Monday, 2 February 2015

(Preview) Most Common Diseases of Ages of 50 Plus - Musculoskeletal disorders (MSDs) - Gout

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By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
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Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

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.

I. Symptoms
According to a cross-sectional survey of a total of 6584 adults (3394 women, 3190 men) conducted by Second Military Medical University, on prevalence of musculoskeletal symptoms, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout showed that symptoms occurred more frequently in the following sites:
1. Knee 7.0% 
2. Lower back 5.6%(95% CI 5.0-6.2%),  
3. Shoulder 4.7%
4. Neck 2.4%
Women complained of rheumatic symptoms more frequently than men. In fact, symptoms are quite noticeable, you may feel well when you go to bed but wake up during the night with intense pain in one or few joints and sometime with fever. The symptoms may go away in a few days, but can return from time to time. Chronic gout can cause lumps below the skin around joints.
III. Causes and risk factors 
A. Causes
The causes of gout is as the result of high levels of uric acid in the body, leading to forming of crystals causes of inflammation due to inability of  your body in getting rid of uric acid.
B. Risk factors
 1.  If you body can not get rid uric acid quickly, intake foods with high levels of purine is associated to increased risk of gout.
2.  According to the review of data base of Birmingham VA Medical Centre,  751 titles and abstracts, 53 studies met the criteria. Risk factors include 
a. Alcohol consumption.
b. Meat intake, seafood intake, sugar sweetened soft drinks, and consumption of foods high in fructose.
c.  Thiazide and loop diuretics.
d. Hypertension, renal insufficiency, hypertriglyceridemia, hypercholesterolemia, hyperuricemia, diabetes, obesity, and early menopause.(2).

3. Genetics
Mutation of gene GLUT9 and ABCG2 is associated to increased risk of  uric acid levels and  gout(3).
4. Medication
Thiazide and loop diuretics users are at increased risk of gout(4).
5. Obesity, weight change, hypertension
a. Higher adiposity and weight gain are strong risk factors for gout in men,
b. Hypertension and diuretic use are also important independent risk factors for gout(5).
c. Obesity, hypertension, insulin resistance and metabolic syndrome(6).
d. Chronic renal failure.
6. Chronic kidney disease
Patient with Chronic kidney disease are at higher risk of gout. Serum uric acid control in gout was poor among patients without CKD and even worse among those with CKD(7).
7. Menopause
Menopause increases the risk of gout, whereas postmenopausal hormone therapy modestly reduces gout risk(8).
9. Etc.

III. Prevention
A. The Do’s and Do not’s list
1. Coffee
 Long-term moderate coffee consumption is associated with a lower risk of incident gout in women(9).

2. Maintaining adequate fluid intake 
Dehydrate is associated with the increased risk of gout. Drinking water or skim milk can improve gout control(10).

3. Weight reduction 
Obesity is not only a risk factor for incident gout but is associated with an earlier age at gout onset(11).

4. Dietary changes
a. Reduce alcohol
Alcohol intake is strongly associated with an increased risk of gout. This risk varies substantially according to type of alcoholic beverage: beer confers a larger risk than spirits, whereas moderate wine drinking does not increase the risk(12).

b. Reduce intake of foods with high levels of purine, such as sardines, herring, kidney and sweetbreads, shrimp, etc. (14).

5. Reduce intake of medications which can cause gout by reviewing them with your doctor, such as Thiazide and loop diuretics.

6. Exercise
“Exercises to relieve gout should be done steady and cautiously as to avoid further irritation to the joints. The best exercises for gout are range of motion types: strength training, stretching and building endurance such as yoga 14a)
7. Etc.

B. Phytochemicals to prevent Gout
1. Quercetin and Rutin
According to Nanjing University, quercetin and rutin inhibited gout and hyperuricemia through theirs promotion of liver absorption and metabolism(15).

2. Morin
Morin (3,5,7,2′,4′-pentahydroxyflavone), a phytochemical found in the twigs of Morus alba L. documented in traditional Chinese medicinal literature to treat conditions akin to gout exert potent inhibitory action on urate uptake in rat renal brush-border membrane vesicles(16).

3. Other phytichemicals
Other phytochemicals, such as puerarin, myricetin, and kaempferol significantly reduced liver uric acid level in hyperuricemic animals(17).
4. Etc.

IV. 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. The options available for the treatment of acute gout (18)may include
a. NSAIDs are commonly prescribed to control gout attacks in patients with hyperuricaemia.
b. Side effects are not limit to 
Ingested NSAIDs may cause  
b.1. Nonspecific colitis (in particular, fenemates)
b.2. Large intestinal ulcers, bleeding, and perforation 
b.3. Classic inflammatory bowel disease and contribute to serious complications of diverticular disease (fistula and perforation)
b.4. Small intestinal perforation, ulcers, and strictures requiring surgery.
b.5. Small intestinal inflammation
b.6. Complications of blood loss and protein loss (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 reduce pain in patients with acute gout – when given early in the very short term(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.  Corticosteroids  are used to reduce and maintaine duric acid serum level 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)
a.  Adrenocorticotropic hormone (ACTH) may be  a useful agent in the therapy of acute gout but not suitable for prophylactic use in the prevention of acute gouty attacks(20).
b. Side effects are not limit to
According to the Children’s Hospital, Helsinki, and at the Aurora Hospital, Helsinki, during 1960–76.
Adrenocorticotropic hormone (ACTH)  caused
 Pronounced side effects, and the mortality was 4.9% with common complications of infections, septic infections, pneumonias, and urinary and gastrointestinal infections as well as arterial hypertension, osteoporosis, hypokalaemic alkalosis, and other marked electrolyte disturbances (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 what the dose be appropriate.

B. In herbal medicine perspective
1. Artichoke

Artichoke (Cynara scolymus L.) leaves inhibited XO with only minimal inhibitory action at 100 microg/mL but the intraperitoneal injection of luteolin, an aqueous ALE, caffeic acid derivatives showed a decrease in uric acid levels(22).

2. Green teas
 Epigallo catechin-O-gallate (EGCG), found abundantly in green tea, inhibited  various diseases such as dermatosis, gout, atherosclerosis and cancer, through its anti-oxidant properties via antagonistic action in some inflammatory processes(23).

3. Alfalfa
In the article by By jeffwend, alfalfa reduced the amount of uric acid available to crystallize through increase uric acid levels in the urine(24).

4. Devil’s claw 
Harpagoside, a Glycoside, the chemical, principle extracted from the Devil’s Claw root, contributes the natural anti-inflammatory properties and may be a potential agent for treatment of gout and other painful disorders of the Musculoskeletal system(25).

5. Purple Sweet Potato
In the study to investigate  the hypouricemic effects of a
Anthocyanin extracts from purple sweet potato (APSP), and allopurinol, in a single oral dose of 100 mg/kg on hyperuricemic mice, reduced the serum uric acid concentration to 4.10 ± 0.04 mg/dL(26).

C. In Traditional Chinese medicine perspectiveAccording to TCM assistant,  gout is a condition of a joint painful wind syndrome caused by
1. Damp-Heat
1.1. Painful obstruction due to the containment of Damp-Heat in the channels can lead to acute articular rheumatism, acute attack of gout, arthritis, hot joints, joint pain, tremors, dark urine, etc.
1.2. Chinese Herbal Formula Xuan Bi Tang used to clear and  damp-Heat, unblock the Channels, eliminate painful obstruction, etc., may be used for treatment of gout
Ingredients include
a. Guang Fang Ji (Radix Aristolochiae Fangchi, Aristolochia Root, Stephania) – 15g.  -expels damp heat in upper jiao, expels superficial swellings, induces urination  
b. Xing Ren (Semen Pruni Armeniacae, Apricot Seed) – 15g.  -regulates lung Qi and water metabolism  
c. Yi Yi Ren (Semen Coicis Lachryma Jobi) – 15g.  -tonify spleen, clear dampness, relieve painful obstructions  
d. Can Sha  (Excrementum Bombycis Mori, Silkworm Feces) – 9g.  -tonify spleen, clear dampness, relieve painful obstructions  
e. Ban Xia  (Rhizoma Pinelliae Tematae, Pinellia Rhizome) – 9g.  -dries dampness, transforms tubidity  
f. Lian Qiao  (Fructus Forsythiae Suspensae, Forsythia Fruit) – 9g.  -clears superficial heat 
g. Zhi Zi  (Fructus Gardeniae Jasminoidis, Cape Jasmine Fruit, Gardenia) – 9g.  -clear heat, drains dampness, induces urination  
h. Hua Shi  (Talcum, Talcum) – 15g.  -clear heat, drains dampness, induces urination  
i. Chi Xiao Dou (Semen Phaseoli Calcarati) – 9g.  -clears heat, drains dampness, induces urination(28).
2. Recurrent Wind-Cold-Damp
2.1. Recurrent Wind-Cold-Damp painful obstruction in which localized constraint generates Heat can lead to acute attack of gout, arthritis, difficulty in movement, joint pain, edema of lower extremities, painful lower limbs, rheumatism;, swelling of joints, etc
2.2. Chinese herbal formula Gui Zhi Shao Yao Zhi Mu Tang used to disperses Damp and Wind, unblocks the Channels. moves Yang, etc., may be used for treatment of gout.
a. Gui Zhi (Ramulus Cinnamomi Cassiae, Cinnamon, Cassia Twig) – 12g.  -warms and unblocks channels  
b. Ma Huang (Herba Ephedrae, Ephedra Stem, ma-huang) – 6g.  -unblocks channels, relieves superficial swellings  
c. Fu Zi (Radix lateralis Aconiti Carmichaeli, Szechuan Aconite Root, Aconite) – 6g.  -warms channels, relieves pain  
d. Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis, Anemarrhena Rhizome) – 12g.  -clear heat from the joints, nourish yin  
e. Shaoyao (Radix Paeoniae , Peony Root) – 9g.  -clear heat, nourish yin  
f. Bai Zhu (Rhizoma Atractyloids Macrocephaelae, Atractylodes White Rhizome) – 15g.  -harmonizes ying and wei Qi levels (Bai Shao)  
g. Fang Feng (Radix ledebouriellae, Ledebouriella Root, Siler) – 12g.  -expels wind and dampness  
h. Sheng Jiang (Rhizoma Zingiberis officinalis Recens, Fresh Ginger Rhizome) – 15g.  -promotes Qi circulation  
i. Gan Cao (Radix Glycyrrhizae uralensis, Licorice Root) – 6g.  -harmonizes other herbs within formula, regulates middle jiao(29).
3. Wind-Damp, Phlegm and Blood stasis
3.1. Wind-Damp, Phlegm and Blood stasis lead to acute attack of gout. arthritis, difficulty in movement, joint pain, edema of lower extremities, swelling of joints;, chills, etc.
3.2. Chinese herbal formula Shu Feng Huo Xue Tang used to disperses Damp and Wind, eliminates Blood stasi, ., may be used for treatment of gout.
a. Gui Zhi  (Cinnamon twig, cassia twig)  2.5g
b. Qiang Huo (Notopterygium root, chiang-huo) 2.5g
c. Bai Zhi (Angelica root) 2.5g
d. Huang Bai  (amur cork tree bark, phellodendron bark) 2.5g
e. Wei Ling Xian (Chinese clematis root, clematis) 2.5g
f. Cang Zhu (Atractylodes rhizome) 2.5g
g.  Chuan Xiong (Sichuan lovage root, cnidium, Chuanxiong root) 2.5g
h. Hong Hua (Safflower flower, Carthamus) 1g
i.  Gan Jiang (Dried ginger rhizome) 1g
j.   Dang Gui (Chinese angelica root) 2.5g
k.  Dan Nan Xing (P Arisaematis cum Fel Bovis) 2.5g
l.    Han Fang Ji (Stephania root) 2.5g(30)

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