Approach of Homeopathic Medicine and Dietary Management of Gouty Arthritis.
Gouty arthritis is a clinical presentation of uric acid disturbance in human body. The role of genetic predisposition is becoming more common causative factor. The clinical picture of gout is divided into four types. Management of gout include patient education, diet and life style changes, as well as cessation of hyperuricemic drugs. The general prevalence of gout is 1–4% of the general population. In western countries, it’ occurs in male 3–6% and in female 1–2%. In many countries, prevalence may increase up to 10% in population.
Gout is a arthritis due to metabolic and endocrine disorders. It is due to deposition of microcrystals of sodium urate monohydrate or uric acid from hyperuricemia body fluids.
Gout is a disorder of purine metabolism manifested by the following features which may occurring singly or in combination.
1) Increased serum uric acid concentration (Hyperuricemia)
2) Recurrent attacks of characteristic type of acute arthritis in which crystals of monosodium urate monohydrate may be demonstrable in the leucocytes present in synovial fluid.
3) Excessive deposition of monosodium urate monohydrate (Tophi) in and around the joints of the extremities.
4) Interstitial tissue and blood vessels involving because of renal disease.
5) Uric acid nephrolithiasis.
Serum urate concentration is a major risk factor for gout development. Uric acid is the end product of purine metabolism in humans who lack the enzyme uricase.Two third of urate formed each day is excreted by the kidney and one third from GI tract.Genetic and environmental factors leads to gout and Hyperuricemia by reducing excretion of uric acid(90%) and or increased production of uric acid (10%)
Hyperuricemia and gout may be classified in to two types
A) Metabolic Origin
Hyperuricemia of metabolic origin comprises about 10% cases of gout which are characterised by overproduction of uric acid.
i) primary metabolic gout
ii) Secondary metabolic gout
B) Renal Origin
Hyperuricemia of renal origin about 90% cases of gout are the result of reduce renal excretion of uric acid.
1) Reduced renal excretion of uric acid
It may be Idiopathic, familial juvenile court nephropathy, drug administration, reduced renal functional mass and reduced glomerular filtration rate.
2) Increased uric acid production
It may be Primary and Secondary.
It has 4 stages
1) Asymptomatic Hyperuricemia
2) Acute gout
3) Intercritucal gout
4) Chronic tophaceous gout
Diagnosis is based on laboratory and radiological features. The diagnosis is identification of characteristic MSU crystals in the synovial fluid by using polarized light microscopy method. Imaging method for diagnosis include conventional radiography, ultrasonography, conventional CT, Dual-Energy CT, Magnetic Resonance Imaging, nuclear scintigraphy, and positron emission tomography.
1) Colchicum Autumnale:
It affects markedly muscles,fibrous tissue, serous membranes,joints,esp.small joints.Adopted to rehumatic , gouty diathesis;person of robust vigorous constitution; disease of old people.Artheritic pain in joints; patient screams with pain on touching a joint or stubbing a toe.it causes extreme relaxation of muscles,pain are tearing,digging, drawing. Pain aggravated by mental exertion, evening, at night and emotions, slightest touch and vibration.many joint affected at a same time.the parts are red,hot, swollen, tearing pains.there is always great prostration, internal coldness and tendancy to coldness. Bad effects from suppressed sweat.dreams of mice. Artheritic pains in joints; patient screams with pain on touching a joint or stubbing a toe. Oedematous swelling and coldness of feet and legs. Buttocks hot.
2) Benzoic acid:
Adapted to gouty,rheumatic and uric acid diathesis.it has a marked action on metabolism.urine repulsive odor, changeable colour,dark brown,acid,enuresis nocturna of delicate children, dribbling,offensive urine of old men.excess of uric acid,vesical catarrh from suppressed gonorrhoea,cystitis. Odor of horse urine.retention of urine in infants.worse by open air,changing weather,motion and uncovering. Better by heat and profuse urination.
3) Arnica Montana:
It is a traumatic remedy of both mental and physical.tendancy to haemorrhage is a indication for this remedy.cutting pain in kidneys.retention of urine in bladder,from over exertion,after labour.involuntary dribbling,with constant urging.wait for a long time for urine to pass.the bladder feels full and sore.the pressure of the urine hurts him/her.limbs ache as if beaten.pain in arms better by hanging down.want of strength in the hands on grasping.cramps in the fingers i.e. writer’s cramp. It’s also helpful in gouty arthritis.knee joints suddenly bend when standing.feet numb. aggravated by injuries,jarring,over exertion and lying on left side. Amelioration by lying down and lying with head low or out stretched.
4) Ledum Palustre:
It is adpted to mostly rheumatic and gouty diathesis. More uric acid and sand in urine. Urine often stops during the flow. Copious clear, colourless urine,deficient in salts. Cramp over hip joints,swollen,blotchy,ecchymotic legs and feet.heels sore and soles painful.trambling of hands when moving or grasping.esaily spraining of ankles.pain in shoulder on raising arm. Better by cold, bathing and reposing and worse by warmth,covers,motion and night. Ball of great toe swollen,painful.black and blue places become green.parts cold to touch but not cold subjectively to patient.emaciation of affected parts.
Jerks or spasms in limb is character of this remedy. Joints are swollen,red, shining and red steaks radiating. Sensation of motion in bladder as of a worm.urine scanty,with tenesmus,dark and tubid.urine loaded with phosphates.haematuria where no pathological condition can be found.heaviness and paralytic feeling in limbs. Cold extremities.involuntary limping.trembiling of limbs,weakness and tottering gait.lies or sit with feet crossed.rush of blood and face.vertigo when stopping. Patient have delirium and menia. Persons who are lively and entertaining when well,but violent and often delirious when sick.quick sensation and motion,pain comes suddenly,last indefinitely and cease suddenly.
6) Berberis Vulgaris:
The renal or vesical symptoms predominant.Rehumatic and gouty complaints with disease of urinary organs.bubbling sensation in kidneys.greenish,blood red,with thick,slimy mucus, transperant,reddish or jelly like sediment urine.urethra burns when not urinating.neuralgia under fingernails,with swelling of finger joints.outerside of thighs cold, ulcerative pains in heels.pain in balls of feet on stepping.intense weariness and lameness of legs after walking a short distance.stitches between metatarsal bonesa as from a nail.aggravation from standing, twilight,motion, jarring and urinating. Rapid changes of symptoms is main character of this remedy.old gouty constitution.pain in region of kindey is more marked.wandaring and radiating type of pains.pain in balls of feet on stepping.
7) Bryonia Alba
It is more adapted to person of a gouty and rehumatic diathesis.patients are irritable, inclined to be vehement and angry.dark or black hair with dark complexion.firm muscular fiber.ailments from chagrin, mortification and anger.one of the chief characteristics is aggravation from the any motion and corresponding relief from absolute rest either mental or physical.more marked delirium,talks constantly about his business,desire to get out of bed and go home.great thirst for large quantities of water at long intervals.red, brown,like beer,scanty and hot urine.knees stiff and painful.hot swelling of feet.joints red, swollen,hot with stitches and tearing.joint complain worse on least movement.every spot is painful on pressure.constant motion of left arm and leg.
Diet and regimen of gouty arthritis:
Worldwide incidence of gouty arthritis increases gradually because of poor dietary habits, lack of exercises, obesity and metabolic syndrome. Purine restricted diet is mostly suggested to patients with Hyperuricemia,gouty arthritis and /or urinary uric acid lithiasis.eating a high purine diet,regular alcohol consumption, obesity and hypertriglyceridemia play a major role in increased production of urate in body.lifestyle changes along with homeopathic medication are often needed to control Hyperuricemia in better way.in patients with gouty arthritis weight reduction and stop alcohol consumptions are very helpful in decrease the level of hypertriglyceridemia, Hyperuricemia urate over production.Obesity is also have a strong positive history with body weight and serum urate concentration. Weight loss should be gradual to prevent ketone production which inhibits uric acid excretion.
Modification of diet:
Protien intake should be normal.carbohydrate intake should be normal.fat intake should be normal cholesterol intake should be less than 300mg/day Healthy body weight maintained is a good impact on gouty arthritis. Weight loss should be gradual is key impact on gouty arthritis. Rapid weight loss through fasting or use of low carbohydrate diets can cause the body to produce ketones which may increase Hyperuricemia.Alcohol should be avoided because alcohol inhibits renal excretion of purines.Adequate fluid intake helps dilute urinary uric acid,which helps prevent formation of renal calculi.so,advised to drink 2-3 liter per day.
Gout is a very common disease condition in population and homoeopathic treatments as well as dietary management are effective in the treatment of gouty arthritis. Disappearance of the signs and symptoms within a short span of time along with the help of homeopathic remedy and dietary management indicates the positive effect of Homoeopathy in the treatment of gouty arthritis.
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