Understanding Medicine: Gout

 

         

          Human body consists of trillion living cells that keep activating, dividing and degenerate daily. Inside human cell, there is a nucleus that function to control cell activity. Nucleus containing nucleic acid, its basic unit is nucleotide. Two types of nitrogenous bases that build the complementary nucleic acid including purine and pyrimidine. The purines, Adenine (A) and Guanine (G) are smaller two-ringed bases while the pyrimidines, Cytosine (C), Thymine (T) and Uracil (U) are larger and have only single ring. Once the nucleic acid broken down in degeneration process of cell, purines (A & G) will be converted into uric acid. Uric acid will then form urine that is eliminated from body through kidney.

         What happen if level of uric acid is too high in our blood stream ? If concentration of uric acid is higher than 6.8 mg/dL, patient will be diagnosed as hyperuricemia.Normally in Ph 7.4, uric acid will loses its proton to become urate ion which will binds to sodim ion, Na+ and subsequently form monosodium urate crystals. If kidneys fail to filter the uric acid, it will accumulate in our body commonly at joints or kidneys where blood flow moves slowly then will cause arthritis. Thus, gout is about inflammatory disease where monosodium urate crystals deposit in certain part of body especially joints. High consumption of shellfish, anchovies, red meat and organ meat may lead to gout. Other than that, increase production of purines in high-fructose corn syrup beverages and decrease clearance of uric acid in patient frequently dehydrate (lack of water intake) and consume alcohol. Besides, sedentary lifestyle that causes obesity and diabetis will increase the risk factor. Patient who undergo chemotheraphy and exposed to radiation are prone to gout because more cell die than at normal rate during procedure thus more nucleic acid degenerate. Genertic predisposition, consumption of certain medications like Thiazide Diuretics and Aspirin may lead to gout as well. Last but not least, patient with chronic kidney disease unable to filter the blood carefully that might decrease excretion of uric acid from bloodstream.

          Common symptoms among patients include red hot tender and swollen known as gouty attack, red, shinky skin around the affected joint as well as feeling itchy at the spot. Area affected as we have mentioned before tend to be at first metatarsal joint of big toe which will cause ‘Podagra’. Patient wakes up feeling like toe on fire, pain most severe in hours after attack and it last days to weeks. Uric acid might also accumulate at knee, ankle, wrist and elbow. Inflammation occur as white blood cell specifically leukocyte try to eliminate the uric acid out. To diagnose and ensure it is gout, doctor will get you a blood test, physical examination and you will undergo x-ray.

          There is no specific way to treat gout but we can only manage to reduce the symptoms and flare. Firstly, treatment aim to decrease pain dan swelling. Your doctor may prescribe non-steroidal anti-inflammatory drug (NSAIDS) like Ibuprofen and Naproxen Sodium. Colchicine drug also helps to reduce white blood cell migration. Other than that, patient able to prevent future flares by doing diet and llifestyle modification. Patient should be well hydrated, avoid alcohol, red meat and seafood as well as stay active to avoid obesity. Alternative treatment is to decrease uric acid levels by taking Xanthine Oxidase under prescription to inhibit covertion of purine to uric acid. Uricosuric medication helps to increase excertion of uric acid to be eliminated from body system.

          If not treated immediately, repeated gout attacks may lead to chronic gout known as ‘Trophi’ (permanent deposit of urate crystals). It also may lead to chronic arthritis, tissue destruction and increase risk of kidney stones (made of uric acid) and urinate nephropathy (crystals in kidney interstitium).