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Known as "the disease of kings and the king of diseases", gout has been studied by physicians and has caused suffering in countless humans since at least the days of Hippocrates. Formerly a leading cause of painful and disabling chronic arthritis, gout has been all but conquered by advances in research. Unfortunately, many people with gout continue to suffer because knowledge of effective treatments has been slow to spread to patients and their physicians.
The four phases of gout include elevated uric acid levels without symptoms, acute gouty arthritis, multiple attacks with intervals between attacks, and chronic tophaceous gout, in which nodular masses of uric acid crystals (tophi) are deposited in different soft tissue areas of the body. Patients with asymptomatic hyperuricemia do not require treatment, but efforts should be made to lower their urate levels by encouraging them to make changes in diet or lifestyle.
Uric acid is a product of the chemical breakdown of the purine bases that compose the genetic material, DNA. As cells die and release DNA from their chromosomes, purines are converted into uric acid which is excreted in the urine and, to a lesser extent, the intestinal tract. The level of uric acid dissolved in the bloodstream is directly related to this delicate balance between uric acid production and excretion. The normal level is approximately 2-7mg/dl.
Though an excess of uric acid is known to cause gout, recent studies show that, in proper concentrations in the blood, it has antioxidant properties and helps protect the cells and tissues from irritation and damage caused by singlet oxygens and hydroxyl free radicals. This protection may prevent tissue wear and aging, in addition to other free-radical diseases.
Thus, uric acid has a new image as being an important part of balanced human function and not just a waste product. With its different effects, uric acid is somewhat like cholesterol in its biochemistry: As with cholesterol, it is both made in the body and obtained through the diet; some people are genetically inclined to elevated levels; and, whereas the right amount is essential to important functions, excesses can lead to problems (cholesterol appears to be much more of a concern on this count than uric acid).
Incidence; Causes & Development
Gout in women occurs almost exclusively after menopause. Women develop gout at an older age than men and have twice the prevalence of hypertension, renal insufficiency and exposure to diuretics. The onset of gout before age 30 in men or before menopause in women is unusual and raises concern about an associated inherited enzyme defect or renal disease.
An attack of acute gouty arthritis is caused by the body's inflammatory reaction to intermittent deposition of needle-like uric acid crystals. When these crystals are ingested by white blood cells, the cells release enzymes that evoke inflammation.
The inflammatory process in gout is unrelated to infection. Rather, it is incited by the deposition in the joint of uric acid crystals usually due to an excess of uric acid in the bloodstream. This can be caused by an increase in production by the body, by under-elimination of uric acid by the kidneys or by increased intake of foods containing purines which are metabolized to uric acid in the body. Certain meats, seafood, dried peas and beans are particularly high in purines. Alcoholic beverages may also significantly increase uric acid levels and precipitate gout attacks. Gout is strongly associated with obesity, hypertension, hyperlipidemia, diabetes and dehydration. A familial pattern is observed in 5-15% of cases.
In most cases, an under-excretion of uric acid by the kidneys is responsible. Among the more common predisposing factors are kidney failure from any cause, diuretics, dehydration, hormonal diseases, alcohol consumption and using low doses of aspirin. About 10% of people with hyperuricemia are overproducers of uric acid. For some of these patients, diseases of the blood and bone marrow or inherited enzyme abnormalities can be implicated. Some are associated with metabolic alterations due to obesity, but for most the exact cause is indeterminable.
Signs & Symptoms
Attacks are usually marked by intermittent joint pain, swelling, redness and warmth. Other symptoms include:- Rapid onset of severe joint pain, swelling and redness, often beginning at night after ingestion of alcoholic beverages, uric acid-elevating medications or high-purine foods.
- In 90% of initial episodes a single joint is involved - especially the joint at the base of the big toe. Gouty arthritis of the big toe afflicts some 90% of patients some time during the course of their disease. The foot, heel, ankle, knee, hands, wrists and elbows are some of the other joints that are frequently involved.
- Attacks tend to last a few days to a few weeks.
- Attacks respond well to medications.
- The frequency of subsequent attacks is variable. 5-10% of patients will never be bothered again, but most relapse within a year.
Diagnosis & Tests
Since several other kinds of arthritis can mimic a gout attack, and since treatment is specific to gout, proper diagnosis is essential. The definitive diagnosis of gout is dependent on finding uric acid crystals in the joint fluid during an acute attack. However, uric acid levels in the blood alone are often misleading and may be transiently normal or even low. Additionally, uric acid levels are often elevated in individuals without gout. While sudden swelling and pain in a joint, especially the big toe, suggests the diagnosis of gout, many other arthritic conditions and some infections present themselves in a similar manner. Gout is the diagnosis if gout medications resolve the symptoms. Uric acid levels are usually elevated around an attack, and reduced when treated successfully.
Prognosis
Untreated cases may develop chronic gouty arthritis in which multiple joints are involved by a long-term destructive process. Tophi (small nodules consisting of uric acid and inflammatory tissues) may be seen on the ear cartilage and along tendons.
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Conditions that suggest Gout / Hyperuricemia:
Risk factors for Gout / Hyperuricemia: | | | | | Cell Salts |  Nat Phos Cell Salt Need |
Diet |
Effects of a Low Carbohydrate Diet | In March 2004, an article was published in the New England Journal of Medicine documenting the effect of meat intake on gout risk. Harvard researchers followed almost 50,000 men for 12 years and found that "each additional daily serving of meat was associated with a 21% increase in the risk of gout." In fact, the Atkins Diet has been blamed directly for the rising incidence of this painful disease. [The Observer, 18 January 2004] |
 Dehydration| | Gout can be caused by dehydration and the use of diuretics such as coffee or alcohol. |
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Laboratory Test Needed |
Elevated Insulin Levels| | Preliminary research suggests that insulin resistance may play a role in the development of gout. Gout is strongly associated with the consequences of insulin resistance i.e. obesity, hypertension, hyperlipidemia and diabetes. |
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Metabolic |
Problems Caused By Being Overweight |
Organ Health |
Chronic Renal Insufficiency| | Patients with impaired renal function filter and excrete less uric acid and therefore become hyperuricemic. Interestingly, patients with renal failure do not develop gout as frequently as expected, despite their high plasma urate levels. The explanation for this phenomenon may be that they have not incurred sustained hyperuricemia levels long enough to develop gout. Only 1% of renal failure patients develop gout but nearly 30% of patients with adult polycystic kidney disease do. |
Kidney Disease| | Hyperuricemia is caused by a variety of means, one of which is abnormal kidney function. In addition, for some individuals gout is a progressive, crippling chronic disease that eventually damages the kidneys. |
Kidney Stones (Urolithiasis) |
Symptoms - Food - Beverages |
Moderate/high alcohol consumption
Consuming beer/wine/hard/consuming hard liquor or consuming beer| | Beer raises gout risk by 49% per daily serving. |
(High) sugared soda consumption| | For gout, soft drinks are worse than hard liquor -- and nearly as bad as beer -- doubling the risk for heavy drinkers. Diet sodas, however, do not affect gout risk. These findings came from a large study of 46,393 male health professionals in Canada who filled in detailed questionnaires about their health and their diet every four years for 12 years. Over that time, 755 of the subjects developed gout.- Two or more soft drinks each day increased gout risk by 85%
- One soft drink a day increased risk by 35%-45%
- 5 or 6 soft drinks a week increased risk by 29%.
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Symptoms - Food - Intake |
(High) refined sugar consumption |
Symptoms - Skeletal |
History of gout |
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Gout / Hyperuricemia suggests the following may be present: | | | | | Circulation | Hypertension (High Blood Pressure) |
Diet |
Effects of a Low Carbohydrate Diet| | In March 2004, an article was published in the New England Journal of Medicine documenting the effect of meat intake on gout risk. Harvard researchers followed almost 50,000 men for 12 years and found that "each additional daily serving of meat was associated with a 21% increase in the risk of gout." In fact, the Atkins Diet has been blamed directly for the rising incidence of this painful disease. [The Observer, 18 January 2004] |
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Lab Values |
High Total Cholesterol |
Laboratory Test Needed |
Elevated Insulin Levels| | Preliminary research suggests that insulin resistance may play a role in the development of gout. Gout is strongly associated with the consequences of insulin resistance i.e. obesity, hypertension, hyperlipidemia and diabetes. |
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Organ Health |
Kidney Disease| | Hyperuricemia is caused by a variety of means, one of which is abnormal kidney function. In addition, for some individuals gout is a progressive, crippling chronic disease that eventually damages the kidneys. |
Chronic Renal Insufficiency| | Patients with impaired renal function filter and excrete less uric acid and therefore become hyperuricemic. Interestingly, patients with renal failure do not develop gout as frequently as expected, despite their high plasma urate levels. The explanation for this phenomenon may be that they have not incurred sustained hyperuricemia levels long enough to develop gout. Only 1% of renal failure patients develop gout but nearly 30% of patients with adult polycystic kidney disease do. |
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Gout / Hyperuricemia can lead to: | | | | | Circulation | Coronary Disease / Heart Attack| | Elevated uric acid levels, as seen in gout, may be associated with a higher incidence of coronary heart disease amongst alcohol abstainers, but has not been seen to occur in those who were light, moderate or heavy drinkers. [ Journal of Clinical Epidemiology,1996;49(6) pp.673-678] |
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Gout / Hyperuricemia could instead be: | | | | | Infections | Lyme Disease| | Lyme disease is similar to gout and is sometimes misdiagnosed as such. |
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Recommendations and treatments for Gout / Hyperuricemia: | | | | | Diet |  Alcohol Avoidance
Low Purine Diet| | A low-purine diet is commonly used to treat gout. Some people need to follow the diet more closely than others to prevent symptoms. |
Caffeine/Coffee Avoidance| | Intake of diuretics (chiefly coffee and alcohol) should be reduced/avoided as far as possible. |
Increased Fruit/Vegetable Consumption| | Especially recommended are cherries. Liberal amounts (up to 1 pound per day) of cherries, blueberries, and other anthocyanoside-rich (i.e. red-blue) berries or extracts should be consumed. Consuming fresh or canned cherries has been shown to be very effective in lowering uric acid levels and preventing attacks of gout. Cherries, hawthorn berries, blueberries, and other dark red-blue berries are rich sources of anthocyanidins and proanthocyanidins. These compounds are flavonoid molecules that give these fruits their deep red-blue color, and are remarkable in their ability to prevent collagen destruction. |
Plant-Based Nutrition| | Preferably no meat should be eaten as it is rich in uric acid forming components. Raw fruit, vegetables, grains, seeds and nuts are highly recommended. |
 Weight Loss| | Achieve normal body weight but avoid rapid weight loss diets, which may result in increased uric acid levels in the blood. |
Increased Water Consumption |
Drug |
NSAIDs| | Medications such as Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and allopurinol are commonly used against gout. The NSAID that is most widely used to treat acute gout is indomethacin. NSAIDs may also have significant toxicity, but if used for the short-term, are generally well tolerated.
NSAIDs are the treatment of choice for acute attacks of gout in most patients. NSAIDs should be used sparingly in elderly patients and should be avoided in patients with renal disease and peptic ulcer disease, and in those receiving concurrent systemic anticoagulation. Corticosteroids are a valuable treatment option for patients in whom NSAID therapy is contraindicated. Acute gouty arthritis and chronic gout require different treatment strategies. |
Conventional Drug Use| | Since the 1800s, colchicine has been the standard treatment for acute gout. While colchicine is very effective, it often causes nausea, vomiting and diarrhea. These side-effects are uncommon when this drug is given intravenously, but because of their unpleasant nature, non-steroidal anti-inflammatory drugs (NSAIDs) have become the treatment of choice for most acute attacks of gout.
Therapy directed at normalizing uric acid levels in the blood should be considered for patients who have had multiple gout attacks or have developed tophi or kidney stones. Several drugs that help the kidneys eliminate uric acid are available, such as probenecid, and a drug that blocks production of uric acid by the body, such as allopurinol. The choice between these two types of drugs depends on the amount of uric acid in the urine. With correct treatment, gout should be well controlled in almost all cases. |
Not recommended:
 Aspirin| | Among the more common predisposing factors for hyperuricemia are kidney failure from any cause, diuretics, dehydration, hormonal diseases, alcohol consumption and using low doses of aspirin. Aspirin and aspirin-containing products should be avoided during acute attacks because they will further elevate uric acid levels. |
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Homeopathy |
Natrium phosphoricum Cell Salt |
Mineral |
 MSM (Methyl Sulfonyl Methane)| | According to Dr. Stanley Jacobs, MD, MSM can be helpful in most musculoskeletal pain and inflammation, including gout. |
Not recommended:
 Molybdenum| | Molybdenum is known to raise uric acid levels which is why people with gout (a condition of elevated uric acid levels) are told to avoid molybdenum supplements.
Note, however: Molybdenum deficiency may reduce uric acid formation, which was not previously thought to be a problem, but it may be important to supplement molybdenum to maintain uric acid levels in midnormal range for the antioxidant function as well as possible others. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Very strongly or absolutely counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended | | | Reasonably likely to cause problems | | | Avoid absolutely |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Anti-inflammatory (Antiinflammatory)
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Antioxidant (Antioxidants)
A chemical compound that slows or prevents oxygen from reacting with other compounds. Antioxidants are substances that protect cells from oxidative damage caused by molecules called free radicals. These chemicals can damage important parts of cells, such as proteins, membranes, and DNA. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, beta carotene, the minerals selenium and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Asymptomatic
Not showing symptoms.
Bioflavonoid (Bioflavonoids, Flavonoid, Flavonoids)
Vitamin P. Any of a group of colored flavones (crystalline compounds) found next to the peel in many fruits. Essential for the stability and absorption of ascorbic acid.
Bursitis
The bursa is a fluid-filled pad that allows your muscles to easily slide over other muscles and bones. Bursitis occurs when this pad becomes inflamed. It usually occurs when you overuse or injure a specific joint, but it can also be caused by a bacterial infection. Symptoms include pain and inflammation around joints such as the elbow, hip, shoulder, big toe, ankle or knee.
Cartilage
Specialized fibrous connective tissue that forms the skeleton of an embryo and much of the skeleton in an infant. As the child grows, the cartilage becomes bone. In adults, cartilage is present in and around joints and makes up the primary skeletal structure in some parts of the body, such as the ears and the tip of the nose.
Cholesterol
A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Chronic Renal Failure (Chronic Renal Insufficiency, Kidney Failure, Renal Insufficiency)
(CRF) Irreversible, progressive impaired kidney function. The early stage, when the kidneys no longer function properly but do not yet require dialysis, is known as Chronic Renal Insufficiency (CRI). CRI can be difficult to diagnose, as symptoms are not usually apparent until kidney disease has progressed significantly. Common symptoms include a frequent need to urinate and swelling, as well as possible anemia, fatigue, weakness, headaches and loss of appetite. As the disease progresses, other symptoms such as nausea, vomiting, bad breath and itchy skin may develop as toxic metabolites, normally filtered out of the blood by the kidneys, build up to harmful levels. Over time (up to 10 or 20 years), CRF generally progresses from CRI to End-Stage Renal Disease (ESRD, also known as Kidney Failure). Patients with ESRD no longer have kidney function adequate to sustain life and require dialysis or kidney transplantation. Without proper treatment, ESRD is fatal.
Collagen
The primary protein within white fibers of connective tissue and the organic substance found in tendons, ligaments, cartilage, skin, teeth and bone.
Corticosteroid (Corticosteroids)
Steroid hormone produced by the adrenal cortex.
Deciliter (dL)
0.1 or one tenth of a liter.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Diarrhea
Excessive discharge of contents of bowel.
Diuretic (Diuretics)
An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
DNA
Deoxyribonucleic acid, the large molecule that is the main carrier of genetic information in cells. DNA is found mainly in the chromosomes of cells.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Epidemiology
The study of the causes and distribution of disease in human populations.
Free Radical (Free Radicals)
A free radical is an atom or group of atoms that has at least one unpaired electron. Because another element can easily pick up this free electron and cause a chemical reaction, these free radicals can effect dramatic and destructive changes in the body. Free radicals are activated in heated and rancid oils and by radiation in the atmosphere, among other things.
Fructose
A simple sugar which occurs naturally in fruit or honey.
Gout
A disease characterized by an increased blood uric acid level and sudden onset of episodes of acute arthritis.
Hyperlipidemia
Increased cholesterol level: Elevated blood fats, either from heredity, from having so many calories in the diet that they are ending up as liver-synthesized storage fats, from an excessively anabolic metabolism. Also from a constellation of less
common disease causes.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Insulin
A hormone secreted by the pancreas in response to elevated blood glucose levels. Insulin stimulates the liver, muscles, and fat cells to remove glucose from the blood for use or storage.
Kidney Stone (Kidney Gravel, Kidney Stones)
A stone (concretion) in the kidney. If the stone is large enough to block the tube (ureter) and stop the flow of urine from the kidney, it must be removed by surgery or other methods. Also called Renal Calculus. Symptoms usually begin with intense waves of pain as a stone moves in the urinary tract. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin. The pain may continue if the stone is too large to pass; blood may appear in the urine and there may be the need to urinate more often or a burning sensation during urination. If fever and chills accompany any of these symptoms, an infection may be present and a doctor should be seen immediately.
Kidneys (Kidney, Renal)
Bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage. The kidneys are sophisticated reprocessing machines, each day handling about 50 gallons of blood to sift out about half a gallon of waste products and extra water. The waste and extra water become urine, which flows to the bladder through tubes called ureters. The actual filtering occurs in tiny units inside the kidneys called nephrons. Every kidney has about a million nephrons. In a nephron, a glomerulus -- which is a tiny blood vessel, or capillary -- intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system. The kidneys recycle chemicals such as sodium, phosphorus, and potassium and thus regulate their levels. Renal: Pertaining to the kidneys.
Menopause (Menopausal)
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Molybdenum
An essential trace element. It helps regulate iron stores in the body and is a key component of at least three enzymes: xanthine oxidase, aldehyde oxidase and sulfite oxidase. These enzymes are involved with carbohydrate metabolism, fat oxidation and urine metabolism. The average adult has about 9mg of molybdenum concentrated mostly in the liver, kidney, adrenal glands, bones and skin. Molybdenum deficiencies are associated with esophageal cancer, sexual impotency and tooth decay.
Multiple Sclerosis (MS)
Demyelinating disorder of the central nervous system, causing patches of sclerosis (plaques) in the brain and spinal cord, manifested by loss of normal neurological functions, e.g. muscle weakness, loss of vision, and mood alterations.
Nausea
Symptoms resulting from an inclination to vomit.
NSAID (NSAIDs)
Non-steroidal anti-inflammatory drug.
Peptic Ulcer (Duodenal Ulcer, Duodenal Ulcers, Gastric Ulcer, Gastric Ulcers, Peptic Ulcers)
A general term for gastric ulcers (stomach) and duodenal ulcers (duodenum), open sores in the stomach or duodenum caused by digestive juices and stomach acid. Most ulcers are no larger than a pencil eraser, but they can cause tremendous discomfort and pain. They occur most frequently in the 60 to 70 age group, and slightly more often in men than in women. Doctors now know that there are two major causes of ulcers: most often patients are infected with the bacteria Helicobacter pylori (H. pylori); others are regular users of non-steroidal anti-inflammatory drugs (NSAIDS), which include common products like aspirin and ibuprofen.
Pound (lb, lbs)
454 grams, or about half a kilogram.
Proanthocyanidin (Proanthocyanidins)
Also called procyanidin, it is a powerful antioxidant that chemically belongs to the class of bioflavonoids. Grape seed extract, pine bark extract, as well as berries such as hawthorn berries, cherries, blueberries, and blackberries and, to a lesser extent, red wine, are natural sources.
Purines (Purine)
These are waste products or metabolites of nucleoproteins. They are not recycleable and are broken down further to the primary excretable form, uric acid. High purine presence in a tissue signifies a recent high turnover in nucleoproteins from injury or cell death, which is why some purines, such as allantoin, will stimulate cell regeneration. Many plants contain allantoin, most noticeably Comfrey. Some foods are heavy purine producers and can elevate serum uric acid levels. These include organ meats, seafood, legumes, and foods such as spirulina, chlorella, and bee pollen.
Uric Acid (Hyperuricemia)
The final end product of certain native or dietary proteins, especially the nucleoproteins found in the nucleus of cells. Unlike the much smaller nitrogenous waste product urea, which is mostly recycled to form many amino acids, uric acid is an unrecycleable metabolite that must be excreted: nucleoprotein to purine to uric acid to the outside in the urine or the sweat. Hyperuricemia: Having elevated blood uric acid, either from a rapid rate of cell breakdown and synthesis (such as might occur from fasting, heavy training, trauma or any number of major diseases), a high consumption of organ meats, glandular supplements or spirulina, or the inability (usually hereditary) to excrete uric acid in the urine as fast as it is produced, even though production itself is not elevated.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Aug 23, 2009
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