythemia, leukemias and nonmalignant conditions of increased cellular proliferation (e.g., psoriasis). Uric acid production will also increase with the accelerated breakdown of adenosine triphosphate (ATP) in glucose-6-phosphatase deficiency, tissue ischemia and myophosphorylase deficiency.

Kidney Excretion

Decreased urinary excretion of urate most often contributes to hyperuricemia. Patients with urate clearances of 6 to 7 ml per minute are more likely to have hyperuricemia after a purine load than those with clearances of 12 to 14 ml per minute. The assessment of renal handling of urate may be part of medical investigation designed to provide information about urate production, renal function, urine flow and the contribution of dietary purine intake to serum and urine urate.

Gout medications are used to:

  1. Relieve the pain and swelling of an acute attack: nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, codeine, Demerol, corticosteroid drugs.
  2. Prevent future episodes: colchicine, probenecid, sulfinpyrazone, and allopurinol.
  3. Prevent or treat tophi: probenecid, sulfinpyrazone, and allopurinol.
  4. Prevent the formation of uric acid kidney stones: allopurinol

Gout Rescue-Alpha Nutrition Program

Gout can be controlled by diet revision. Usually, a combination of medication and diet revision will achieve the best control. Attacks of Gout are exceedingly painful experiences and most victims are motivated to implement preventive measures.

The purine content of food is only a contributing cause to gout. Other factors in the flood supply influence uric acid metabolism and also influence the kidneys ability to excrete uric acid. Acidic foods and beverages such as tea, coffee usually have to be avoided. If blood uric acid levels are high, several cups of coffee can tip the balance by acidifying the blood and urine and an attack of gout can be triggered.

Many gout suffers will feel minor symptoms as their tissue uric acid levels rise- aching and tenderness in susceptible joints - for many days before an acute attack. If they heed the warning and stop all risky foods, the uric acid levels will subside and the painful attack is averted. The highest purine content is found in animal foods, especially meats and some seafoods. The total consumption of meat should be reduced and organ meats avoided. The only vegetable foods with high purine content are legumes, especially kidney beans.

The Alpha Nutrition Program has features that are helpful to gout sufferers, especially if gout accompanies other food-related diseases such as obesity, atherosclerosis and diabetes. The goal in an overweight person is to make a permanent diet change following Alpha Nutrition principles. We usually recommend combing diet revision with the preventive medication such as probenicid.

A food holiday on Alpha ENF will quickly reduce  uric acid levels while establishing the foundation for a new, healthier diet regimen. Phase 1 of Alpha Nutrition works well to reduce uric acid levels and can be used as a retreat strategy when warning symptoms appear. There are four conditions in phase 1 to reduce uric acid concentrations:

  1. Maximum portion size of poultry 3 oz/day
  2. Smaller portions of peas and green beans (never both on the same day)
  3. Add baking soda to alkalinize the urine: 1/2 teaspoon two to four times a day
  4. Increase water intake - 8 x 8 ounce glasses per day.

    You are at Alpha Online, the host of the Inflammatory Arthritis Center. The topics are from the book, Managing Arthritis by Stephen Gislason MD. Alpha Education books refer to the Alpha Nutrition Program, a standard method of diet revision.

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