Monday, 25 November 2013

Gout Treatments In conventional medicine perspective

Musculoskeletal disorders (MSDs) is medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints. A shoulder disorder was found in 27% of subjects, rheumatoid arthritis in 1% and osteoarthritis (OA) of the hand, hip, and knee in five, seven, and 18% of subjects, respectively. Disability was frequent: a walking distance of < 500 m was found in 60% and ADL dependency in 40% of the group. Factors related to one or both of these disability measures included female gender, hip and knee OA, impaired vision, cognitive impairment and neurological disease(1a).
Types of Musculo-Skeletal disorders in elder(2a)
1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia
I. Gout mostly effected one joint is defined as a acute and recurrent condition of arthritis as a result of uric acid builds up in blood cause of joint inflammation.
VI. Treatments
A. In conventional medicine perspective
A.1. Acetaminophen
a. Acetaminophen such as Tylenol can help to relive the pain of Gout.
b. Side effects if overdose are not limit to
b.1. Nausea and vomiting     
b.2. Appetite loss     
b.3. Sweating     
b.4. Diarrhea     
b.5. Irritability
b.6. Abdominal pain
b.7. Etc.

A.2. In the study of  Gout–what are the treatment options? indicated that The options available for the treatment of acute gout (18)are
a. NSAIDs are commonly prescribed to control gout attacks in patients with hyperuricaemia.
b. Side effects are not limit to 
Dr. Bjarnason I, and the research team at King’s College School of Medicine and Dentistry, in the study of Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans, showed that Ingested NSAIDs may cause a nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs. Large intestinal ulcers, bleeding, and perforation are occasionally due to NSAIDs. NSAIDs may cause relapse of classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation). NSAIDs may occasionally cause small intestinal perforation, ulcers, and strictures requiring surgery. NSAIDs, however, frequently cause small intestinal inflammation, and the associated complications of blood loss and protein loss may lead to difficult management problems. The pathogenesis of NSAID enteropathy is a multistage process involving specific biochemical and subcellular organelle damage followed by a relatively nonspecific tissue reaction. The various possible treatments of NSAID-induced enteropathy (sulphasalazine, misoprostol, metronidazole) have yet to undergo rigorous trials(19).
2. Colchicine
a. Colchicine, used for a long period in gout, was approved for the first time in 2009 by the FDA for the prophylaxis and the treatment of acute attack, on the basis of a pivotal trial that showed the efficacy in the very short term – that is 24 h of a well-tolerated, low-dose regimen of Colcrys (colchicine, URL Pharma, Philadelphia, USA) to reduce pain in patients with acute gout – when given early(20).
b. Side effects are not limit to
1. Diarrhea
2. Dizziness
3. Flushing
4. Hair loss
5. Headache
6. Loss of appetite
7. Nausea; sore gums
8. Stomach pain
9. Vomiting
10. Etc.
3. Corticosteroids
a. researchers suggested that Systemic corticosteroids could be used in severe polyarticular flares. Anti-IL1 should provide a therapeutic alternative for severe cortico dependant gout with tophus. To prevent acute flares and reduce tophus volume, uric acid serum level should be reduced and maintained below 60mg/L (360μmol/L).
b. Side effects are not limit to
b.1. Stomach irritation
b.2. Rapid heartbeat
b.3. Nausea
b.4. Insomnia
b.5. A metallic taste in the mouth
b.6. Etc.
4. Adrenocorticotropic hormone (ACTH) and
a. In the study of  Effects of adrenocorticotropic hormone (ACTH) in gout by Alexander B. Gutman, M.D.1, T.F. Yü, M.D indicated that ACTH effected a very rapid and satisfactory response in the local and systemic manifestations of acute gout in seven of eleven cases treated, including one patient refractory to colchicine. ACTH therefore appears to be a useful agent in the therapy of acute gout. In many of these patients, however, ACTH was not convincingly superior to colchicine, and in four instances colchicine terminated attacks responding unsatisfactorily to ACTH. Unlike colchicine, ACTH is not suitable for prophylactic use in the prevention of acute gouty attacks(20).
b. Side effects are not limit to
In the study of 162 children with infantile spasms were treated with ACTH at the Children’s Hospital, Helsinki, and at the Aurora Hospital, Helsinki, during 1960–76. In a large proportion (37%) of the children the treatment caused pronounced side effects, and the mortality was 4.9%. The most common complications were infections: septic infections, pneumonias, and urinary and gastrointestinal infections. Other side effects were arterial hypertension (11), osteoporosis (2), hypokalaemic alkalosis (2), and other marked electrolyte disturbances (10). In children necropsy showed fresh intracerebral haemorrhages. Four children developed oliguria and hyperkalaemia during and after withdrawal of ACTH. One of them had tubular necrosis confirmed by renal biopsy. Infections were significantly more common with large doses (120 units) of ACTH than with small ones (40 units). It is concluded that side effects, even severe ones, are more common during treatment than had been assumed(21).
5. Intra-articular corticosteroids 
a. Intraarticular steroid injections are injected directly into an affected joint to improve joint function.
b. Side effects are not limit to
b.1. Infection
b.2. Facial flushing
b.3. Local skin atrophy and depigmentation
b.4.  Crystalline synovitis
b.5. Allergic reaction
b.6. Uterine haemorrhage
b.7. Etc.
The most important determinant of therapeutic success is not which anti-inflammatory agent is chosen, but rather how soon therapy is initiated and that the dose be appropriate.
b. Side effects are not limit to
b.1. Constipation
b.2. Diarrhea
b.3. Dizziness
b.4. Drowsiness
b.5. Headache
b.6. Heartburn
b.7. Nausea
b.8. Stomach upset
b.9. Etc.
7. Etc.
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