Gout is a disease hallmarked by elevated levels of uric acid in the bloodstream. In this condition, crystals of monosodium urate (MSU) or uric acid are deposited on the articular cartilage of joints, tendons, and surrounding tissues. It is marked by transient painful attacks of acute arthritis initiated by crystallization of urates within and about the joints and can eventually lead to chronic gouty arthritis and the deposition of masses of urates in joints and other sites. The disease has a preference for the big toe of middle-aged men - it swells, turns red and becomes sore. The soreness is such that just walking through a room can cause severe pain.

Historically, it was known as "The Disease of Kings" or "Rich man's disease". Gout is characterized by excruciating, sudden, unexpected, burning pain, as well as swelling, redness, warmth, and stiffness in the affected foot. This occurs most commonly in men's toes but can appear in other parts of the body and affect women as well. Among some of these patients, the concentration in the blood is so high that the uric acid 'overflows' and settles in the joints and possibly in the skin. Low-grade fever may also be present. The patient usually suffers from two sources of pain. The crystals inside the joint cause intense pain whenever the affected area is moved. The inflammation of the tissues around the joint also causes the skin to be swollen, tender and sore if it is even slightly touched. For example, a blanket or even the lightest sheet draped over the affected area can cause extreme pain.

The are two kinds of gout.

Primary hyperuricaemia. Hyperuricaemia means an increased level of uric acid in the blood. It is usually caused by an hereditary abnormality in the system that changes the nucleic acid into uric acid. In this case the body is incapable of excreting uric acid fast enough even during normal circumstances.

Secondary hyperuricaemia. Is caused by another disease or because of consumption of certain medicines (eg diuretic preparations, which increase the output of urine, and acetylsalicylic acid derivatives including aspirin). In these cases, the problem is that the body produces such large quantities of uric acid that the kidneys cannot keep up.

Prior to the onset of symptoms of gout, there is usually a latent period of several years in which the concentration of uric acid in the blood has gradually increased. This condition is called asymptomatic hyperuricaemia. Some 95 per cent of the people with this condition never develop gout. The first gout attack is often at night. Typically, the afflicted person wakes up in the middle of the night with extreme pain near the joint of the big toe (if the pain is in the knee it is called gonagra). The joint is swollen and may turn a shining purple.

Gout usually attacks the big toe (approximately 75 percent of first attacks); however, it also can affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, or spine. In some cases, the condition may appear in the joints of small toes that have become immobile due to impact injury earlier in life; the resulting poor blood circulation can lead to gout.

Patients with long-standing hyperuricemia can have uric acid crystal deposits called tophi (singular: tophus) in other tissues such as the helix of the ear. Elevated levels of uric acid in the urine can lead to uric-acid crystals precipitating in the kidneys or bladder, forming uric-acid kidney stones.

Gout attacks are brought on by several factors including:

• overconsumption of alcohol, especially beer.
• some foods with a high content of protein and purines, such as liver, kidneys, sardines, and anchovies.
• being overweight.
• haemorrhages in the gastrointestinal canal.
• bodily trauma with extensive tissue destruction.
• major surgery.
• conditions in which there is a high rate of cell turnover, eg leukaemia, lymphoma, psoriasis.

Essential oils can be used in a variety of ways to achieve these results. Detoxifying oils, such as Cypress, Fennel, Juniper and Lemon are used in baths and massage to help the body throw off poisons. Painkilling oils, such as Benzoin, Camomile, Lavender and Rosemary are used in baths, local massage or compresses on the affected joints, and local circulation can be improved by the use of rubefacient oils - Black Pepper, Ginger and Marjoram, for example.

Whenever heat is applied to a painful, stiffened joint in the form of baths, hot compresses or warming massage, it is very important to move the joint as much as possible immediately afterwards, otherwise the heating can cause congestion which will make the condition worse rather than better. Any of these forms of treatment will reduce pain in the joint and make some movement possible. If very little unaided movement is possible, the therapist should gently manipulate the joint through as wide a range of movement as possible at the end of the massage. Gentle exercise is very helpful, yoga undoubtedly being the most valuable.

Aromatherapy treatment will include cold compresses, massage and dietary advice, and follows the same lines as that outlined under ARTHRITIS, since gout is basically a form of extremely acute localised arthritis.

See also Arthritis and Joint Pain Relief.