Gout

Gout usually affects men over age 30 with a family history of gout but it can occur at any time and also affects women especially after menopause. Recent food and alcohol excess surgery infection physical or emotional stress or the use of certain drugs can lead to the development of gout symptoms.

Signs and Symptoms

• Extreme pain in a single joint usually the base of the big toe but other joints can also be affected (such as the feet fingers wrists elbows knees or ankles)
• Joint is shiny red-purple swollen hot and stiff
• Fever as high as 39°C (102.2° F) with or without chills
• Attack develops over a matter of hours and may get better over a few days or weeks
• In later attacks you may see lumps (called tophi) just under the skin in the outer ear hands feet elbow or knee

What Causes It?

The body either produces too much uric acid doesn't excrete enough uric acid or both so that the acid accumulates in tissues in the form of needle-like crystals that cause pain. Gout generally occurs because of a predisposition to the condition but it can result from blood disorders or cancers such as leukemia or the use of certain drugs.

What to Expect at Your Provider's Office

Your health care provider will examine the affected joint evaluate how painful it is and may ask if there is any history of gout in your family. Your provider may take a sample of fluid from the affected joint draw blood for a blood test or take X-rays to rule out other possibilities.

Treatment Options

Treatment Plan

To treat gout you must stop drinking any alcohol and avoid foods that trigger your attacks. There are two types of drugs that are helpful with gout. The first type of drug relieves pain and inflammation. The second type reduces the amount of uric acid that you produce and/or helps uric acid to pass from your body.

Drug Therapies

Prescription

For pain relief:

• Colchicine—for pain relief; can be taken orally or administered intravenously; toxicity and severe side effects limit its IV use; can prevent future attacks
• Corticosteroids—dramatic pain relief; can have severe side effects
• Analgesics—for severe pain; do not take aspirin at the same time

Uric acid reducing drugs:

• Uricosuric agents—effectively reduce uric acid levels; various side effects; do not take aspirin at the same time
• Allopurinol—effectively reduces uric acid levels; various potentially serious side effects

Over the Counter

• Ibuprofen—relieves pain; various side effects

Complementary and Alternative Therapies

A combination of therapies can be very effective at decreasing both the length and frequency of attacks.

Nutrition

• Maintain a healthy weight. However it is important to avoid crash dieting and rapid weight loss.
• Drink plenty of water because dehydration may make gout worse.
• Restrict purines in your diet. Purines increase lactate production which competes with uric acid for excretion. Foods with a high purine content include beef goose organ meats sweetbreads mussels anchovies herring mackerel and yeast. Foods with a moderate amount of purines include meats poultry fish and shellfish not listed above. Spinach asparagus beans lentils mushrooms and dried peas also contain moderate amounts of purines.
• Do not drink alcohol especially beer.
• Cherries—One half pound of cherries per day (fresh or frozen) for two weeks lowers uric acid and prevents attacks. Cherries and other dark red berries (hawthorn berries and blueberries) contain anthocyanadins that increase collagen integrity and decrease inflammation. Cherry juice (8 to 16 ounces of per day) is also helpful.
• Vitamin C—8 grams per day can lead to decreased blood uric acid levels. Note that there is a small subset of people with gout who will actually get worse with this level of vitamin C.
• Folic acid—10 to 75 mg per day inhibits xanthine oxidase which is required for uric acid production.
• EPA (eicosapentaenoic acid) inhibits pro-inflammatory leukotrienes. Dose is 1 500 mg per day.
• Niacin—Avoid niacin in doses greater than 50 mg per day. Nicotinic acid may bring on an attack of gout.
• Vitamin A—There is some concern that elevated retinol levels may play a role in some attacks of gouty arthritis.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink two to four cups per day.

• Devil's claw (Harpagophytum procumbens) reduces pain and inflammation. Dose is one to two grams three times per day of dried powdered root four to five ml three times per day of tincture or 400 mg three times per day of dry solid extract during attacks.
• Bromelain (Ananas comosus)—proteolytic enzyme (anti-inflammatory) when taken on an empty stomach. Dose is 125 to 250 mg three times per day during attacks.

Homeopathy

Some of the most common remedies used for gout are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Aconite for sudden onset of burning pain anxiety restlessness and attacks that come after a shock or injury
• Belladonna for intense pain that may be throbbing; pain is made worse by any motion and better by pressure; joint is very hot
• Bryonia for pain made much worse by any kind of motion; pain is better with pressure and with heat
• Colchicum for pains made worse by motion and changes of weather especially if there is any nausea associated with the attacks
• Ledum when joints become mottled purple and swollen; pain is much better with cold applications and is worse when overheated

Physical Medicine

• Hot and cold compresses—three minutes hot alternated with 30 seconds cold provide pain relief and increase circulation.
• Bed rest for 24 hours after acute attack. However prolonged bed rest may make the condition worse.

Following Up

If you have had several attacks and the joint has suffered damage your provider may refer you to an orthopedist.

Special Considerations

People who have had gout have an increased risk of developing kidney stones high blood pressure kidney disease diabetes mellitus high levels of triglycerides and atherosclerosis.

Supporting Research

The Burton Goldberg Group compilers. Alternative Medicine: The Definitive Guide. Tiburon Calif: Future Medicine Publishing; 1997.

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. St Louis Mo: Mosby-Year Book; 1999.

Larson DE ed. Mayo Clinic Family Health Book. 2nd ed. New York NY: William Morrow and Company; 1996.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Publishing; 1997.

Rose B. The Family Health Guide To Homeopathy. Berkeley Calif: Celestial Arts Publishing; 1992.

Theodosakis J Adderly B Fox B. The Arthritis Cure. New York NY: St Martin's Press; 1997.

Tierney LM Jr McPhee SJ Papadakis MA eds. Current Medical Diagnosis and Treatment 1994. Norwalk Conn: Appleton & Lange; 1994.

Werbach MR. Nutritional Influences on Illness. New Canaan Conn: Keats Publishing Inc; 1987.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.