Looking at this causation of arthritis we can see that there must be two chief forms in which it will be met with; one of acute arthritis, in which the uric acid is driven quickly out of the blood into numerous joints, and a more or less decided rise of temperature results, partly owing to the complete clearance of uric acid from the blood and consequent rapid combustion, and partly also to the local irritation in numerous parts of the body.
This is known as acute arthritis, and in certain conditions has been called acute rheumatism, and in certain other conditions acute gout.
I have long preferred merely to call it acute arthritis due to uric acid.
Here we have an acute trouble corresponding with very marked signs of the absence of uric acid from the blood, and the treatment which will relieve this condition is to bring the uric acid back into the blood as quickly as possible by means of solvents.
There is thus a law that all local precipitation diseases are relieved by solvents, and that all collaemic diseases are relieved by precipitants; in other words, by those things which clear the uric acid out of the blood and drive it into the fibrous tissues ; these being but two sides of the same process.
But there is a second form of arthritis associated with different conditions. The capillary reflux is not quick; it may even be decidedly slow, and there are marked signs of debility and anaemia; these demonstrating the presence of more or less chronic excess of uric acid in the blood.
The uric acid troubles in the fibrous tissues of the heart commonly called endocarditis and pericarditis and ascribed to the unknown factor rheumatism, have really an identical causation with the uric acid irritation in the fibrous tissues of the joints which we have just been considering.
Excess of uric acid in the blood causes, as we have seen, a very considerable addition to the labors of the heart in driving the blood forward through the capillaries into the veins.
When, under this increased strain, the fibrous tissues in the valves of the heart become seats of diminished alkalinity, uric acid is precipitated into them in exactly the same way as into the fibrous tissues of the joints, and this is the reason why joint troubles and heart troubles are so very commonly met with together.
In the valves of the heart also we get first a small irritation, then a small precipitation of urate, and in succession a further extent of irritation and a further precipitation of urate, till a comparatively large tract on the surface of any valve is involved in the urate irritation.
This, I may mention in passing, practically always affects the valves of the heart which are most exposed to pressure and strain, just as outside the heart uric acid is always precipitated on all those joint structures most in use or most subject at the particular time to pressure, injury, or strain.
Once a lesion has been produced on the valves of the heart, this lesion, like that in any of the joints, may act as a uric acid filter, attracting more and more uric acid to itself for days, weeks, months and even years. People are much too apt to imagine that an attack of endocarditis having once originated and been treated by solvents is over and done with for ever.
This is very rarely the case, for if solvents are not given for a sufficient length of time to extract all the uric acid from the damaged tissue, further quantities of uric acid are certain to find their way there, with the hourly and daily fluctuations in the amount of uric acid and its solubility in the blood and tissue fluids.
In this way it comes about that what was at first a microscopic nodule of irritation on a valve, becomes gradually a widespread roughened surface with more or less hypertrophy of the fibrous tissues, and this irritation continued and kept up for weeks, months and years, eventually ends in a contracted or even calcareous mass of fibrous tissue, such as we find in the last stage of what is known as the ” button-hole mitral valve.”
What we learn from this natural history of endocarditis is, I think, that the only safety from its continued progression lies in the complete removal of the original focus of uric acid precipitation, and in the careful guarding of that focus from further precipitation in the future by means of solvents and the diet which excludes excess of uric acid from the body.
{ 1 comment… read it below or add one }
i have also a high uric acid and theres a time that always attack, sometimes it attack once a week my gout ,so i treat my gout thru cleaning diet by eating fruits n drink a lot of water and milk just one week i a month.
{ 1 trackback }