Conditions

Gout

Gout is a metabolic disorder that causes extremely painful attacks of arthritis, usually in a single joint, most notably the joint at the base of the big toe. However, it can affect the other joints including the knees, ankles, wrists, feet and the small joints of the hands.

Gout occurs when uric acid in the body migrates into the tissue surrounding a joint. As the excess uric acid accumulates, needle-shaped crystals form and become lodged within the joint. The surrounding tissue becomes inflamed and the nerve endings become severely irritated, resulting in extreme pain.

Uric acid is a by product often produced by the body; while others are ingested in certain foods. Uric acid cannot be absorbed and must be excreted in urine. If the kidneys are not filtering as they should, the blood becomes saturated with uric acid, which may then start to crystallize in various parts of the body, especially the joints.

Signs and Symptoms:

• Pain in a single joint, often at the base of the great toe, but can be in other joints of the feet, fingers, wrists, elbows, knees, and ankles
• "Exquisite" pain and tenderness
• Swelling, heat, and stiffness of joint
• Shiny red or purple coloration of joint
• Fever up to 39°C (102.2°F) with or without chills
• Begins in hours and may subside over a few days or up to three weeks
• In later attacks, may see tophi (accumulations of urate just beneath the skin) in hands, feet, olecranon, prepatellar bursa, and in external parts of ears.
• Untreated, attacks will be more frequent and more severe

Diagnosis:

After a physical examination your doctor may have your blood tested for serum uric acid levels. Usually this is sufficient for a diagnosis.

Treatment Options:

Gout is often completely controlled by proper treatment.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
• Abstinence from alcohol
• Dietary restrictions (avoid fat, alcohol, sardines, anchovies, scallops, organ meats, sweetbreads, cocoa, spinach, asparagus, eggs, oatmeal, and mushrooms)
• Medication to reduce the amount of uric acid produced or to promote its excretion

Traditional Treatments:

• The over-the-counter painkillers ibuprofen, ketoprofen (Orudis), and naproxen (Aleve) relieve both pain and inflammation, and can be effective for relieving symptoms. Acetaminophen (Tylenol) can also be used, but it tends to be less effective for this condition. Do not use any product that contains aspirin. Aspirin inhibits the excretion of uric acid.
• If over-the-counter painkillers are not effective, your doctor will likely give you a prescription nonsteroidal anti-inflammatory drug (NSAID). Medication in this category include a higher-potency version of ibuprofen as well as indomethacin and naproxen.
  If prescription NSAIDs are not sufficient to relieve the pain, your doctor may resort to stronger medications such as codeine or meperidine (Demerol). These are powerful narcotics that block the perception of pain. Possible side effects include sedation, slowed breathing, low blood pressure, stomach upset, and constipation.
• If you are unable to tolerate NSAIDs, colchicine (a compound derived from the autumn crocus) may be prescribed. Though no one knows exactly how, this drug helps relieve the pain of an acute gout attack. It can be dramatically effective, but it causes adverse side effects in four out of five people treated with it, so avoid it if possible.
• Steroids such as hydrocortisone and triamcinolone, taken by mouth or administered intravenously and/or by local injection, are often very effective for solving an attack of gout. Because these drugs depress the immune system and place stress on the adrenal glands, they should be used in the lowest effective dose and for the shortest time possible.

Once the acute attack has subsided, you must take care to avoid certain medications, including aspirin and diuretics, as well as certain foods that can increase the level of uric acid in the blood. If your doctor deems repeat attacks very likely, he or she may recommend medications to ward them off. One possibility is a daily low dose of colchicine. Other choices include drugs to increase excretion of uric acid in the urine, such as probenicid, or to inhibit the production of uric acid, such as allopurinol. Side effects can be serious so discuss these medications with your doctor before taking them.

Complementary and Alternative Therapies:

A combination of therapies can be very effective at decreasing both the length and frequency of attacks. Alternative therapies are often most useful in decreasing the frequency and severity of attacks, but may not necessarily offer the best pain relief. Alternative therapies avoid the sometimes-toxic effects of some pharmaceutical agents used for gout.

Nutritional Supplementation:

• Take a good multivitamin and mineral supplement daily, but read the label first to make sure it contains no more than 5,000 IU of vitamin A and that the form of vitamin B3 it contains is niacinamide rather than niacin.
  Warning: Vitamin A in amounts over 5,000 IU can worsen gout. Niacin raises uric-acid levels and increases heat and inflammation.
• Flaxseed oil contains essential fatty acids that act as natural anti-inflammatories. Take 1-teaspoon two or three times daily.
• Glucosamine sulfate helps to relieve pain. Take 300 mg twice daily.
• Green-food supplements such as chlorella, spirulina, and green barly are among the most densely packed bioavailable whole-food sources of cleansing chlorophyll. They are also a source of gamma-linolenic acid (GLA), and vitamin E, which are helpful for gout because they reduce acidity in the body. Follow the product label.
• Vitamin C and the bioflavonoids work together to reduce inflammation, which helps ease the pain. Select a formula that provides both vitamin C and the bioflavonoids and take up to 1,000 mg daily.
• Folic acid is important in facilitating the nucleoprotein breakdown and inhibits the production of the enzyme responsible for the production of uric acid. Take 200 mg per a day.

Alternative Therapies:

• Turmeric and bosweilla have significant anti-inflammatory capabilities. Follow the label directions.
• Black cherry and celery seed, both, reduce inflammation and can help to neutralize the harmful effects of uric acid.
• Alfalfa is a good source of minerals and other nutrients that help to reduce serum uric acid. Take 2,000 to 3,000 mg daily in tablet or capsule form.
• Bilberry extract is a good source of anthocyanidins and proanthocyanidins, which reduce uric-acid levels and inhibit tissue destruction.
• Apply cayenne powder, mixed with enough wintergreen oil to make a paste, to the affected areas to relieve inflammation and pain.
• Devil's claw and yucca can aid in relieving pain.
• Other beneficial herbs include birch, burdock, colchicum tincture, hyssop, and juniper.
• Hawthorn offers some of the same properties as bilberry.
• Nettle root increases the excretion of uric acid from the kidneys.

General Recommendations:

• Don't be afraid to exercise but avoid heavy-duty exercise that causes pain.
• Eat only raw fruits and vegetables for 2 weeks; frozen or fresh cherries and cherry juice.
• Eat foods like rice, millet, starchy vegetables, green vegetables, corn, cornbread, fruit, cheese, eggs, nuts and milk.
• Avoid foods high in purines (compounds that contribute to uric acid formation). Purine rich foods to avoid include: anchovies, mackerel, shellfish, asparagus, herring, meat gravies and broths, mushrooms, mussels, sardines, peanuts, baker's and brewer's yeast, mincemeat, and sweetbreads. Thyme and thyroid extracts can also pose a problem if taken for long periods of time.
• Consume plenty of water.
• Avoid rich foods such as cakes and pies.
• Avoid the amino acid glycine. Glycine can be converted into uric acid more rapidly in people who suffer from gout.
• If you are overweight, lose the excess pounds. Losing weight lowers serum uric acid levels. Avoid crash diets, as abruptly cutting back on foods or fasting for longer than three days may result in increased uric acid levels.
• Consider using homeopathic remedies. Belladonna, Arnica, and Rhus toxicodendron are some homeopathic remedies that can work for gout.
• Limit caffeine, cauliflower, dried beans, lentils, fish, oatmeal, pears, poultry, spinach and yeast products.

Warnings:

• Vitamin A in amounts over 5,000 IU can worsen gout.
• Niacin raises uric-acid levels and increases heat and inflammation.