Gout is a metabolic disorder.

It is a crystal deposit disease.

This is disturbed purine metabolism characterized by pain, swelling of 1st metatarsophalangeal joint initially followed by other joint.

These leading to excessive accumulation of uric acid in blood due to over production and under excretion

(less).

An acute attack affects a single joint especially big toe but it may affected other joint.

Aetiology

Primary Gout

1. Metabolic defect

• Idiopathic
• Enzyme defect
• Glucose 6 phosphate deficiency
• Type 1st glycogen storage disease

2. Faulty renal excretion of uric acid

• It is a major cause

Secondary Gout

1. Increased Production

• Chronic Haemolytic Aneamia
• Myeloproliferative disorder
• cytotoxic drug
• Psoriasis
• Carcinomatosarcoma

2. Decrease excretion

• Acute and chronic
• Function Impairment
• Drugs-Thiazide
• Diabetic ketoacidosis
• Lactic Acidosis 
• Dehydration
• Starvation
• Diabetic Insipidus
• Chronic Lead poisoning
• Chronic Alcoholism

Acute Gout

An attack may last for two week after which the joints become completely normally till another attack occur.

Predisposing Factor

Trauma

Acute Infection

Surgery

Exposure to cold

Drugs

Excessive of alcohol

High profile diet

Injection of foreign protein

Diuretic

Chemicals

Premonitory Symptoms

Nausea 

Vomiting

Flatulence

Abdominal pain

Renal colic

Polyuria

Clinical Feature

Age-above 40 years

Sex-males(8times more common in male)

The attack is usually occurs at night awakening the patient from sleep

1st metatarsophalangeal joint commonly affected

Other site- Ankle, heel, knee, hand

Skin over the joint became scaly

Itching during recovery

Local vein are much prominent

General symptoms

Anorexia

Fever

Chill

Malaise

Headache

Local symptoms

Excruciating pain

Tenderness

Swelling

Tense skin

Chronic Gout

The attack recurs at the interval of months and years

Gradually the stage come when irreversible changes develops in joints

Clinical Feature

Pain become persistent

Stiffness

Deformity of Joint

Location- wrist, ankle, knees, elbow, shoulder, hip

Tophi- Sodium Biurate Crystal begin to deposit in particular tissue and cartilage.

Especially tophi develops in ear and giving rise to swelling called tophi.

Tophi may also develop in hand, feet, Prepatellar Bursa.

Bursa particularly Ulnar Bursa may be inflammed, swollen with fluide exudate.

Progressive function lost.

Disability of joint

Deformity

Complications

Renal faliure

Diabetes Mellitus

Renal calculi

Bursitis

Hypertension

Nephrosclerosis

Artherosclerosis

Investigation

Serum uric acid level- increase

ESR-increase

Urine- volume deminished, high coloured urine

Urine show urate crystals

X-ray

Needle biopsy (tophi)- show birefringent crystal of Uric acid

Antistreptolysis Titre - increase

Treatment

NSAID

Steroid- prednisolone 40-80ml/day

Lacto vegetarian diet

Low dose of aspirin

Hot and cold compress over the affected joint

Bed rest

Analgesic drug- Colchicine (0.6-1.2mg)

Uric Acid Inhibitors

Uricosuric Drug

Homoeopathic medicine for Gout

1. Urtica urens
2. Benzoic acid
3. Colchicum
4. Ledum pal

Urtica urens

It is best suited remedy for Gout.

Gout and Uric Acid diathesis.

Symptom return at the same time every year.

Rheumatism associated with urticaria like eruption.

Pain in acute Gout deltoid, pain in ankles, wrist.

Benzoic Acid

Benzoic Acid is highly effective remedy for gout.

It is very useful medicine when colchic fails in gout

Excessive uric acid

Joints cracks on motion

Tearing with stitches

Pain in tendo Achillis

Rheumatic Gout, nodes very painful

Gouty deposits

Swelling of the wrist

Pain and swelling of knee

Bunion of greater toe.

Tearing pain in greater toe.

Worse in open air by uncovering.

Colchicum

Affects markedly synovial membrane of the joint.

Has specific power of relieving the gouty paroxysmal.

It seems to be more Beneficial in chronic affection of these parts

The parts are red, hot, swollen.

Tearing pain worse in evening and at night and from touch, stubbing the toe hurts exceedingly.

Sharp pain down left arm.

Worse from warm weather.

Inflammation of greater toe, gout in heel, cannot bear to have it touched or moved.

Knees strike together, can hardly walk.

Edematous swelling and coldness of legs and feet.

Ledum Pal

It is very important remedy for gout

Affects especially the rheumatic diathesis, going through the all changes, from functional pain to altered secretion and deposit of solid, earthy matter in the tissue

The rheumatism begins in the feet and travels upward

Gouty pains shoot all through the foot and limb, and in joints, but especially small joints.

Swollen, hot, pale.

Throbbing in right shoulder

Crackling in joints

Worse from warm of bed

Gouty nodosities

Ball of great to swollen

Rheumatism begin in lower limbs and ascends.

Soles painful and hardly step of them.

The selection of homoeopathic remedies based on symptom similarities and doses according to the Susceptibility of patient.

Don't take homoeopathic medicine without any prescription / without any advise of physician.