Gout Treatment – Understanding the Various Approaches

Gout Treatment – Understanding the Various Approaches. Gout is a form of arthritis that is associated with uric acid overload and deposition of uric acid salts (urates) in the affected joints. Uric acid is created in the liver when the body breaks down purine nucleotides.  Normally, two thirds of the circulating uric acid is eliminated via kidneys and one third is eliminated through bile secretion into the gastrointestinal tract. The causes of uric acid elevation can be classified into three functional types: increased production of uric acid, decreased excretion of uric acid, and mixed type.

Causes of increased production include high levels of purine in the diet and increased purine metabolism. Causes of decreased excretion include kidney disease, certain drugs, and competition for excretion between uric acid and other molecules. Mixed type causes include high levels of alcohol and/or fructose in the diet, and starvation.

Uric acid forms crystals (urate deposition) when it reaches a concentration of 6.2 grams per deciliter and above.  Urate deposition in the joints, acute gouty attack, is a very painful condition which typically happens abruptly and lasts for days and possibly weeks without appropriate therapy. In contrast to the common belief that gout exclusively affects the big toes; the disease can affect any joint in the body.  Joints frequently affected by gout include: bases of the toes (1st metatarsal joints), ankles, elbows, wrists, shoulders and 2nd and 3rd knuckles (metatarsophalangeal joints).   Although infrequent, gout can affect even the cervical and lumbar spine.  Recurrent gouty attacks can cause joint destruction and the formation of deformities. In addition to joint damage, urate crystals can form kidney stones and large tumor-like soft tissue lesions (tophi).

Gout Treatment Therapy

Typically, gout treatment is divided into therapy during acute gouty attacks and maintenance therapy between the attacks.

The traditional gout treatment therapy of acute gouty attacks is mainly focused on pain and inflammation control, and incorporates potent anti-inflammatory drugs such as corticosteroids (prednisone and methylprednisolone), nonsteroidal anti-inflammatory drugs, NSAIDs (indomethacin, diclofenac, naproxen, ibuprofen etc) and colchicine.

The traditional maintenance therapy for gout treatment is a long-term therapy (frequently, life-long therapy) focused on reduction of the uric acid overload. Two drugs, allopurinol and febuxostat, inhibit production of uric acid in the liver. Probenecid accelerates elimination of uric acid via kidneys. The ultimate goals of the therapy for gout are control of blood uric acid level below 5.0 gram per deciliter and elimination of uric acid crystals from the joints.

Dietary interventions for gout treatment include administration of low purine diet. The gout diet requires elimination of high purine containing products such as:

•    Meat: beef, mutton, veal, pork, venison, chicken, duck and turkey. Other organ meat such as brain, kidney, liver, pancreas, thymus, heart, and neck
•    Sea foods: cod, crab, lobster, snapper, salmon, tuna, trout, sardines and anchovies
•    Vegetables: cauliflower, asparagus, peas, spinach, lima beans, navy beans and lentils
•    Oatmeal
•    Alcoholic beverages
•    Yeast containing products

Although a low purine diet may benefit gout treatment, compliance with the gout diet is extremely difficult. An alternative therapy to drugs and diet restrictions can be found in food supplementation.

Nontraditional therapies for acute gouty attacks frequently incorporate food supplements and herbs with anti-inflammatory gout treatment activities such as:

•    High-dose omega-3 fish oil
•    Devil’s claw
•    Boswellia
•    Turmeric

Nontraditional therapy for gout treatment maintenance (between acute attacks) includes:

•    White mulberry fruit extract (morus albus)
•    Yucca schidigara extract
•    Black currant seed oil
•    Black cherry extract
•    Celery seed extract
•    Rose hip extract
•    Guggul
•    Triphala

Another direction in the nontraditional maintenance therapy for gout treatment is alkalinization of the urine. This can be achieved via administration of sodium bicarbonate, potassium citrate, magnesium citrate, and Bicitra under strict urine pH control.

Manage Gout Treatment

Gout treatment can be efficiently managed with both traditional and nontraditional therapies. The direction and supervision of therapy should be guided by a knowledgeable physician. Do not postpone the administration of the therapy, since it can efficiently prevent irreversible joint damage and disability.

Read more about gout treatment and other health issues at IFSMED.