A recurrent acute arthritis of peripheral joints which results from
depositions, in and about the joints and tendons, of crystals of monosodium
urate from supersaturated hyperuricemic body fluids; the arthritis may become
chronic and deforming.
The inflammatory process here is unrelated to infection. Rather, it is incited
by the deposition in the joint of uric acid present in the bloodstream.
An attack of acute gouty arthritis is caused by the formation of needlelike
crystals of the deposited uric acid. When these crystals are ingested by
white blood cells, the cells release enzymes that evoke inflammations. Uric
acid is a normal breakdown product of urine metabolism. When extreme, the
gouty process results in large deposits of uric acid, or tophi, around joints.
Classically, it occurs acutely as intermittent attacks of joint pain, swelling,
redness and warmth. In some individuals, it is a progressive, crippling
chronic disease that also damages the kidneys. Gout is 20 times commoner
in men than women. Obesity, high blood pressure and atherosclerotic heart
disease are often associated. A familial pattern is observed in 5-15% of
cases.
To understand gout it is first necessary to have a basic knowledge of the
chemistry of uric acid. This naturally occurring substance is a product
of the chemical breakdown of the purine bases that compose the genetic material,
DNA. As cells die and release DNA from their chromosomes, purines are converted
into uric acid which is excreted in the urine and, to a lesser extent, the
intestinal tract. Levels of uric acid dissolved in the bloodstream is directly
related to this delicate balance between uric acid production and excretion.
The normal level is approximately 2-7 mg./dl.
Hyperuricemia describes high blood concentrations of uric acid. In the most
cases an underexcretion of uric acid by the kidneys is responsible. Among
the more common predisposing factors are kidney failure from any cause,
diuretics, dehydration, hormonal diseases, alcohol and low doses of aspirin.
About 10% of people with hyperuricemia are overproducers of uric acid. For
some of these patients, diseases of the blood and bone marrow or inherited
enzyme abnormalities can be implicated. Some are associated with metabolic
alterations due to obesity, but for most the exact cause is indeterminable.
Only 1 in 20 cases of hyperuricemia goes on to develop gout. Attacks of
gout are caused by the body’s inflammatory reaction to intermittent precipitation
of uric acid crystals into the joints.
The signs and symptoms of acute gout are:
- There is a rapid onset of severe joint pain, swelling and redness. The
often begins at night after ingestion of alcoholic beverages, uric acid-elevating
medications or high-purine foods. - In 90% of initial episodes a single joint is involved–especially the
joint at the base of the big toe. Gouty arthritis of the big toe, afflicts
90% of the patients some time during the course of their disease. The foot,
heel, ankle, knee, hands, wrists and elbows are some of the other joints
that are frequently involved. - Attacks tend to last a few days to a few weeks.
- They respond well to medications.
- The frequency of subsequent attacks is variable. 5-10% of patients will
never be bothered again, but most relapse within a year. - Untreated cases may develop chronic gouty arthritis in which multiple
joints are involved by a long-term destructive process. Tophi, small nodules
consisting of uric acid and inflammatory tissues, may be seen on the ear
cartilage and along tendons.
Whilst sudden swelling and pain in a joint, especially the big toe, suggests
the diagnosis of gout, many other arthritic conditions and some infections
present themselves in a similar manner.
Actions indicated for the processes behind this disease:
Anti-Rheumatics will help to some degree, but only those
that have marked diuretic properties.
Diuretics play the pivotal role in any attempt at going beyond symptom
relief, as they can help flush the urates from the body.
Anti-Inflammatories may help, but not any where near as much as the
patient would like. The inflammation is an appropriate body response to
the presence of crystals.
Analgesics may help. However, the legal herbal analgesics do very
little in such cases.
System Support
General elimination must be adequate so if necessary support the liver and
kidneys.
Specific Remedies
The anti-lithic and many diuretic remedies are often considered specifics.
Colchicine, from the Autumn Crocus (Colchicum autumnale), is a specific
allopathic drug. However it is very unsafe to use the whole plant due to
its inherent toxicity.
One possible prescription:
Eupatorium purpureum 2 parts
Agropyron repens 2 parts
Apium graveolens 2 parts
Guaiacum officinalis 1 part to 5ml of tincture taken 3 times a day
Urtica dioica strong infusion drunk often
Broader Context of Treatment
- Eat raw fruit, vegetables, grains, seeds and nuts. Especially recommended
have been Cherries and Strawberries. - Preferably eat no meat as it is rich in uric acid forming components.
- Drink 6 pints of fluid a day. Slightly alkaline natural springwater
has been recommended. - Avoid purine rich foods: anchovies, asparagus, crab, fish roe, herring,
kidney, liver, meat gravies and broth, mushrooms, mussels, peas & beans,
sardines. - Avoid rapid weight loss diets. This may result in increased uric acid
levels in the blood. - Avoid all alcoholic drinks