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Arthritis Diet and Exercises

¿Qué es la Gota?


What is gout? Hello, welcome back Today we’re going to talk about one of humanity’s old diseases, which is gout The so-called ‘Disease of Kings’ Why is it called that way? Because one of the risks involves eating food from other animals For instance, red meat, viscera, etc And alcohol, specifically wine and beer So in those times, only the wealthy could buy those things and hence, get gout Besides, the noble had different mutations or diseases that made them prone to developing gout And we all know that the noble were always inbreeding, so suddenly all members of nobility had gout That’s why it’s known as the Disease of Kings That’s also why I decided to do this video in purple, since it’s the color of royalty This is because since the Phoenicians, there was a city called Tiria And there were some molluscs which produced purple ink, and couldn’t be found elsewhere And with this ink people could color clothes and fancy stuff It was so expensive, that only rich people were able to buy it and things coloured purple Around 9 thousand molluscs were needed to produce 1 gram of ink So I hope you enjoy this video, with the Disease of Kings and the ‘King Color’, and that you understand everything Let’s study, then, the Disease of Kings… Gout. This old disease, which has been known for long, is the main reason why articulations get ill Crystals are induced, and make those particular articulations swell There are two main types, which we have to identify One where the clustered crystal is going to be called Monosodium Urate And if we’re talking about this, then it’s going to be called Gout This Monosodium Urate is going to be very similar to Uric Acid However, if the cluster is not composed by Monosodium Urate but by Calcium Pyrophosphate Then we will call it Pseudogout or Calcium Pyrophosphate Deposition Disease (CPPD) Of course, these two are going to have different origins Monosodium Urate is going to come from purines Whereas Calcium Pyrophosphate is going to be common among people who can’t Control the amount of calcium they have in their blood, for different hormonal problems How important is Gout? It’s the main articulation disease induced by crystals, it causes a lot of pain to many people In the USA there are roughly 8.9 million people who have gout Around the world, it is estimated that 9 to 14 out 1000 people have gout The ones among it is most common are the elder people How old? After around 45 years of age, gout becomes more and more common What causes it? It’s something related to purines What are purines? If you recall some of your biology classes, purines are substances which make up our DNA Our whole DNA is made up by these purines, mainly Adenine and Guanine Though not exclusively Whether these purines are metabolised because our cells die, or because they’re old… or because they produce these substances They have to be metabolised, and they produce something called Uric Acid Let’s take Adenosine, for instance Our cell dies, and our DNA is left there and we don’t use it anymore So our Adenosine is metabolised into Inosine, another substance, which is turned into Xanthine And there comes the first important enzyme, which is Xanthine Oxidase that turns it into Uric Acid at last So who is responsible for the formation of Uric Acid? Primarily, Xanthine Oxidase Once we have Uric Acid, the body can choose to do two things with it One, recycle it. Because the body loves recycling things in case we need them Soon we’ll see how it can be recycled Or two, excrete it Which means that it goes to the kidneys to be eliminated through urine So who is going to be in charge of recycling it? The Organic Anion Transporter, which is located in the kidneys It takes the Uric Acid which was supposed to be eliminated through urine… And it takes it back into the blood so that all that nitrogen isn’t lost, since it’s so valuable for the body So Xanthine Oxidase produces it, and the Organic Anion Transporter recycles it Which generates a renal excretion Which substances have many purines and make our body produce a lot of uric acid? The things that have the most are red meat, viscera, bacon, meat in general, anchovies, sardines and beer As you can see, all of the above have tons of DNA since they come from animals It has DNA from the mitochondrion, the nucleus, etc Which means that it contains all of the animal’s genetic information and when we eat it, we metabolise it… Becoming uric acid And about the beer, sadly, it’s also the thing we can get lots of purines like Adenine and Guanine from Somewhere in the middle are fish and whole grains, which also have either animal or plant DNA So they have a moderate concentration of purines These can be eaten by a person who has gout, but he/she must be careful These have to be mostly avoided, especially when the patient has gout And lastly, these are things which have very little uric acid, although it’s still present Vegetables, fruits, butter, eggs, cheese, chocolate, coffee and nuts Most of these have very little DNA. Hence, they contain less purines, and make us produce less uric acid So once we have eaten our juicy meat, our system begins to turn it into uric acid in our blood What happens here? It’s ‘already in our blood’, but that isn’t specific enough The blood in our belly, isn’t the same as the one in our hands or our feet And it’s going to vary in two particular situations The first one being temperature Central temperature, the one closer to the heart, is warmer since it’s protected by muscles, fat, etc. Let’s suppose it’s 38ºC Which isn’t fever But it is a little hotter than the rest of the body Besides, our central temperature is filled with oxygen, nutrients… And so our PH or how acid we are inside, is going to be high (or not so acid) Let’s suppose it’s 7.4 For instance Here we aren’t acid and we are quite warm So when the uric acid is here, nothing happens and it’s all right However, if we go to our hands or feet, we are not as warm as here Let’s suppose that our feet are 36.7ºC We are colder, maybe because it’s windy down there, or because we aren’t wearing socks… We don’t have as much muscle or fat, etc. So it’s colder And because it’s further, much of the oxygen has already been used up, many ‘dirty’ products have gathered, etc. Well, not dirty Thus, our PH is more acid Our periferia is always more acid than the center of the body Let’s suppose our PH is 7.27 Of course this varies from person to person Why is this important? Because there are two ways uric acid can manifest It can be liquid, when it’s in the body’s center Or it can be less soluble in our periferia This is similar to when we’re drinking a cup of coffee, and said coffee is really hot Since it’s very hot, we add a lot of sugar so that it becomes sweeter What happens if we add too much sugar? It becomes supersaturated So this sugar starts to accumulate, and to concentrate at the bottom part of the cup This is what we call a supersaturated coffee, because it can’t be dissolved anymore No matter how hard we try to mix it, it will still remain at the bottom What can I do about it? I can heat up the coffee By making it hotter, its dissolving capacity increases as well, so I can make at least part of this sugar dissolve So that it no longer stays at the bottom However, if it cooled down, more sugar would stay at the bottom It’s the same with the body. The center is hotter and is able to dissolve more uric acid But when we go to the periferia, and both our temperature and PH are lower… then uric acid starts to precipitate just like our coffee mug And gets stuck there So we were saying it can be liquid or not This is going to be for supersaturated substances In other words, when water is no longer capable of dissolving a substance In the body’s case, it’s going to be more or less in 6 mg/dl, but let’s say it’s 9 mg/dl When a person gets to 9 mg/dl it’s because his/her blood is filled with uric acid Just like the coffee mug, it’s beginning to precipitate Not in the center, but in the periferia If I have 9 mg/dl in my blood, and everywhere else I have 7 mg/dl, then uric acid is going to get out of my blood And into every other place, which could be the articulations in my feet And so on Once the uric acid is in my articulation, it’s going to start producing crystals These crystals are indissoluble And it begins precipitating. All of the molecules start to come together and mix Because they can no longer dissolve in water They form a kind of lump When we have these crystals free, these gather and start to accumulate in certain parts of our articulations If an enormous amount is gathered, we are going to call this uric acid rock ‘tophus’ In this case, tophus in articulations In spite of the formation of tophi in articulations, specially little ones They can form anywhere. For instance, here we have an ear with tohpus Uric acid started accumulating, because unlike the heart, it’s more acid and colder So after it gathers, it forms these big crystals, which are tophi What are the most common places where tophi form? As we’ve already mentioned it, it’s the cold and acid places. So generally, the furthest articulations The fingers in your hands and feet, your toes and wrists, and maybe knees and elbows It’s not as common, but knees and elbows are also in It could also happen in the central articulations, but it’s rare since it’s warmer and less acid Here, I show you what this uric acid can do in articulations, which if you recall, produced crystals And these are commonly found examples These are uric acid crystals, which formed in the patient’s foot, very far from the heart What is the importance of these crystals? Out of all the forms of uric acid, these crystals are like spears, they can hurt cells a lot So when the immune system finds them, it traps them, some cells called ‘macrophages’ eat them… So it starts storing them here And it generates very important swelling responses It swells a lot This macrophage walks all around the articulation, and every time it finds a uric acid crystal… It’s going to generate a swelling response through certain substances, such as cytokines, chemokine, etc Everything that creates inflammation and pain, which we have already covered in previous classes What is the key part in all of this? It’s the free crystals that most easily create the swelling response Why doesn’t this huge tophus, filled with crystals, generate as much of a swelling response? Because ultimately, the macrophage can only make contact with the crystal on the surface And it can’t eat the whole tophus, since it’s a small cell in comparison This would be the macrophage, it can’t eat all this However, the free crystals can be detected and eaten by the macrophage, and hence… generate important swelling responses, a lot of pain, and the whole gout process So the free crystals are the main responsible ones for the pain and the attack of gout What are the risk factors? Who are most common to suffer from gout? Of course, one of the most important ones is hyperuricemia We’ve said it already, if we have too much uric acid in our blood, then it’s going to go to our articulations, ears, etc Being male is also a factor. It can also happen to women, but it’s much more common among men This is due to testosterone, an important hormone, which can cause muscles to have more exchange When we start losing testosterone, which could be because andropause is getting closer, or something else Then the DNA that is free in our blood because of all these muscles that die… Or that are exchanging DNA or other things, increases and thus, that gives you a higher risk to get gout Genetics. What does this mean? There are some families which have something wrong with their genes that metabolise purines Consequently, every member of the family has gout episodes Diet, which is very important. We’ve already talked about the kinds of food can produce it But specially alcohol, and specifically beer That delicious drink is disastrous to those who are prone to having gout The metabolic syndrome, which is a disease distinguished for obesity, hypertension… Resistance to insuline, lipid problems, etc All of that is associated to uric acid not being metabolised properly And so, we are more likely to have gout This is specially important because there are great dangers when there’s an excess of uric acid… And metabolic syndrome combined, such as diabetes or hypertension Some medicines can also cause an increase in uric acid, specially diuretics Which is bad, because they are given to people with hypertension. And could be counterproductive here Renal diseases, since without our kidneys, we can’t eliminate uric acid, it concentrates and we get gout And articulation diseases If we have artritis, and our articulation isn’t all right, whenever our uric acid increases, it can cause gout Now what is going to be present alongside gout? Having high levels of uric acid in our blood. Despite most of it being dissolved We can have crystals if we are oversaturated, in our blood, heart, etc Hence, we can activate the microphages, swelling, etc. This is going to lead to the fact that having a lot of acid Can cause strokes in the heart, brain, renal insufficiency, etc. This is why it’s so important to check your uric acid Because if it’s elevated, it can be manageable and said strokes can be preventible Considering that uric acid is another risk factor Let’s say there is someone with an articulation with all the signs of a swelling response For instance, it’s red, it hurts, it’s just one articulation. So one would think is gout Because on top of it all, he/she’s fat, drinks a lot of beer, is fond of red meat, and all of his/her family had gout How can we diagnose it? We’re going to make a puncture We are going to introduce a needle and we’re going to get some liquid out To find directly the crystals that are forming in that articulation And so we ask: ‘I’ve had another 8 gout attacks this year, do I need to get stung again?’ ‘Do I need to get stung again? Or can we just assume it’s gout?’ The answer is no. It’s always necessary to sting and get some liquid out Why is this? Because even though the patient may be having a gout attack, if we don’t examine it correctly… This articulations with tophi, crystals and uric acid, are likely to get infected… And develop something called ‘Septic Arthritis’ So if the patient has a gout episode, it hurts him and he can’t walk, etc. However, eventually, inflammation decreases and movement is recovered No problem there But if the patient was infected, whether it was because bacteria entered, because the articulation is damaged… Because the uric acid spears have harmed it, or some other reason If it’s an infection, in approximately 4 hours, the damage to the articulation is permanent Which means that in 4 hours or so, we can have an articulation that will no longer work 4 to 6 hours And in 24 to 48 hours or so, a poorly treated articular infection can cause a total loss of said articulation Which means that an articular infection caused by gout, in under 2 days can cause that articulation’s total loss It can also cause chronic pain permanently, and huge complications When just by administrating antibiotics would have improved the patient’s condition That’s why it’s crucial that a punction be taken, and that whether or not there are bacteria be determined Additional or instead of the gout attack This is very important So it doesn’t matter how many times there has been a gout attack, there should always be a punction If there’s no punction, you should ask your doctor what’s going on So what do we have to do? For those who are constantly attacked by gout, which can be very frustrating and limiting We have to take into account 3 important measures Number 1: evidently, we have to decrease hiperuricemia. Decrease the amount of uric acid in our blood So that it doesn’t accumulate in our articulations. That way it won’t create crystals or inflammatory response Number 2: ‘I tried to decrease himeruricemia, but I still got a gout attack and my foot hurts a lot’ Or the hand, elbow, whatever The doctor has to give something to the patient, for the pain to become bearable To let the patient have a relatively normal life, while he/she is enduring the gout attack And if there has already been an acute attack Number 3: Avoid future attacks Which means that we have to avoid any attacks, even if there is a change in the amount of uric acid in our blood So when do we begin decreasing uricemia or the amount of uric acid in our blood? According to some guides, we can’t diminish uric acid until there has been a first gout attack It appears that things are changing a little. It’s starting to be thought that it should be done before any attack Since it’s a brain and heart stroke risk factor But well, up until now, we do it until after there has been a first gout attack What do we hope to achieve? Once there has been an attack, we have to keep our uric acid under 6mg/dl If we are under this, the risk of an upcoming gout attack is lower, and so, the patient becomes less prone to them We have to avoid risk factors, as well Which include avoiding red meat, beer, changing drugs which can increase uric acid, etc. Doing exercise, avoiding obesity, not being resistant to insulin are also in About nutritional requirements, it’s been proved that milk and skimmed milk can decrease uric acid levels And so can Vitamin C, when consumed in high dosis We also have to avoid drugs that raise the amount of uric acid, such as diuretics used for hypertension Of course, something has to be given for hypertension, but it’s suggested that diuretics be replaced We should decrease our purine consumption, we’ve already covered what kinds of food to avoid And lastly, we have to consume drugs that will decrease our amount of uric acid or hypouricemiants Which ones are these? If you recall the way uric acid is produced, we can do 2 things We can block its production, which can be blocked by ‘Alopurinol’ Which would cut the cycle Or we can increase the renal excretion, and block this organic anion transporter, so that it can’t be recaptured So if there is a little being produced, it’s eliminated I want to add something here. Even though I’m mentioning the two drugs that can decrease the amount of uric acid Please don’t take these without medical guidance. You should always talk to your doctor before taking them Since they have important side effects. Blocking an metabolic route is no easy task Besides, taking these drugs in the wrong circumstances, can even increase the chances of having a gout attack What other drugs have been proved to be useful when diminishing the levels of uric acid? Aspirin, in low dosis, for some unknown reason makes us urinate uric acid And some drugs used for hypertension, called ARBs, such as Losartan, can also lower our uric acid levels If we give these drugs to a patient, we could unintentionally cause a gout attack Why did this happen? You may recall that if we have elevated uric acid levels in our blood, this is going to go to our articulations It creates tophi, because it was supersaturated here, and the sugar gathers at the bottom of the cup And besides, there are a few free crystals, which are going to be eaten by macrophages And they are going to generate this intense inflammatory response, which is the gout attack itself What happens, then, when I start taking drugs to decrease my uric acid levels? I don’t have 9 mg/dl anymore, but 5 mg/dl And with 5 mg/dl, the uric acid no longer goes from the blood to the articulation, but the other way around And as these free crystals go out to be eliminated by the kidney, this tophus will dissolve eventually Then, it starts to let new free crystals go. Therefore, the macrophages find these, create the swelling response And generate the gout attack So if I start taking the drugs to decrease my uric acid levels, I can have gout attacks if I’m not careful What should we do if we are having a gout attack? Firstly, we have to do something to block that pain and swelling signal The most usually diagnosed drugs for these are NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) For instance, ketorolac, diclofenac, paracetamol, indomethacin, etc. All of these can be administrated Basically, they are going to block one of the substances that macrophages produce The well-known prostaglandins, which we’ve already talked about in the inflammation video We’ve mentioned that prostaglandins cause pain and inflammation So when we block them, we are blocking one of the most important pain and inflammation conducts Why can’t we take aspirin? We’ve already mentioned it, the aspirin changes the amount of uric acid radically Hence, I favor the production of free crystals and I can worsen the attack Maybe it can hurt my patient less, because it has the anti-inflammatory effect… But if it was going to hurt only 2 days, now it’s going to hurt for a week or two Because these crystals keep being freed due to these changes in our uric acid Another choice we have are steroids. Basically, they completely block the production of… Pro-inflammatory substances by macrophages Since they inhibit, directly in the nucleus, the genes which are implicated in producing these substances They get into the DNA, and completely block the inflammation genes Thus, macrophages can’t produce any inflammatory response If I block all the swelling with steroids, how come they are not the most commonly used? The NSAIDs are the most commonly used That’s because steroids not only cause immunosuppression But they cause that no cell from the immune system works So they make the patient prone to having an infection As we’ve seen previously, steroids have many more side effects If they are consumed for a long time or in high dosis, they can produce osteoporosis, stretch marks Fat lumps, which has the shape of a full moon, etc. They can cause depression, anxiety, and even psychosis attacks So steroids can be really good, but they aren’t to be taken lightly. They can be dangerous if one’s not careful You can also take colchicine, which basically paralyses the macrophages It has some things called microtubules, which allow it to move through all the swelling Find the crystals, eat them, then produce all of the pro-inflammatory substances Colchicine blocks this tubes, paralyses the macrophage and it doesn’t let him eat the crystals So it also blocks this inflammatory response The downside is that Colchicine is highly toxic. It can produce holes in the stomach Malfunction of the bone marrow, etc. So again, none of these drugs should be taken without medical guidance And never in the event of a gout attack, should uricosurics be taken Neither substances that make us urinate uric acid, nor those that block its synthesis, such as probenecid, etc. All of those should be avoided in case of an acute attack, for the same reasons as aspirin They can worsen the attack of gout we have at the moment The colchicine blocks the tubules, paralyses the macrophage so that it can’t move or eat the crystals Now my patient or family member has come out of that acute gout attack What should I do next so that he/she doesn’t have a relapse? Because she/he’s going to have to start taking a drug to keep the uric acid in check So how can I avoid a relapse? I give him/her the same drugs given to control the attack, and an anti-inflammatory environment is created So my macrophages are going to detect the uric acid crystals, since it’s unavoidable to produce them But either they’re not going to produce prostaglandins, because we’ll give NSAIDs for up to 6 months or more They are not going to produce prostaglandins and I’m not going to suffer the whole attack Or I’m going to give Colchicine and then, the macrophages are going to be paralysed Despite the crystals being there, they aren’t going to eat them Or I’m going to give steroids, so I’m going to block and paralyse the macrophages Again, these drugs have to be given for a long time. For 6 months even From the moment we are lowering the uric acid levels, to the moment it’s below what we want Which is more or less 6 mg/dl In that moment, I can consider suspending the treatment The immune system won’t be altered with the crystals I’ll be freeing This way, I can lower the levels of uric acid relatively safely With the same drugs. However, they’re not given in the same dose as when the attack is present They are given in lower dosis to avoid side effects, and succeed in healing Lastly, I just want to point out that steroids can be drunk. For instance, a pill daily. Or if it’s a well-trained doctor, it can be injected into the articulation itself What is the advantage of this? I’m blocking only the cells of the affected articulation, not the whole body And I also avoid the side effects of the steroids. Which are osteoporosis, stretch marks, muscle loss, fat lumps Psychosis, depression, immunosuppression, etc. Which can happen if they are not administrated carefully If the patient drinks the steroids, he/she won’t necessarily have these effects, but it’s still a possibility We’ve mentioned it previously as well, but when I want to suspend the treatment, it can’t be done abruptly That is very dangerous The dose has to be reduced slowly. The process can take months So we have to be very careful if we’re giving or taking steroids, whether it’s for gout or some other disease Well, this is it. Here are some articles I used to make this class I highly recommend them, and that would be it Well this was it for the Disease of Kings: Gout I hope you understood, and that you know what to do from now on to prevent it and stop it Or what to do in the event of an attack I hope you enjoyed the video And as always, help us change the world, share the information

100 thoughts on “¿Qué es la Gota?

  1. Padezco de gota y es la mejor explicación que he tenido de mi padecimiento, excelente video. Estoy suscrito. Gracias.

  2. yo estoy seguro ke la gota ocurre cuando uno toma medicamentos farmaceuticos que venden sin recetas ejemplo limpia utera antes de un test de colon cancer

  3. cuando una persona saludable de repente sufre de sintomas de gota , es porke algun medicamento ke ingerio , le causo este problema ke dana los rinones, hay muchas prescripiones ke causan esto , hay ke tener cuidado, porke los doctores recetan y los pacientes sufren y aguantan

  4. A mi me duelen tres dedos del pie derecho aveces no tolero estar de pie sólo se me calma con cansancio gracias por esa buena enceñanza

  5. Demasiado tecnicismo bio-químico para explicar la enfermedad, si pretende estàr dirigido al gran publico es un fracaso, si lo que ha querido es llegar a estudiantes de medicina, pues puede tener sentido … NO HAY QUE HACER TAN "BIOQUÍMICA" LA EXPLICACIÓN …. ES DEMASIADO E INÚTIL … SE REQUIERE ALGO MÀS PRACTICO PARA LAS GRANDES MAYORÍAS..

  6. 11:03 El PH ES MAS ALTO NO BAJO, YA QUE EN LOS PIES ES MAS FRIO ASI QUE SUPERA EL PH DE 7 QUE ES NEUTRO ENTONCES ES ALCALINO.

  7. Doctor disculpe podría aserme el favor de que cuando tenga tiempo me dediqué 5 minutos para que me escuche me encuentro muy enferma de mis pies no encuentro la forma de mejorar ya que los doctores que me an atendido no mejoro le suplico que por favor se comunique con migo le pagare sus onorarios

  8. Yo estoy seguro que con cloruro de magnesio, se acabaran muchos males que padece la humanidad, y con el bicarbonato de sodio. A estos elementos no los promueven por qué son muy baratos, pero eficazes.

  9. Entonce!!!!! Que alimentos podemos comer para no enfermarnos 😓🤒 porque todo es malo o tiene esteroides 🤔🤔🤔🤔🤔

  10. en Guadalajara está haciendo mucho calor Yo pienso que por eso siento que traigo la gota no soy diabética ya no sé ni qué tomar

  11. además ando muy cansada tengo dolor de ciática y cadera tengo 59 años Gracias por la explicación

  12. Hola buenas tengo una pregunta mi esposo sufre de ácido úrico pero el no consume carnés rojas y no toma licor, ni cerveza pero sufre de está enfermedad, y no sufre de tensión, ni de azúcar afortunadamente no volvió a comer pescado por qué le forma tofos en codo y además la última crisis que le dio de ácido úrico le dio en hombro y le formó una pequeña protuberancia en el esternón, así actúa el ácido úrico?

  13. Hola pubñicante, me gusta el tema seguramente algo podria aprender de esta pubñicacion y otras, a proposito de otras. La manera de seguirte seria por la campanita si embargo tengi una pregunta para ti antes de proceder. Tienes una religion? y si es, Si!, cual es? Bueno me da igual de cual seas total son todos criminales pero la peor de todas es la catolica, la unica ´´religion´´ que historuicamente ha retrazado la ciencia, las demas nada!

  14. Mira, en español. Si tienes aalgun dios, no tienes ninguna posibilidad de enseñarme algo que no sepa ya!

  15. Excelente publicacion, en ningun momento se mensionan los demonios anti ciencia que serian dios, cristo y 3ra la maldita religion!

  16. Qué buena información sobre todo para prevenir y comentarlo con el doctor porque ni los doctores lo dicen y cuando les preguntó cambian O ebaden las preguntas me preguntan donde agarro ésas informaciones bien por su informacion gracias 👍.

  17. Muchas gracias por este video. Tengo 29 anos y he sufrido esta maldita enfermedad desde que tenia como 20. Y nunca hetomado pero siempre he comido frijoles y tambien carnes rojas moderadas. Pero ultimamente estoy evitando los frijoles y nada de carne roja exepto la carne de pollo. Este es un exelente video y me encanto como explicaste todo. Creo que es el mejor que he visto aqui en youtube. Saludos de California. Creo que que necesito tener una dieta con muy pocas purinas y ayudar con con cosas naturales que para que disminuya todo el acido urici. Me gustaria hablar con un especialista que sepa muy bien de acerca de la gota. Muchas gracias otra vez.

  18. OYE HERMANO YO TENGO UN DEDO HINCHADO Y ESTOY BEBIENDO AMOXICILINA 500 MILIGRAMOS. Tu crees que con esa medicina yo podria curarme de esa hinchazon del dedo que creo que es producido o por la gota o por alguna infeccion

  19. No creí que fuera tan malo tan agresivo es casi letal Gracias muy importante esta información muchas gracias cuál es la especialidad para ver este mal por favor si alguien sabe

  20. Rayos me encanto la información, que buena explicación, me quede todo el vídeo ni me di cuenta, ojala hací explicaran los maestros de hoy en día.

  21. Que puedo tomar para el acido urico alto? Tengo 37 años y ultimamente no me cuido mucho en la alimentacion como de todo en especial carnes,y cuando pasa me da dolor en los tobillos y las manos, que puedo tomar

  22. Buen video, desde hace como un mes vengo tomando 20 oz de café en las mañanas, hoy en la mañana desperté con un fuerte dolor en un dedo de la mano, era como si tuviera una aguja por dentro, pudiera ser sintoma de comienzo de esta enfermedad?
    Casi no como carne pero si pienso que he estado tomando mucho café, algo a lo que jamas mi cuerpo estaba acostumbrado.

  23. Hola cómo está disculpe mi esposo está sufriendo de gota pero paso casi 5 años investigando q era lo q tenía en el codo como me contactó con usted le agradecería explicación muy interesante gracias

  24. Pregunta yo hago mucho ejercicio y como 500g de carne roja al día
    Bebo mucha agua y casi nunca tomo alcohol
    Podría tener gota ?

  25. Fijado por sinpsis emp entonses q chingado voy a comen q me deje satisfecho y no este comiendo cada rato

  26. Hola a mi me da un dolor desconcertante de cuando en cuando en ciertas articulaciones y pienso que puede estar relacionado al ácido burico básicamente en tobillo y otras veces entre el pie y rodilla. Aumenta en dolor al acostarme no se me pone rojo pero si duele mucho. Trabajo con aire acondicionado. Mi esposo me trató de hacer un ligero masaje y dolía muchísimo como si hiciera mucha fuerza. El dolor a ratos aumenta luego como que se calma en fin es como intermitente

  27. excelente, no soy de ver videos muy largos pero este me cautivó hasta el final interesante tu aporte gracias por compartir

  28. he tenido un ataque de gota. tengo menos de 30 años, pero el medico no me sigue viendo porque tengo el acido urico normal. que deberia hacer ?

  29. Muchas gracias por la informacion, he bajado el nivel de 9 a 4 ahora es li contrario de los tofos pequenos que tengo en las articulaciones de la mano dx pasan a la sangre. Se puede extraer quieurgicamente estos tofos? Cuales serian los beneficiios?. Excelente explicacion.Saludos desde Genova

  30. Quisiera saber si tengo gota tengo un dolor muy fuerte em el dedo cuando intento caminar siento q se me parte el pie y el dedo en 2 boy 2 dias von un dolor extremo .coomo lo puedo aliviar

  31. Que importante es la buena alimentación y un buen programa rutinario de ejercicios cardiovasculares!🤔🤔 Me pongo a dieta y me ejercito de aquí en adelante…

  32. Me da risa cuando hablan de los porcentajes dados oficialmente. En mis r1 años jamás he conocido a nadie que tenga esa enfermedad 🤣

  33. Porfavor contestame mi pregunta es porque si ya pasaron 10 dias tome antibioticos y medeciana q me receto el doctor entonces porque todavia tengo inflamado mi dedo pequeño del pie izquierdo ? Tengo miedo que mi articulacion ya este dañada

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