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

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 drinking alcoholic beverages and avoid the foods that trigger your attacks. Besides NSAIDs, you may be given other drugs.

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 anthocyanidins that increase collagen integrity and decrease inflammation. Cherry juice (8 to 16 oz. per day) is also helpful.
• Vitamin C—8 g 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 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Devil's claw (Harpagophytum procumbens) reduces pain and inflammation. Dose is 1 to 2 g three times per day of dried powdered root, 4 to 5 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 3 to 5 pellets of a 12X to 30C remedy 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.

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