Gout
Signs and Symptoms
- Extreme pain in a single joint, usually the base of the big toe; it can also affect other joints (such as the feet, fingers, wrists, elbows, knees, or ankles).
- Joint is shiny red or purple, swollen, hot, and stiff.
- Fever as high as 102.2°F (39°C), with or without chills.
- Symptoms can develop very quickly, with the first episode often occurring at night, then go away after 5 to 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 produces too much uric acid, does not excrete enough uric acid, or both. The acid accumulates in tissues in the form of needle-like crystals that cause pain. Uric acid is formed when the body digests purines, compounds found in some foods and beverages, including dried beans, liver, wine, and beer. 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.
- Surgery
- Metabolic syndrome
What to Expect at Your Doctor's Office
Your doctor will examine the affected joint, evaluate your pain, and may ask if there is any history of gout in your family. Your doctor 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 doctor may give you ibuprofen or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and swelling. You must avoid alcohol and foods that trigger your attacks. Besides NSAIDs, you may receive other drugs. Colchicine can help treat an acute attack and prevent future attacks but has serious side effects. Corticosteroids, corticotropin, and intra-articular corticosteroids are also used, particularly in people who have contraindications to NSAIDs and colchicine. The Food and Drug Administration (FDA) has approved other medications to treat gout, including allopurinol (Zyloprim), febuxostat (Ulonic), and pegloticase (Krystexxa). Most rheumatologists use combination therapy to treat acute gout. In a patient without complications, NSAIDs are the preferred therapy. These drugs help control gout but do not cure it.
Complementary and Alternative Therapies
A combination of therapies can be very effective at reducing both the length and frequency of attacks. When choosing complementary and alternative therapies (CAM) for gout treatment, it is best to work with a knowledgeable provider. Herbs and supplements that may be beneficial for some people, may be harmful for others. If you are pregnant, or thinking about becoming pregnant, do not use any CAM therapies unless directed to do so by your physician.
Nutrition and Supplements
These nutritional tips may help reduce symptoms:
- Eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may test for food sensitivities.
- Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Some nutrition-minded doctors promote a low fructose diet to treat gout. Another theory states that one half pound of cherries per day (fresh or frozen) for 2 weeks lowers uric acid and prevents attacks. Cherry juice (8 to 16 oz. per day) is also helpful.
- Eat more high fiber foods, including oats, root vegetables (such as potatoes and yams), and psyllium seed.
- Avoid refined foods, such as white breads, pastas, and sugar.
- Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
- Cut down on foods containing oxalate, such as spinach, rhubarb, beets, nuts, chocolate, black tea, wheat bran, strawberries, and beans.
- Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
- 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.
- Use healthy cooking oils, such as olive oil or coconut oil.
- Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Avoid alcohol, and tobacco.
- Drink 6 to 8 glasses of filtered water daily to help flush uric acid from the body. Dehydration often triggers a gout attack.
- Exercise at least 30 minutes daily, 5 days a week.
- Avoid sugar-sweetened soft drinks. Diet soft drinks have not been associated with the risk of gout.
- Preliminary studies suggest moderate coffee consumption may help alleviate symptoms.
You may address nutritional deficiencies with the following supplements:
- A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc and selenium.
- Omega-3 fatty acids, such as fish oil, to help reduce inflammation and promote general health. Cold-water fish, such as salmon or halibut, are good sources. Talk to your provider before taking omega-3 supplements if you are taking blood-thinning medications, such as aspirin or warfarin (Coumadin).
- Inositol hexophosphonate (IP-6). Check with your alternative health care provider for proper dosing. Caution: May increase the blood-thinning effects of anti-clotting medications, such as warfarin (Coumadin) and others. IP-6 may lower iron and calcium in the body.
- N-acetyl cysteine, for antioxidant effects.
- Vitamin C, as an antioxidant. In one study, higher vitamin C intake was independently associated with a lower risk of gout.
- Acidophilus (Lactobacillus acidophilus). When needed to maintain gastrointestinal and immune health. Some acidophilus products may need refrigeration. Although acidophilus is good for the immune system, people with severely-compromised immune systems should check with their physicians before starting a probiotic supplement. Check the labels carefully.
- Methylsulfonylmethane (MSM), to help reduce inflammation.
Avoid taking extra niacin and vitamin A. Both may play a role in 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 before starting any treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas 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. You may use tinctures alone, or in combination, as noted.
- Cranberry (Vaccinium macrocarpon). For kidney health. You may also take 8 to 16 ounces of unsweetened cranberry juice daily.
- Green tea (Camelia sinensis). For antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
- Devil's claw (Harpagophytum procumbens). For pain and inflammation. Devil's claw may increase the blood-thinning effect of certain medications, such as aspirin and warfarin (Coumadin). Devil's claw should never be used during pregnancy, or while breastfeeding. It can potentially affect blood sugar levels, as well as blood pressure, and can interact with many medications.
- Cat's claw (Uncaria tomentosa) standardized extract. For inflammation, immune, and antibacterial/antifungal activity. Cat's claw may worsen certain conditions, such as leukemia or some autoimmune disorders. Cat's claw may also interact with many different medications. Talk to your doctor.
- Bromelain (Ananus comosus). For pain and inflammation. Bromelain can increase the blood-thinning effect of certain medications, such as aspirin and warfarin (Coumadin).
- Turmeric (Curcuma longa). For inflammation. Tumeric may increase the blood-thinning effect of certain medications, such as aspirin and warfarin (Coumadin).
Acupuncture
Acupuncture may help manage pain associated with gout.
Homeopathy
Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of gout symptoms (such as pain and inflammation) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account your constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for you individually.
Some of the most common remedies used for gout are listed below. A common dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until your symptoms improve.
- 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 motion worsens pain and pressure improves it, 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 that worsens with motion, or if pain is better with pressure and with heat.
- Colchicum. For pains made worse by motion and weather changes, 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
Nettle tea compress, applied externally. Use 1 to 2 tsp. per cup of hot water.
Following Up
If you have had several attacks and the joint is damaged, your doctor 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.
Gout is a risk factor for other chronic conditions , including heart attack and cancer, especially prostate cancer. Speak with your physician.
Supporting Research
Bope ET, Kellerman RD, eds. Conn's Current Therapy 2014. 1st ed. Philadelphia, PA: Elsevier Saunders; 2013.
Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout. [Review]. Curr Opin Rheumatol. 2010;22(2):165-72.
Choi HK. Diet, alcohol, and gout: how do we advise patients given recent developments? Curr Rheumatol Rep. 2005;7(3):220-6.
Choi HK, Curhan G. Coffee consumption and risk of incident gout in women: the Nurses' Health Study. Am J Clin Nutr. 2010;92(4):922-7.
Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008; [Epub ahead of print].
Choi HK, Gao X, Curhan G. Vitamin C intake and the risk of gout in men: a prospective study. Arch Intern Med. 2009;169(5):502-7.
Dubchak N, Falasca GF. New and improved strategies for the treatment of gout. Int J Nephrol Renovasc Dis. 2010;3:145-66.
Eggebeen AT. Gout: an update. Am Fam Physician. 2007;76(6):801-8. Review.
Falasca GF. Metabolic diseases: gout. Clin Dermatol. 2006;24(6):498-508.
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.
Hak AE, Choi HK. Lifestyle and gout. Curr Opin Rheumatol. 2008;20(2):179-86.
Jana S, Shekhawat GS. Critical review on medicinally potent plant species: Gloriosa superba. [Review]. Fitoterapia. 2011;82(3):293-301.
Kang EH, Lee EY, Lee YJ, et al. Clinical features and risk factors of postsurgical gout. Ann Rheum Dis. 2008;67(9):1271-5.
Kedar E, Simkin PA. A perspective on diet and gout. Adv Chronic Kidney Dis. 2012;19(6):392-7.
Kolasinski SL. Food, drink, and herbs: alternative therapies and gout. Curr Rheumatol Rep. 2014;16(4):409.
Kuo CF, Luo SF, See LC, et al. Increased risk of cancer among gout patients: a nationwide population study. Joint Bone Spine. 2012;79(4):375-8.
Kuo CF, Yu KH, See LC, et al. Risk of myocardial infarction among patients with gout: a nationwide population-based study. Rheumatology (Oxford). 2013;52(1):111-7.
Lai HM, Chen CJ, Su BY, et al. Gout and type 2 diabetes have a mutual inter-dependent effect on genetic risk factors and higher incidences. Rheumatology. 2012;51(4):715-20.
Lee SJ, Terkeltaub RA, Kavanaugh A. Recent developments in diet and gout. Curr Opin Rheumatol. 2006;18(2):193-8.
Li EK. Gout: a review of its aetiology and treatment. Hong Kong Med J. 2004;10(4):261-70.
Li S, Micheletti R. Role of diet in rheumatic disease. [Review]. Rheum Dis Clin North Am. 2011;37(1):119-33.
Park KY, Kim HJ, Ahn HS, et al. Effects of coffee consumption on serum uric acid: systematic review and meta-analysis. Semin Arthritis Rheum. 2016;S0049-0172(16).
Pascual E, Sivera F. Therapeutic advances in gout. Curr Opin Rheumatol. 2007;19(2):122-7.
Peterson DM. Nonsteroidal anti-inflammatory drugs and colchicine to prevent gout flare during early urate-lowering therapy: perspectives on alternative therapies and costs. J Pain Palliat Care Pharmacother. 2010;24(4):402-4.
Richette P, Bardin T. Gout. Lancet. 2010;375(9711):318-28.
Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther. 2006;8 Suppl 1:S2.
Schelesinger N. Overview of the management of acute gout and the role of adrenocorticotropic hormone. Drugs. 2008;68(4):407-15.
Schlesinger N, Dalbeth N, Perez-Ruiz F. Gout -- what are the treatment options? Expert Opin Pharmacother. 2009;10(8):1319-28.
Schumacher HR Jr, Chen LX. Newer therapeutic approaches: gout. Rheum Dis Clin North Am. 2006;32(1):235-44, xii. Review.
Shannon JA, Cole SW. Pegloticase: a novel agent for treatment-refractory gout. Ann Pharmacother. 2012;46(3):368-76.
Suresh E, Das P. Recent advances in management of gout. QJM. 2011 Dec 23. [Epub ahead of print].
Vaghamshi R, Jaiswal M, Patgiri BJ, et al. A comparative pharmacological evaluation of Taila (oil) and Ghrita (ghee) prepared with Guduchi (Tinospora cordifolia). Ayu. 2010;31(4):504-8.
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):1165-72.
Zhang SJ, Liu JP, He KQ. Treatment of acute gouty arthritis by blood-letting cupping plus herbal medicine. J Tradit Chin Med. 2010;30(1):18-20.
Zhang Y, Chen C, Choi H, et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis. 2012;71(9):1448-53.
Zhang Y, Neogi T, Chen C, et al. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis Rheum. 2012;64(12):4004-11.