Topic:GOUTY Topic: GOUTY ARTHRITIS Allotment: otment: 30 - 45 minutes Time All
Date: Da te: August 15, 2010
General Objective: At the end of 45 minutes of heal he alth th te tea aching ab about out Gouty Ar thr thr itis, the client will be itis, be abl able e to kno now w the natu tur r e, causes uses,, signs and symptoms symptoms,, and and r isk f isk acto ctor r s of the dise disea ase. Mor eover, the client will be eover, be abl able e to lear n the dise disea ase management of gouty ar thr thr itis by modifying the r itis isk f isk acto ctor r s. s.
Specific Objectives: 1. 2. 3. 4. 5.
The client will be be abl able e to define what Gout Ar thr thr itis is and f itis ami milliar ize its st ize sta ages. The client will be be abl able e to kno now w the causes uses,, signs and symptoms symptoms,, and and r isk f isk acto ctor r s of Gout Ar thr thr itis. itis. The client will be be abl able e to lear n the di dia agnosis and tr eatment of Gout. The client will be be abl able e to kno now w the foods which int intak ake e must be minimized to r educe the r educe isk of isk Gout Ar thr thr itis. itis. be abl able rbal medicine as an aid in lower The client will be e to adapt the use of herbal he medicine,, UlasimangBato, as ing the ur ing ic acid leve ic evell.
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What is gout?
Gout is a kind kind of ar thr thr itis. It can cause an atta itis. ttack of sudden bur ning ning pain, in, stiffness, stiffness , and and swelling lling in a joint joint,, usuall usually y a big big toe. These atta ttacks can happen over over and and over over unl unless gout is tr eated. Over ver time, time, they can har m your your joints joints,, tendons, tendons, and and other other tissues. Gout is most common in men.
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What causes gout?
Gout is caused by too much ur ic acid in the blood. ic blood. Most
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of the time, having too much ur ic acid is not har mful. Many people with high levels in their blood never get gout. But when ur ic acid levels in the blood ar e too high, the ur ic acid may for m har d cr ystals in your joints. Your chances of getting gout ar e higher if you ar e overweight, dr ink too much alcohol, or eat too much meat and fish that ar e high in chemicals called pur ines. Some medicines, such as water pills (diur etics), can also br ing on gout.
What is uric acid?
ic acid Ur
What are the symptoms?
The most common sign of gout is a nighttime attack of 2 mins. swelling, tender ness, r edness, and shar p pain in your big toe . You can also get gout attacks in your foot, ankle, or knees. The attacks can last a few days or many weeks befor e the pain goes away. Another attack may not happen for months or year s.
is a waste pr oduct nor mally pr esent in the blood as a r esult of the br eakdown of pur ines. Excessive amounts of ur ic acid can cause cr ystals to for m in the joints and cause gout.
See your doctor even if your pain f r om gout is gone. The buildup of ur ic acid that led to your gout attack can still har m your joints. 2
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www.webmd.com
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How is gout diagnosed?
Your doctor will ask questions about your symptoms and do a physical exam. Your doctor may also take a sample of f luid f r om your joint to look for ur ic acid cr ystals. This is the best way to test for gout. Your doctor may also do a blood test to measur e the amount of ur ic acid in your blood.
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www.webmd.com
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What are the risk factors?
Gout - What Increases Your Risk
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Gout is caused by too much ur ic acid in the blood (hyper ur icemia). The following r isk f actor s can either cause hyper ur icemia or make joints mor e susceptible to the for mation of ur ic acid cr ystals: Being male Family histor y of gout Obesity Moderate, r egular, or heavy consumption of alcohol, especially beer A diet r ich in meat and seafood, which can be high in pur ines Use of medicines that r emove salt and water f ro m the body (diur etics) Regular use of aspir in (mor e than 1 or 2 aspir in tablets a day) Fr equent episodes of dehydration Acute illness or infection Lead exposur e (may occur thr ough work, diet, or 3
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hobbies) Ver y low-calor ie diets Injur y to a joint Gout and other conditions Cer tain other conditions and diseases appear mor e often in people who have gout than in people who don't, though studies have not shown a clear r actor elationship. It is thought that gout shar es r isk f s (such as obesity, hyper tension, and high levels of tr iglycer ides) with cer tain diseases, including: Diabetes. Kidney (r enal) disease. Har dening of the ar ter ies (ather oscler osis). Hear t disease.
What are the different stages of gout?
Gout usually develops after a number of year s of buildup of ur ic acid cr ystals in the joints and surr ounding tissues. A gout attack usually star ts dur ing the night with moderate pain that gr ows wor se. A gout attack typically causes pain, swelling, r edness, and war mth (inf lammation) in a single joint, most often the big toe (this symptom is called podagra), followed by
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the eventual disappearance of all symptoms. Mild attacks may stop after several hour s or last for 1 to 2 days. These attacks ar e often misdiagnosed as "tendinitis" or "sprain" even though ther e was no trauma or over use. Sever e attacks may last up to several weeks, with sor eness lasting for up to 1 month. Most people have a second attack of gout within 6 months to 2 year s after their fir st attack but ther e may be inter vals of many year s between attacks. If untr eated, the f r equency of attacks usually incr eases with time. Ther e ar e four stages of gout.2 First
stage: High blood uric levels
The ur ic acid level in the blood may be higher than nor mal, but ther e ar e no symptoms of gout. High ur ic acid in the blood (hyper ur icemia) may never pr ogr ess beyond this stage, and symptoms of gout may never develop. Some people may have kidney stones befor e having their fir st attack of gout. Second stage: Acute gout arthritis
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ic acid Ur
cr ystals begin to for m in the joint f luid, usually in one joint-most commonly the big toe-and the body often r esponds with a sudden inf lammator y r eaction: a gout attack. Although the big toe is the most common site for a gout attack, gout may develop in other joints, including the knee, ankle, and joints in the foot, wr ist, and finger s. After the gout attack is over, the affected joint and surr ounding tissues feel nor mal within days until the next attack, which often occur s within 2 year s. Third stage: Interval gout If you have pr eviously had an attack of gout, you will ver y likely have another . In this type of gout, you have no symptoms for a per iod of time between acute attacks. In many people this per iod becomes pr ogr essively shor ter as attacks occur mor e often. Later attacks may be mor e sever e, last longer, and involve mor e than one joint. Fourth
stage: Chronic tophaceous gout
If gout symptoms have occurr ed off and on without tr eatment for several year s, they may become ongoing (chr onic) and f r equently affect mor e than one joint. Ther e may no longer be per iods of time between 6
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attacks. This stage of gout is f r equently confused with other for ms of ar thr itis, most commonly osteoar thr itis. By this time, enough ur ic acid cr ystals have accumulated in the body to for m gr itty nodules called tophi. When located just under the sur fa ce of the skin, these deposits ar e usually fir m and movable. The overlying skin may be thin and r ed. Tophi that ar e ver y near the skin may appear cr eam-color ed or yellow. At fir st, tophi ar e usually found on or near the elbow, over the finger s and toes, or on the outer edge of the ear . If the condition pr ogr esses without tr eatment, tophi may for m in the car tilage of the exter nal ear or the tissues ar ound the joint (bur sae, ligaments, and tendons), r esulting in pain, swelling, r edness, and war mth (inf lammation). Pr ogr essive cr ippling and destr uction of car tilage and bone is possible. This stage of gout is uncommon because of advances in the early tr eatment of gout. How is it treated?
5 mins. To stop a gout attack, your doctor can give you a shot of cor ticoster oids, or pr escr ibe a lar ge daily dose of one or mor e medicines. The doses will get smaller as your symptoms go away. Relief f r om a gout attack often begins within 24 hour s if you star t tr eatment r ight away. To ease the pain dur ing a gout attack, r est the joint that hur ts. Taking ibupr ofen or another anti-inf lammator y 7
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medicine can also help you feel better . But don't take aspir in. It can make gout wor se by raising the ur ic acid level in the blood. To pr event futur e attacks, your doctor can pr escr ibe a medicine to r educe ur ic acid buildup in your blood. If your doctor pr escr ibes medicine to lower your ur ic acid levels, be sur e to take it as dir ected. Most people continue to take this medicine for the r est of their lives. Paying attention to what you eat may help you manage your gout. Eat moderate amounts of a healthy mix of foods to contr ol your weight and get the nutr ients you need. Avoid r egular daily intake of meat, seafood, and alcohol (especially beer ). Dr ink plenty of water and other f luids.
What are the disease management methods for gout?
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Gout - Home Treatment Decr ease the pain of an acute attack. Rest the affected joint until the attack eases and for 24 hour s after the attack. Elevate painful joints. Relieve inf lammation by taking nonster oidal anti8
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inf lammator y dr ugs (NSAIDs). Do not take aspir in, which may abr uptly change ur ic acid levels and may make symptoms wor se. Pr event r ecurr ences. Contr ol your weight. Being overweight is a r isk f actor for gout. If you ar e overweight, a diet that is low in f at may help you lose weight. But avoid f asting or ver y low-calor ie diets. Ver y low-calor ie diets incr ease the amount of ur ic acid pr oduced by the body and may br ing on a gout attack. For mor e infor mation, see the topic Weight Management. Limit alcohol, especially beer . Alcohol can r educe the r elease of ur ic acid by the kidneys into your ur ine, causing an incr ease of ur ic acid in your body. Beer, which is r ich in pur ines, appear s to be wor se than some other beverages that contain alcohol.1 Limit meat and seafood. Diets high in meat and seafood (high-pur ine foods) can raise ur ic acid levels. Talk to your doctor about medicines you take. Cer tain medicines that ar e given for other conditions r educe the amount of ur ic acid eliminated by the kidneys. These include pills that r educe the amount of salt and water in the body (diur etics, or "water pills") and niacin. Regular use of low-dose aspir in may raise the ur ic acid level. Since low-dose aspir in may be impor tant for thepr evention of str oke or hear t attack, your doctor may want you to continue to take low-dose aspir in. 9
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Modify your r isk f actor s. Keep your weight within the nor mal range for your height. Follow a moderate exer cise pr ogram. Avoid a diet r ich in meat and seafood. Making changes in your diet may help with your gout. Have an evaluation for lead poisoning if you have been exposed to lead in your job or thr ough hobbies. Continue to take the medicines pr escr ibed to you for gout. But if you have not been taking medicines that lower ur ic acid (such as pr obenecid or allopur inol) pr ior to the attack, do not begin taking it when the attack begins. These medicines will not help r elieve acute pain and may actually make it wor se. In the past, gout was thought to be due to dr inking too much alcohol and eating too many r ich foods. Although eating cer tain foods and dr inking alcohol may tr igger a r ise in the level of ur ic acid in the body, these habits may not by themselves cause gout. Gout is most often caused by an over pr oduction of ur ic acid (due tometabolism pr oblems) or decr eased elimination of ur ic acid by the kidneys.
What are the foods to avoid and foods that are safe to eat?
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Diet and gout
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Pur ines (specific chemical compounds found in some foods) ar e br oken down into ur ic acid. A diet r ich in pur ines f r om cer tain sour ces can raise ur ic acid levels in the body, which sometimes leads to gout. Meat and seafoodmay incr ease your r isk of gout, while dair y pr oducts may lower your r isk. One study found that pur ines in vegetables do not incr ease the r isk of gout.1 Foods
to limit (very high in purines):
Or gan meats, such as liver, kidneys, sweetbr eads, and brains Meats, including bacon, beef , pork, and lamb Game meats Any other meats in lar ge amounts Anchovies, sar dines, herr ing, macker el, and scallops Gravy Beer
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to eat occasionally (moderately high in purines, but may not raise your risk of gout): Fish and seafood (other than high pur ine seafood) Oatmeal, wheat bran, and wheat ger m Foods
that are safe to eat (low in purines):
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Gr een vegetables and tomatoes Fr uits and f r uit juices Br eads and cer eals that ar e not whole-grain Butter, butter milk, cheese, and eggs Chocolate and cocoa Coffee, tea, and carbonated beverages Peanut butter and nuts Dairy products that may lower your risk of gout: Low-f at or nonf at milk Low-f at yogur t
How does Ulasimangbato (Sinaw-sinaw) help?
If you have exper ienced a gout attack or have high ur ic acid in your blood (hyper ur icemia), it may help to r educe your intake of meat and seafood, as well as alcohol.1, 2 Changing your diet may help lower your r isk of having futur e attacks of gout. Doctor s r ecommend that overweight people who have gout r each and stay at a healthy body weight thr ough moderate daily exer cise and r egulation of their f at and calor ic intake. Ulasimang- bato (Peper oniaPellucida) y
A weed, with hear t-shaped leaves also known as "pansit-pansitan", gr ows in shady par ts of the gar den and yar d. It is effective in fighting ar thr itis and gout. The leaves can be eaten f r esh (about 12
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a cupful) as salad or like tea. Parts utilized:
y
leaves
Use: y
Lower s ur ic acid. (Rheumatism and gout)
Preparation:
y
y
Wash leaves well. One and a half cup leaves ar e boiled in two glassfuls of water over lower fir e. Do not cover pot. Cool and strain. Divide into thr ee par ts and dr ink each par t thr ee times a day after meals. May also be eaten as salad. Wash the leaves well. Pr epar e one and a half cups of leaves. Divide into 3 par ts and take as salad thr ee times a day.
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