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  Last-Modified:  05/03/06 09:24         

Gout is one of the most common forms of arthritis - an inflammation of a joint. Due to gravity, it usually affects the first meta-tarsophalangeal joint - your Big Toe. Intense pain can appear over night and you can have fully blown Gout, within 24 hours. Approximately 18% of people who develop gout, have some family history of this condition, and do have higher than average levels inherited from a parent.

Gout is caused by excess Uric Acid accumulating in the body, normal a waste product that a younger person might dispel quickly. The Uric Acid settles in the joint and crystals are deposited and formed there. Eventually these deposits can build up like a stalagmite. only much quicker, and put your bones all out of shape.

As in most ailments there are several factors why this might happen. Uric Acid production increases, due to diet. Gout attacks, once said to be a rich man's disease, may be increased by eating a high dietary intake of rich foods that contain Purine -  such as in shellfish, livers, kidneys, sweetbreads, tongue, cream sauces, red meat, sardines, scallops, peas. lentils, beans and drinking more than 2 - 3 units of alcohol a day.

The class of chemical compounds known as Purines, were first found in a waste product of metabolism, known as Uric Acid, which causes gout. Purine, coined by chemist Emil Fischer, in the 19th century, comes from the Latin PURUS - pure, clean and New Latin, URICUS  - being uric acid, from urine.

Some medications can also increase Uric Acid levels. Examples include low-dose aspirin, diuretics such as hydrochlorothiazide and immuno-suppressants, used in organ transplantations.

HYDROCHLOROTHIAZIDE is a diuretic. Diuretics increase the amount of urine passed, which causes the body to lose water and salt. Hydrochlorothiazide helps to treat high blood pressure (hypertension). It is not a cure. It also reduces the swelling and water retention caused by various medical conditions, such as heart, liver, or kidney disease. Generic hydrochlorothiazide capsules or tablets are available.

In time, further increase in Uric Acid levels affecting the blood, may lead to deposits of monosodium urate crystals, in and around the joints. These crystals attract white blood cells, leading to quite severe gout attacks. Uric Acid can also cause deposits in the urinary tract, causing kidney stones. Kidney ailments causing a lessening of the kidney's functions may increase Uric Acid.

Such was, is, the pain caused by this malady, this old drawing depicts what only a sufferer can feel.

Symptoms & Signs

Gout most always first develops in the joint of the first toe / the big toe, or the Hallux. Early signs may be just a small tickly twinge in or around the big toe. It may appear, but as has been said, be due to several factors, or a culmination of several factors. Patients often get it, but it soon regresses and does not actually return.

Common symptoms include the following:

• Discomfort

• Tingling

• Higher sensitivity around the big toe

• Pain

• Inflammation

• Redness

• Stiffness

• Swelling

All in all, unless diagnosed, it can only get worse if your life-style stays the same.

Touching or moving the toe may be intensely painful and it is said that having as much as a sheet over the toe increases the pain.

Symptoms of gout develop quickly, sometimes in less than a day, and typically occur in only one joint at a time. Rarely does Gout develop in two or three joints at the same time. If widespread symptoms occur, the condition is probably not gout, and further diagnosis must be sort

If left, and Gout goes untreated, for a long period of time, it can damage joints, and sometimes cause a permanent disability. History of some people not being treated, has shown some horrendous disfigurements.

Be aware of the presence of Gout, and be careful. Experts in the treatment of arthritis, rheumatologists evaluate patients to determine whether gout is the cause of their arthritis, educate them about the role of medications and other measures to treat gout, and act as a resource to primary care physicians.

Several kinds of arthritis can appear, at first to be Gout, so a proper diagnosis is crucial. Gout is generally suspected when a patient experiences a swelling of a joint, followed quickly by intermittent  intense pain. Initial attacks often occur at night, and will wake you up.

A correct diagnosis will depend on finding the characteristic crystals. The medical operative, will insert a needle into the affected joint and extract a clear fluid that lubricates the joint called, synovial; this will be examined under a microscope to determine whether monosodium urate crystals are present.

Synovial fluid is a thick, stringy fluid found in the cavities of joints. It has an egg-like consistency, in fact  synovial comes from the Latin for egg. Synovial fluid reduces friction between the articular cartilage and other tissues in joints to lubricate and cushion them during movement.

Crystals can also be found in deposits that occur under the skin, called Tophi, that occur in advanced gout.

Elevated blood level of Uric Acid, sometimes referred to as Hyperuricemia, occurs when the liver produces more Uric Acid than the body can excrete in the urine, or when a diet is irregularly high in rich foods, so testing the blood can be misleading, as these may be temporarily normal, or even low during attacks. Uric Acid levels are also often elevated in people who do not have gout.

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