Gout, The Fact Of High Protein In Diet

Gout, The Fact Of High Protein In Diet


   What is gout?

  • Gout is a form of inflammatory arthritis occurred as a result of deposition of monosodium urate crystals in the joint, It usually affects the big toe joint causing swelling , inflammation accompanied by sever pain, the symptoms get worse named as gout flares, some times disappeared named as gout remission.
  •  This disease become more complicated when the symptoms worsen forming a chronic gouty arthritis which is the most sever form of gout.  It is caused by the chronic hyperuricemia ( uric acid > 7 mg / dl).
  • Uric acid is the end product of purine metabolism caused by xanthene oxidase enzyme that oxidizes many reaction up till forming the end product of protein metabolism named by uric acid salts. 
  • Most of uric acids in the blood is excreted by the renal Proximal convoluted tubules. Diuretic drugs also may interfere with the uric acid excretion leading to its retention with subsequent increase of its serum level. 

  • When serum uric acid increases, Monosodium urate crystals are precipitated around the joint tissue causing pain and swelling and inflammation. In addition, these crystals considered foreign bodies that are being attacked and phagocytosed by macrophages leaving sever  inflammation at the articular tissue. 

       What are the main gout symptoms?

   Gout attacks are often very painful and happen suddenly named as gout flares as we mentioned before, that usually starts overnight and lasts for weeks followed by a period of remission in where the symptoms disappear. this period may lasts for years or may be months or weeks untill the second wave of gout attack starts. Symptoms occurred in affected joint includes:

1. Intense pain usually affects the big toe joint, but it can occur in any  other joint. the other commonly affected joints include the ankles, knees, elbows, wrists and fingers. The pain is  often  more severe within the first 12 hours .

2. The affected joint become inflamed, swollen, tender, warm and red. 

3. As gout progresses, The affected joint cannot be moved totally.

     What are the causes of gout:

  •      a.  High protein diet results in formation of uric acid crystals that are selectively precipitated in and around the joint tissue with in the body.
  •      b.  During treatment of some hematologic malignancies like leukemia as a result of tissue break down and tumor lysis
  •       c.Drugs like diuretics and aspirin as both can decrease uric acid excretion leading to its retention  .
  •      d. Kidney diseases could impair uric acid excretion from the proximal convoluted tubules as  uric acids are mainly excreted from it. About 90% of gout disorder have reported to be from kidney disorders leading to its retention in the body.

 Who are at risk of  gout disease?

1. People who have a certain chronic diseases as heart failure, hypertension, diabetes, kidney failure.
2. People who use a certain medications like diuretics or aspirin.
3. People who are usually consuming  diets of high protein content as red meat, scallops, tuna and sardines. this protein is broken down into uric acid.
4. Over weighted individuals at a higher risk .
5. Men are in a higher risk than females.
6. Over drinking of alcohols and consuming meat increases your gout risk. It was estimated that about 12% of gout cases have dietary causes and there is a significant correlation between drinking alcohol, eating meat, and eating shellfish and having gout disease  because these foods that are high in purines and produce a lot of uric acid. Chicken and potatoes also seem to be connected.

   Diagnosis of Gout Disease:

  • by checking the hyperuricemia which defined as plasma urate level is more than 7 mg/dl in males and more than 6mg/dl in females. This also based on the symptoms and the appearance of the affected joint. to help diagnosis of gout the following tests can be done :

    • Joint fluid test. by using a needle to draw fluid from your affected joint. when the fluid is examined under a microscope, urate crystals can be detected 
    • Blood test.  to measure the levels of uric acid in your blood. However, this test is   misleading as Some people have high uric acid levels, but never experience gout. And some people have signs and symptoms of gout, but don't have unusual levels of uric acid in their blood.
    • X-ray. Joint X-rays can be helpful to detect other causes of joint inflammation.
    • Ultrasound. by using sound waves to detect urate crystals in joints.

  • Treatment of gout disease: 

1. By using of Hypouricemic Drugs for chronic gout as
    a. Drugs triggers  uric acid excretion like probenecid .
    b. Drugs decrease uric acid synthesis like thiopurinol.
    c. Drugs triggers uric acid metabolism like uricase enzyme.

2. Using  of Anti-Inflammatory Drugs  for acute gout : as Colchicine, Non Steroidal Anti Inflammatory Drugs (NSAIDs), Steroids drugs( Corticosteroids).
       
 - Colchicine It is a specific drug for gouty arthritis. It makes reduction of inflammation and relief of pain usually after 12-24 hours from oral administration. colchicine prevent the inflammatory reaction of immune cells and also prevents cell division via its binding to microtubular system preventing swelling and  inflammation of the affected joint.
 - Non Steroidal Anti Inflammatory Drugs (NSAIDs):They provide a symptomatic relief of acute gouty attacks faster than colchicine, they are like ibobrufen, ketoprofen naproxen, indomethacin and so on but not aspirin.
 - Corticosteroids :They are used as anti- inflammatory and anti-immunological drugs that are uses when colchicine and NSAIDs are not sufficient to control the acute attacks, They are transported to cell nucleus and interacts with many DNA receptors and affects their function.

3. Following a healthy diet style by eating less purine rich food like red meat and scallops, avoid drinking alcohol and try consuming a little amount of food in your diets in order to lose your weight.
4. Avoid some medication that triggers uric acid retention like diuretics and aspirin.
5.Avoid smoking in order to avoid the congestive heart diseases and hypertension that aggravates uric acid increasing in the blood. 

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