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Gout

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Gout is a type of arthritis that occurs when too much uric acid builds up in the body, causing crystals to form in joints and joints to become inflamed. It can be hereditary or the result of another condition. Gout usually affects men over 40 with a family history of gout, but it can occur at any time and also affects women, especially after menopause. Excessive intake of food and alcohol, 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
• Symptoms can develop very quickly, with the first episode often occurring at night, then go away after 5 - 10 days only to come back later
• 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. Risk factors include:

• Family history of gout
• High levels of triglycerides
• Drinking too much alcohol
• Eating foods rich in purines, such as meat, shellfish, and sweetbreads. Uric acid is formed when purines break down.

What to Expect at Your Provider's Office

Your health care provider will examine the affected joint, evaluate your pain, 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

Your health care provider may give you ibuprofen or another nonsteroidal anti-inflammatory drug (NSAID) to help with the pain and swelling. You must avoid alcohol and the foods that trigger your attacks. Besides NSAIDs, you may be given other drugs. Colchicine can help treat an acute attack and prevent future attacks but has serious side effects. Probenecid, allopurinol, and sulfinpyrazone are also help prevent future attacks. These drugs help control gout but do not cure it.

Complementary and Alternative Therapies

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

Nutrition and Supplements

• Maintain a healthy weight. However, it is important to avoid crash dieting and rapid weight loss.
• Drink plenty of water to help the kidneys flush uric acid from the body. Dehydration often triggers a gout attack.
• Restrict purines in your diet. 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 2 weeks lowers uric acid and prevents attacks. Cherries and other dark red berries (hawthorn berries and blueberries) contain anthocyanidins that increase collagen integrity and decrease inflammation. You may prefer to take cherry fruit extract as a pill (1,000 mg three times per day during an attack; 1,000 mg per day to prevent attacks).Cherry juice (8 - 16 oz. per day) is also helpful.
• Vitamin C, taken in high doses, can help decrease blood uric acid levels, but should not be taken without a doctor's supervision. Note that there is a small subset of people with gout who will actually get worse with high levels of vitamin C. Also, a single high does can free up too much uric acid and cause kidney stones.
• Folic acid -- 400-800 mcg per day inhibits xanthine oxidase, which is required for uric acid production.
• Bromelain, an enzyme found in pineapple, is an anti-inflammatory. Take 200 - 300 mg three times per day between meals. As the attack subsides, take two times per day to prevent future attacks.
• Quercetin, a bioflavonoid, is an anti-inflammatory that may also help reduce uric acid levels. It is usually taken with bromelain in the same amount (200 - 300 mg three times per day).
• EPA (eicosapentaenoic acid), found in fish oil, inhibits pro-inflammatory leukotrienes. Dose is 1,500 mg per day.
• Avoid taking extra niacin and vitamin A. Both may play a role in some attacks of gout.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Devil's claw (Harpagophytum procumbens) reduces pain and inflammation. Dose is 750 mg three times per day in capsule, or 1 tsp. three times per day of tincture, between meals during attacks. DO not take devil's claw if you have diabetes or take blood-thinning medication.
• Stinging nettle ( Urtica dioica or Urtica urens ) can be used to help support kidney function, which is often compromised as the body tries to rid itself of excess uric acid. Take 250 mg three times per day or make a tea by steeping 3 - 4 tsp. of dried leaves or root in 2/3 cup boiling water for 5 minutes. Strain and cool. Drink three to four cups a day. Do not take stinging nettle if you have diabetes or high blood pressure, or take blood-thinning medication. Do not take it if you are pregnant.

Homeopathy

Some of the most common remedies used for gout are listed below. Usually, the dose is 3 - 5 pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms get better.

• Aconite for sudden onset of burning pain, anxiety, restlessness, and attacks that come after a shock or injury. Also take if your joints are swollen and painful.
• Belladonna for intense pain that may be throbbing, if pain is made worse by any motion and better by pressure, or if the joint is very hot.
• Berberis vulgaris for spasms of pain in joints or twinges made worse by walking. There may be back pain and a tendency to develop kidney stones.
• Bryonia for pain made much worse by any kind of motion, or if 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, or if the pain is much better with cold applications and is worse when overheated.
• Rhus toxicodendron for stiff, swollen joints that are hot and painful, or if the pain is worse with cold applications and better with heat.

Physical Medicine

• Hot and cold compresses -- three minutes hot alternated with 30 seconds cold provide pain relief and increase circulation..
• Nettle tea compress, applied externally. Use 1 - 2 tsp. per cup of hot water.

Following Up

If you have had several attacks and the joint is damaged, your health care provider may refer you to an orthopedic specialist.

Special Considerations

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

Supporting Research

Bindoli A, Valente M, Cavallini L. Inhibitory action of quercetin on xanthine oxidase and xanthine dehydrogenase activity. Pharmacol Res Commun 1985;17:831–9.

Blau LW. Cherry diet control for gout and arthritis. Tex Rep Biol Med . 1950;8:309–311.

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

Foltz-Gray, D. Alternative Treatments for Arthritis: An A to Z Guide . Atlanta, Ga: Arthritis Foundation; 2005.

Gagnier JJ, Chrubasik S, Manheimer E. Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med . 2004 Sep 15;4:13.

Mills S, Bone K. Principles and Practice of Phytotherapy . London: Churchill Livingstone, 2000.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998.

Oster KA. Xanthine oxidase and folic acid. Ann Intern Med 1977;87:252–3.

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

Stein HB, Hasan A, Fox IH. Ascorbic acid-induced uricosuria: a consequence of megavitamin therapy. Ann Intern Med 1976;84:385–8.

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

Wegener T, Lupke NP. Treatment of patients with arthrosis of hip or knee with an aqueous extract of devil's claw ( Harpagophytum procumbens DC.). Phytother Res 2003;17(10):1165-1172.

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

• Review Date: 6/30/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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