@(What is gout?)

The Korean word for gout is tongpoong. Tong stands for pain and poong means wind. It is said that gout inherited this name because patients experienced pain from vibration caused by even the slightest of breezes. Another theory explaining the origins of the word says that gout was named after this word because the pain induced by gout occurred suddenly and disappeared just as fast. Much like the wind.
Gout can be considered a form of arthritis caused by the deposition of urin-acid in the joints that is the source of pain. The majority of gout patients are male with females consisting of only 2% of the entire number of patients. Therefore, it can be said that gout is a 'man's disease'. This could explain why cases of gout are frequent in people who drink often, favor consumption of meat, and are obese. People who take a certain type of medication for treating hypertension are also at a high risk of developing gout. And because physical constitution, or hereditary factors influence the development of gout, there are cases where the illness strikes more than one family member. In other words, gout is caused by a combination of environmental and hereditary factors.
<--The knee joint featured in the photo, was taken from a patient who had gout. The deposition of urin-acid in the knee joint almost resembles plaster.

@Why does uric-acid form?
Gout can be defined as a disease that causes arthritis due to a rise in the level of urin-acid within the body. Consequently, it can be said that the presence of gout is directly related to hyperurinemia. Hyperurinemia is a state where the level of urin-acid within the blood is exceedingly high. Urin-acid is the result of purinolysis. Purin is a component of DNA, which is visible in the nucleus and chromosome of an animal cell. ¨çDuring the destruction of a cell, purine is formed from the DNA and is eventually becomes urin-acid.

¨èAlso, when consumed meat is being digested in the intestines, urin-acid is also generated. This urin-acid is then excreted through movement of the kidneys. However, because the kidneys can only excrete a limited amount of urin-acid at a time, urin-acid easily accumulates within the body. Also, while the majority of mammals possess an enzyme that breaks down urin-acid and enables them to avoid the urin-acid from accumulating, humans and anthropoids do not possess this enzyme, and that is why they suffer from gout. There is about 1200mg of urin-acid in a healthy adult and of this amount, 700mg is changed and refilled daily. Of this total amount, urin-acid gained from food consumption accounts for only one seventh while the remaining six sevenths undergo synthesis within the body. Therefore, this might explain why in recent times, eating habits have not been strictly adhered. Next we will consider the excretion of urin-acid. 75 percent of urin-acid is excreted via the kidneys in the form of urine. The remaining 25 percent becomes combined with digestive acids such as bile and undergoes the same excretion process in the intestines. Here, we can witness the importance of the kidneys when excreting urin-acid.

The mechanism for hyperurinemia can determine whether purine or purin-acid is abundant within the body, purine from consumed foods is abundant or whether excretion of urin-acid is diminishing in the kidneys. is abundant. The total amount of urin-acid within the body and the level urin-acid in the blood cells change according to these 3 factors. This is called a urin-acid pool. Hyperurinemia and gout is caused when 1 or more of these factors reoccurs and becomes persistent. Since urin-acid doesn't dissolve very quickly when inside the body tissue, if the urin-acid level within the body increases, there is bound to crystallization of urin sodium in the form of needles around areas in the hands and feet. This is why arthritis occurs.

¢º internal synthesis
¢º urin-acid readings
¢º urin-acid pool within water
¢º feces
¢º urine

@Why do gout spasms occurs?

If the urin-acid level within the blood and tissue is 1.0mg/dl above the natural limit, crystallization has a good chance of occurring within tissue and joints. Crystals made from urin-acid are a needlized form of urin salt. These crystals are responsible for causing infections because they produce chemical agents. Also, because urin salt crystals are considered to be invading matter, they become consumed by white blood cells. This process is called probing. This situation can be compared to when the white blood cells attack invading foreign matter such as germs and eliminate them from our body system. When white blood cells combat these foreign substances, our body experiences rashes, fever, swelling and pain. Although an exact explanation has yet to be found, the hostile reaction of white blood cells and body tissue towards urin-acid crystals can be defined as the main cause of gouty arthritis.

About 70% of all gout related pain spasms occur in the girdle bones of the toes. Besides this area, gouty arthritis occurs in the ankles, knees, fingers, elbows and wrists. Usually, pain symptoms start to begin in the nighttime at either one of the paired areas. It is extremely rare for multiple joints to be affected simultaneously. Arthritis usually affects a single joint at about 80% of the time. The chances for arthritis to occur in both paired joints or multiple locations are only 10-20%. However, if left untreated for long periods of time, the number of joints and the affected scope of swelling will increase. If a gout attack occurs, within hours, the affected area becomes reddish accompanied by swelling, and by the next morning, it becomes difficult to walk because of the pain. Because infections occur in the joints, they begin to fill with fluid and the area of infection will spread to other adjacent locations. This situation can be compared to when an infection occurs due to pyogenic bacteria. Skin in the infected areas will become reddish and begin to swell. If left untreated, the pain will reside after about a week and the swollen skin will become wrinkled and the skin color turns into reddish black with slight pigmentary deposits. After the surface of the skin peels away, all symptoms seem to disappear. However, we must not be fooled into believing that the disease has left the body just because the pain no longer exists.

<Pre-gout attack period >
Once you experience a spasm, in the hours or sometimes a day leading up to the actual gout attack, you will sometimes experience uneasiness, dull pain, heaviness, and a slight burning sensation in the gout affected areas. This is called the pre-gout attack period. If, during this period, symptoms are left untreated, you will most likely experience a gout attack. There are also symptoms of slight loss of appetite, vomitting, and hardening of the affected area. Pain might occur in large joints such as the knee and not the toes. In the case of young persons, symptoms might be accompanied by a slight fever throughout the body. The majority of gout patients are said to have experienced this pre-gout attack period. We must pay attention to the warning signs because timely treatment can either prevent the onset of gout or shorten the healing process. (Western medicine uses a drug called coliteen to suppress spasms or minimize the affects of spasms. However, this method is only a temporary remedy because all it does is numb the pain)

<Development of gout>
After experiencing the first spasm, it takes an average of 12 years for full blown gout to appear. Generally, people who have experienced spasm when young and who also have strong hereditary links to the disease are more prone to have high levels of urin-acid within the blood cells and progress of the disease is quicker. Also, during this period, urin-acid crystals will deposit at not only the joints, but also the heart, brain, skin, and kidneys with tohpus appearing in the earlobes. As deterioration of the bones and joints progresses, joints will become deformed or dislocated and you will experience a deterioration in function which will ultimately affect your everyday life. You can verify this by taking an X-ray. The bones will appear to have been scratched by a mouse and if the disease progresses, the entire bone will dissolve. Urin-acid also deposits in the kidneys, thereby causing kidney difficulties. And in the terminal stages, patients may succumb to uremia.

@What is tophus?
Tophus is defined as urate calculus that has deposited in areas around the cartilage, joints, and in muscle and subcutaneous tissue. It can easily form in small areas throughout the bloodstream and usually can be seen in the earlobes. It can also form around the toe joints, elbows, fingers, and ankles. By conducting a vivisection, we can also observe its presence in the kidneys. Tophus consists of a white matter that is similar to thick liquid and if allowed to grow, will penetrate the skin.
Also, uremic gout patients are 10-30% more likely to develop kidney stones.
And 20% of gout patients first experienced pain related to kidney stones than did experience pain from gout itself.
Gouty kidneys are state where the function of the kidneys is limited due to the deposition of urin-acid in the kidneys. Since patients with this condition (uremia) have trouble secreting waste matter from within their body, the body becomes intoxicated with harmful matter. Upon developing uremia, the amount of secreted urine reduces and the face turns to blackish blue. The body also feels weak accompanied by swelling. The eyelids also become swollen and the skin area around the shin becomes soft.
Finally, if you experience gout, you may develop other complications such as high blood pressure, diabetes, hyperlipidemia, myocardial infarctionk, cerebral ischemia, because sugar and fat metabolism are negatively affected.

@Dietary recommendations for gout patients
Western medicine teaches patients to practice abstinence and refrain from consuming alcohol, beef and fish, however, this method is not very helpful in both preventing and treating gout. The following is an example of foods that should be avoided.
It is important to note that whatever the disease, you need to consume a wide variety of foods to maintain the basic physical stamina necessary for fighting the disease. Immoderate dieting can actually be harmful so you must pay attention.
<Foods that are taboo>
Alcohol (especially beer), pork, flour based foods, barley, red bean, buckwheat (noodles), mung bean, brown rice, blowfish, carp, gible, strawberries, grapes, cabbage, lettuce, kiwi, parsely, cucumber, sea cucumber, sea squirt, oysters, abalone, crabmeat, shellfish, shrimp, clams, turtles,
What about exercise?
The majority of gout patients tend to believe that if physical stress is placed on the joints, gout spasms will reoccur. Contrary to this belief, moderate exercise conducted regularly can actually help prevent gout. Exercise helps prevent urin-acid from depositing in the joints, and also because metabolism is enhanced, it will increase the outflow of waste matter from within the body. Therefore, selecting an exercise that can be conducted continuously such as swimming, jogging, hiking and bicycle riding and for everyday workouts can be a good way to not only prevent gout but also maintain health.