Gout

Question 1

Gout

Answer 1

Arthritis due to deposition of monosodium urate (MSU)
crystals within joints causing acute inflammation.

Question 2

Gout: Signs and symptoms

Answer 2

• Monoarticular arthritis most commonly affecting the big toe
• Most often affecting men.
• Pain, swelling, redness and heat. Shiny skin.
• Can affect other joints (e.g., knee).
• Reaches its peak within 24 hours, often with fever and malaise.

Question 3

Gout: Pathophysiology

Answer 3

• Hyperuricaemia is the key risk factor for gout and is a
  prerequisite for MSU crystal formation. Uric acid is the final breakdown product of purine metabolism
• Interleukin 1β is the key cytokine mediating inflammation in gout.

Question 4

Gout: Purines

Answer 4

• Purines are part of the chemical structure of DNA and RNA found in all of the body’s cells, and in virtually all foods.
• When cells die, the purines in the DNA and RNA are released and recycled. Metabolism of foods release purines.

Question 5

Gout: Co-morbities

Answer 5

• Hyperuricaemia: Increases NF k β , disrupts eNOS activity, shows pro oxidant effects, increases RAAS activity.
• Linked to hypertension, CVD, T2DM and kidney disease.

Question 6

Gout: Causes and risk factors

Answer 6

Uric acid overproduction
* Dietary purines
* High cell turnover disorders e.g., leukaemia, haemolytic anaemias , psoriasis
* Chemotherapy ― increased cell death.
* Fructose
* Medication side effects ― increase urate renal retention.
* Renal insufficiency (CKD) ― impairs uric acid
* Alcohol (e.g., beer)
* Genetics
* Obesity and insulin resistance (IR)
* Dehydration.

Question 7

Gout: Natural approach

Answer 7

CNM Naturopathic Diet with a focus on reducing uric acid levels:
* Avoid / minimise : Alcohol, fructose, pro-inflammatory foods
* Low purine diet
* Address specific causes, e.g., IR, obesity
* Optimise omega 3:6 ratio
* Minimum of 2L of water
* Moderate protein

Question 8

Gout: Supplements

Answer 8

Quercetin
EPA
Methylfolate
Tart cherry
Celery
Nettle

Question 9

Gout: Quercetin

Answer 9

Dose: 200 - 400 3x/day

XO inhibition
Anti-inflammatory
Antioxidant

Question 10

Gout: EPA

Answer 10

Dose: 3g/day

XO inhibition
Anti-inflammatory
Increases renal urate excretion

Question 11

Gout: Tart cherry

Answer 11

Polyphenols
Inhibiting COX, NFkB
Reduces uric acid
XO inhibition

Question 12

Gout: Methyl folate

Answer 12

XO inhibition

Question 13

Gout: Celery

Answer 13

XO inhibition

Question 14

Gout: Nettle

Answer 14

Dieretic
Increases urinary excretion of uric acid