Gout – causes, symptoms, diagnosis, treatment, pathology

Gout – causes, symptoms, diagnosis, treatment, pathology

Gout is an inflammatory disease in which monosodium
urate crystals deposit into a joint, making it red, hot, tender and swollen within hours. When this happens, it’s called a gouty attack. The underlying cause is hyperuricemia—too
much uric acid in the blood, which results in the formation of sharp, needle-like crystals,
in areas with slow blood flow like the joints and the kidney tubules. Over time, repeated gouty attacks can cause
destruction of the joint tissue which results in arthritis. To understand where the uric acid comes from,
let’s start with purines, which, together with pyrimidines, are nature’s most common
nitrogen-containing heterocycles. A heterocycle being any molecular ring or
cycle with different types of atoms. Purines, as well as pyrimidines, are key components
of nucleic acids like DNA and RNA, and when cells, along with the nucleic acids in those
cells, are broken down throughout the body, those purines are converted into uric acid—a
molecule that can be filtered out of the blood and excreted in the urine. Uric acid has limited solubility in body fluids,
though. Hyperuricemia occurs when levels of uric acid
exceed the rate of its solubility, which is about 6.8mg/dL. At a physiologic pH of about 7.4, uric acid
loses a proton and becomes a urate ion, which then binds sodium and forms monosodium urate
crystals. These crystals can form as a result of increased
consumption of purines, like from consuming purine-rich foods like shellfish, anchovies,
red meat or organ meat. Also, though, they can result from increased
production of purines, for example high-fructose corn syrup containing beverages could contribute
to the formation of uric acid by increasing purine synthesis. Another way crystals could form is from decreased
clearance of uric acid, which can result from dehydration from not drinking enough water
or from consumption of alcoholic beverages, both of allowing uric acid to precipitate
out. Regularly eating these kinds of foods can
also lead to obesity and diabetes, both of which are risk-factors for gout. Hyperuricemia can also develop as a result
of chemotherapy or radiation treatment, since cells die at a faster-than-normal rate. Also, some individuals have a genetic predisposition
to overproduction of uric acid while others with chronic kidney disease may be unable
to excrete the uric acid. Finally, there are some medications like thiazide
diuretics and aspirin which can also increase the levels of uric acid and therefore the
risk of gout. Now gout most often affects the first metatarsal
joint of the foot—or the base of the big toe, and when it does, this condition is called
podagra. Classically in podagra, a person will wake
up from sleep feeling like their big toe is on fire; even the weight of the sheets can
be painful. The pain is most severe in the hours immediately
following the attack and then generally lessens over time, but that discomfort and swelling
can last for days or weeks. Gout can affect other joints as well like
those in the ankles, knees, wrists, and elbows. This inflammation and local pain’s ultimately
caused by white blood cells, or leukocytes, which migrate to the site to help eliminate
uric acid and release proinflammatory chemicals, including cytokines. Treatment of a gouty attack is typically focused
on decreasing the pain and swelling, most often with nonsteroidal anti-inflammatory
medications, or NSAIDS, like ibuprofen or naproxen sodium, but occasionally with corticosteroids
as well. Colchicine which has anti-inflammatory effects
by inhibiting white blood cell migration has also been used for a long time to treat gouty
attacks. To treat the underlying cause of increased
uric acid, though, it’s important to modify the diet, doing things like staying well hydrated
(with water), reducing or eliminating soda, alcohol, red meat, and seafood, and staying
active to ward off obesity. There are also medications that help to decrease
uric acid levels, which include xanthine oxidase inhibitors like allopurinol. Xanthine oxidase is an enzyme involved in
the breakdown of purines to uric acid, so inhibiting this enzyme results in less uric
acid production. Uricosuric medications, like probenecid, increase
excretion of uric acid by the kidneys. Over time, repeated gouty attacks can develop
into chronic gout, which is a type of arthritis with joint tissue destruction and permanent
joint deformity. Chronic gout can eventually lead to permanent
deposits of urate crystals—called tophi, which form along the bones just beneath the
skin. Individuals with chronic gout are also at
an increased risk for developing kidney stones made of uric acid, as well as urate nephropathy,
which is when urate crystals deposit in the interstitium of the kidney. Okay, as a quick recap, gout is a type of
inflammatory disease that typically affects the first metatarsal joint, which is the base
of the big toe, where uric acid precipitates to form monosodium urate crystals, which deposit
in the joint lead to inflammation and pain. Thanks for watching, you can help support
us by donating on patreon, or subscribing to our channel, or telling your friends about
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20 comments on “Gout – causes, symptoms, diagnosis, treatment, pathology

  1. yogayantra Dominique Post author

    well, i have known many, many people with gout. The best cure (when possible, i.e. when the nervous system is strong) is fasting. In many people I have known, it was the definitive solution.
    I'd love to see s video on the biochemistry of fasting, though, of course, the Big Pharma may not like it at all.

  2. ana jen Post author

    Dark cherry juice (syrup) from a NATURAL health care store or straight dark cherries works to eliminate an attack QUICKLY.
    Also NO ALCOHOL (especially BEER due to the YEAST in it)
    No donuts/bagels/yeast type stuff.

  3. carada07 Post author

    I have disintegrating disc`s in my back, & and allot of neck pain. Arthritis can also be a problem I`ve got. Imake use of this arthritis treatment method “Rοngοdο Ruzο” (Google it) on my neck, back and sides of my body, and the pain disappears. I can function for the day. With assistance from proper diet and also prevention of inflammation-causing food, your condition will enhance a lot. .

  4. Anthony Poselenzny Post author

    Eliminating the foods listed won’t help most folks and eating those foods won’t cause obesity. Most gout is caused by metabolic syndrome caused by too much sugar and carbohydrates being ingested.

  5. M Wal Post author

    makes sense there's so many gout patients in cardio, i can make the link now with thiazide diureticum and asperin. Thank you!

  6. twitchster77 Post author

    Gout can be INCREDIBLY painful…to the point where you can't put any pressure at all on your foot. That means no walking at all. It really sucks. It feels like having a broken bone in your foot.

  7. twitchster77 Post author

    The thought of having Chronic Gout makes me feel sick. The idea of the pain never going away. Huh.

  8. Bill Jones Post author

    Ok, so, from all the videos of doctors, know it alls, liberals and expert users of the English language, the only real cure is to quit eating. Drink boat loads of coffee and only eat Cherries if you get hungry.

    Well,no shit Sherlock, this sounds simple enough to me. What works for me, since gout settles in my toes, I hang myself upsidedown by my feet at night and sleep like a fruit bat. This does work, but, now I get a head ache. To cure that, in the morning I take two aspirin with four cups of espresso, for the caffeine, bing, bang bong I am so full of energy that my day just flies by.

    I have tried and tried…….I can tell you WD-40 does not work. At least, not for me anyway….🤪 I am beginning to feel all my aches and pains are my parents fault. They should have skipped it that night.

    Ya’ think?

  9. Jennie Hughes Post author

    This was very helpful information. I'm in the middle of an episode right now but can't get to the hospital or urgent care. Taking Naproxen and staying hydrated. Apple cider vinegar seems to help as well .
    At least it doesn't seem to be getting worse and it doesn't and having it covered with a sheet doesn't make the pain worse .
    Massaging around the area seems to help as well .
    Thank you so much for putting this video up .

  10. Abraham Mohetaue Post author

    Im watching this in hopes I do not have this 😂😥 Surely im not the only one and also laughing because i really hope i do not have this. Great video btw 😊

  11. Kelzzz Belllz Post author

    I’ve been bk in forth 2 the docs I’ve still no answers I’m thinking this could actually been what’s wrong..my symptoms are burning feet, all the bones are sore in my feet also,they turn all reds in purple colours my knees are sore and my back my fingers get sore time from time but not every day like my feet. Anyone with gout does this sounds like it? Any help would be appreciated


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