GOUT AND ITS MANAGEMENT

Gout is crystal induced inflammation of joints caused by deposition of monosodium urate monohydrate crystals in joints. This condition happens due to chronic hyperuricaemia (increase in serum uric acid levels) over a period of time, maybe few months.

Symptoms and signs:

Podagra is gout of the foot, mainly the great toe. Inflammation of great toe with redness, swelling and pain.

Arthritis of other joints can also happen like ankle, finger, wrists, elbow and knees. Monoarticular involvement (single joint) is seen in gout, but polyarticular inflammation can also happen simultaneously or in succession.

Complications of gout:

If gout is not treated it can lead to severe degenerative arthritis, secondary infections, urate or uric acid nephropathy, renal stone, fracture in joints with tophaceous gout (masses of white growth around joint due to uric acid crystals).

Risk factors for gout:

Obesity, diet rich in purines, alcohol, genetic, medications (low-dose aspirin, diuretics), CVS and renal conditions predispose to development of gout.

Diagnosis:

Gout can be confirmed by aspiration of joint synovial fluid and analysing for presence of crystals.

Serum uric acid levels (should be less than 6 mg/dl) if more than 6.85 mg/dl with gout symptoms is usually confirmatory.

24-hour urinary uric acid evaluation.

Blood studies (including WBC count, triglycerides, HDL, glucose, renal and liver function tests).

Plain radiographs (x-ray) findings consistent with gout. Erosions with overhanging edges are generally considered pathognomonic for gout.

Ultrasound of involved joint. A “double-contour” sign, consisting of a hyperechoic, irregular line of MSU crystals on surface of articular cartilage overlying an adjacent hyperechoic bony contour.

CT scan or MRI maybe indicated to confirm the diagnosis and to rule out osteomyelitis.

Treatment:

Acute attack of gout caused due to crystal-induced inflammation of joint. So medicines to relieve that acute episode. Mostly, anti-inflammatory medications are used. Other drugs like corticosteroids, colchicine or combination of above is used if there is no relief.

Once acute episode subsides therapy for lowering the uric acid levels is given like Allopurinol, Febuxostat, or Probenecid. These agents can precipitate acute attacks of gout.

Dietary measures:

1. Avoid or restrict purine rich food like some fishes (shell fish), meat, mushrooms, green peas, spinach, asparagus, broccoli sprouts and cauliflower.
2. Avoid excess of alcohol mainly beer.
3. Avoid sodas and high-fructose drinks.
4. Limit use of fruit juices, table salt and sugar, desserts.
5. Drink plenty of water ≥ 8 glasses of water daily.
6. Low fat diet.
7. Exercise to reduce weight.

Homeopathic treatment for gout:

Homeopathy management depends on what stage the patient has come to us with gouty symptoms. If acute inflammation of joints then acute medicine is prescribed, but if patient is having chronic hyperuricaemia and its sequelae then the totality of chronic symptoms of patient is taken into account and chronic constitutional remedy is given for relief and control of uric acid levels.

Some remedies which are commonly indicated for gout are:

1. Benzoic acid: Gout nodes are very painful. Gout with urinary symptoms, strong smelling urine. Bunion of great toe. Useful remedy when Colchicum fails in treating gout.

 

2. Colchicum autumnale: Gouty joints are red, hot and swollen. Tearing pains worse from touch, evening and night. Gout with stomach symptoms nausea and vomiting. Stubbed toe is extremely painful.

 

3. Ledum palustre: Gouty pains shoot through the foot and limbs and all joints mainly small joints. Gouty nodosities. Cracking in joints worse from warmth. Ball of great toe swollen. Pains begin in lower limbs and ascends upwards. Better from putting feet in cold water.

 

4. Lycopodium: Symptoms of pain run from right to left and worse from 4 to 8 pm. Mainly for chronic symptoms of increased uric acid. Pain in heel on walking as from a pebble. Painful callosities of sole. Worse from heat or warm room.

 

5. Ranunculus sceleratus: Boring pains, sudden burning sticking in right toe. Gout of finger and toes.

 

6. Urtica urens: Antidotes ill-effects of eating shell fish. Gout and uric acid diathesis. Acute pain in deltoid muscle due to gout. Pain in ankles and wrists. Worse from snow, cool moist air, touch.

 

There are many more homoeopathic remedies depending on symptoms of patient. So it is advisable to take homoeopathy at hands of experienced homoeopathic doctor.

 

Dr. Zubin S Dehmeri, MD(Hom.)

Email: drzubin123dehmeri@gmail.com

Mob: +91-9819219042.