HISTORY and NOMENCLATURE
Gout is a very old and ancient disease causing harm to mankind since 4000 years. Gout was known to ancient Egyptians, Greeks and Romans. The name ‘GOUT’ is from the latin word ‘GUTTA’ which means ‘DROP’. There are also some additional names depending upon the site of affection;if it is being manifested at joint between the great toe and foot then it is called ‘PODAGRA’ ; if the joints in the knee are affected then it is called ‘GONAGRA’ and if the joints in hands are affected then it is called ‘CHIAGRA’.
In 1859, Garrod completed “The Nature And Treatment of Gout And Rheumatic Gout”, one of his ten propositions in this book stated firmly and clearly that the gout inflammation is caused by the deposited urate of soda. Another, that an excess of the uric acid leads to crystallization and inflammation.
The normal uric acid level in serum should be maintained to avoid the suffering of the gout. The physiologic range of serum uric acid in male is 3.1 to 7 mg/dl and for female it is 2.5 to 5.6 mg/dl. In blood the uric acid is soluble at 37o C temperature and at the pH between 7.35 to 7.45, beyond these physiologic limits it gets insoluble and gets accumulated in joints and kidneys.
Hyperuricemia may occur either due to a defect in the metabolism of purine or due to defect at renal level to excrete the uric acid.
In the first condition, there may be a deficiency or defect in enzymes which are essential in purine metabolism like SAICAriboside, AICAriboside or there may be idiopathic congenital error in purine metabolism.
In the second condition, which is most common for producing hyperuricemia, there is reduced excretion of uric acid by the kidneys which may either result from decreased glomerular filtration of uric acid, enhanced tubular reabsorption of uric acid or there may be decreased secretion of uric acid by the nephrons.
Generally, the manifestations of Gout are marked with the beginning of 3rd decade of life with male preponderance. In various cases it has been noticed that the gout has familial inheritance and is associated with the genetic history of the hyperuricemia.
Clinically, the history of the gout is seen in 4 phases :asymptomatic hyperuricemia, acute gouty arthritis, asymptomatic intervals and chronic tophaceous stage. There may be associated nephropathy and urate nephrolithiasis.
PATHOGENESIS AND RELATION TO MIASM
According to Dr Hahnemann’s etioclinical classification of the diseases, we can say that the gout is the true miasmatic disease which gets evoluted.
Hyperuricemia and synovitis represent miasm Psora, which if not corrected gets progressed to miasm Sycosis represented by depositions of needle shaped crystals of the monosodium urate in the joints. There is also effusion at the joint of polymorphs, macrophages with microcrystals of urate, this condition is known as ‘Acute Gouty Arthritis’.
Recurrent attacks of acute gouty arthritis leads to ‘Chronic Tophaceous Arthritis’, in this condition there is encrusting of articular cartilage due to deposition of monosodium urate; there is synovial proliferation, pannus formation and progressive destruction representing miasm Syphilis.
The prescription of a doctor from the Modern Medicine for the treatment of gout contains NSAIDs, corticosteroids and other supportive medications whereas in Homoeopathy has following marvellous medicines for the gout :
LYCOPODIUM :- Tearing in shoulders and elbow joints. One foot hot and other cold. Chronic gout with chalky white deposits in the joints. Pain in heel on treading as from a pebble. Painful callosities on soles, toes and fingers.
LEDUM PALUSTRE :- for rheumatic and gouty diathesis, have gout stones in the wrist joint, joints of fingers and toes. Sensation of throbbing pain in left shoulder and right hip joint. In acute condition the joints are swollen, hot, inflamed and are worse at night. In chronic condition there is a hard nodule formation, first in the joints of feet and then in hands. The ankles and soles are very painful and sensitive, can hardly step on them. There is swelling with shooting pain in knees when walking.
RHODODENDRON :- there is a gout with fibrous deposits in the great toe joint. There is aggravation during rest, before and during a storm and there is amelioration by warmth, wrapping, moving or walking about.
BRYONIA :- Knees stiff and painful. Hot swelling of feet. Joints red, swollen, hot, with stitches and tearing ;worse on least movement.
CAUSTICUM :- tearing in limbs ; better by warmth, especially heat of the bed. Burning in joints. Cracking and tension in knees ; stiffness in hollow on knee.
ABROTANUM :- Gout; joints stiff, swollen, with pricking sensation; wrists and ankle-joints painful and inflamed. Very lame and sore all over.
AESCULUS HIPPOCASTANUM :- Aesculus is full of gouty sufferings; gout in all the joints, gouty rheumatic affections, neuralgic affections. Especially in this rheumatic tendency found from the elbows to the hands, in the forearm and hands. Rending, tearing pains, flying hither and thither without any particular order, relieved by heat.
ANTIMONIUM CRUDUM :- gouty or rheumatic state, in which the symptoms change with the changes of the weather; worse in cold, damp weather, worse from cold bathing, better from the heat of a hot bath, worse from taking sour wine, and worse from stimulants of any kind.
BENZOICUM ACIDUM :- gouty constitution, and then they have relief when the urine is copious and heavily laden with deposits; but on comes an attack when they have more or less urine, but it is light in specific gravity, and then they are full of pains; in that way they fluctuate.
ARNICA MONTANA :- Gout with great fear of being struck by persons coming towards him across the room.
DIET AND REGIMEN
To avoid the suffering of the gout, one must consume food rich in vitamin C like broccoli, tomatoes, as they reduces the uric acid in the body. As alcohol contains purine, high intake of it should be avoided. Regular consumption of the coffee also reduces the risk of gout. High intake of meat and seafood increases the risk of gout. Though vegetables like peas, beans, lentils, spinach, mushrooms, oatmeal and cauliflower have high purine content but they do not contribute to form the gout.