Diseases

Gout symptoms and therapy

Gout symptoms and therapy



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Stinging joint pain after eating a lot of meat or excessive alcohol consumption are typical signs of an acute attack of gout. The disease can easily go into a chronic stage and cause permanent damage to the joints. However, there are relatively good therapeutic options both against the pain during the acute relapses and against the recurrence of the symptoms. Naturopathic measures for gout also have a very convincing effect and various home remedies are excellent for prevention.

Definition

Gout is often understood as a joint disease, but is actually a metabolic disease, the consequences of which can manifest not only in the joints, but also in the area of ​​the internal organs (especially the kidneys). Due to malfunctions in the purine-uric acid metabolism, uric acid accumulates excessively in the organism (hyperuricaemia) and uric acid crystals are formed, which are deposited in the joints and cause inflammation there. Hyperuricaemia also damages the kidneys in the long term, which in the worst case can result in life-threatening kidney failure.

Symptoms

The disease is characterized by a batch-wise course, whereby the acute phases are also referred to as gout attack, gout attack and acute gouty arthritis. Such an attack usually occurs relatively suddenly and is particularly noticeable through inflammation of the joints, which is caused by deposits of uric acid crystals. Recent research has shown that the crystals trigger the mechanism of direct "crystal-mediated cell death" and corresponding necrosis in the tissue. This in turn is the cause of the inflammation.

The inflammation of the joints is accompanied by swelling, overheating, redness and pain. The inflammation can theoretically manifest itself in every joint in the body. However, the big toe joints, ankles and wrists are particularly often affected. A visible sign of the acute attack is a "severely inflamed joint that feels very hot and is very red to bluish in color, swollen and extremely sensitive to touch," explains the German Rheumatism League. In addition, accompanying symptoms such as fever, headache, rapid heartbeat and nausea can be observed. If left untreated, the acute flare-up can last up to ten days.

Chronic course

If the disease is not treated, the attacks can be ascertained at ever shorter intervals, causing irreversible damage to the affected joints in the long term. Bone destruction and joint deformities are typical consequences. In the further course, the disease changes to a chronic stage after a few months to years. "The joints are then destroyed to such an extent that the patient often suffers from constant movement pain or swelling," reports the German Rheumatism League. The uric acid salt crystals can also deposit in the kidneys and lead to the formation of kidney stones, for example. As a result, kidney function is impaired, which makes this form of the disease far more dangerous for patients than joint gout. Last but not least, there is also a risk of deposits of the uric acid crystals under the skin, for example on the ears, in bursa bags or tendons. In many patients, a so-called gout node (gout tophus) forms, which is also visible externally as a marked thickening.

Gout causes

Regarding the causes of the disease, it can be stated that the majority of the patients have a genetic disposition, so that the disease is at least partially inheritable. In the further course, the symptoms are caused by an impairment of the purine-uric acid metabolism, which is characterized by an excessive formation of uric acid and / or an insufficient excretion via the kidney. Ultimately, too much uric acid remains in the organism, the level of uric acid in the blood rises (hyperuricaemia) and urine crystals begin to deposit in various places. The first symptoms often appear after a particularly rich meal (with a lot of meat and / or fish), excessive alcohol consumption, an infectious disease or unusually heavy physical exertion, as this increases the amount of uric acid in the body. The disorder of the purine-uric acid metabolism itself is due to an impairment of kidney function in many sufferers, but it can also be caused by diseases of the hematopoietic system and other rare diseases.

Risk factors

Numerous factors can cause a gout attack, with high meat, fish and alcohol consumption in particular being an often underestimated risk. The purines contained are metabolized to uric acid, which drives up their concentration. Fasting and dieting in combination with diuretics can also be mentioned as risk factors. Furthermore, the consumption of lemonade and fruit juice drinks is also linked to the disease, such as the excessive consumption of fresh peas, raisins, tomatoes or tofu. Some medicines are also known to be potential triggers. Caution should therefore be exercised when using medicines to lower blood pressure if there are already problems with the purine-uric acid metabolism.

Diagnosis

The increased uric acid level in the blood can be detected relatively easily using a uric acid test. In healthy people, uric acid levels of three to six milligrams per 100 milliliters of blood serum are normal. Men usually have a slightly higher value than women. If the value increases to more than seven milligrams per 100 milliliters, this can indicate a gout disease. The uric acid test is still the most important tool for early diagnosis. An examination of the synovial fluid for uric acid crystals can also provide important clues for diagnosis later on. Ultimately, however, the characteristic clinical picture of the complaints is also decisive for the diagnostic evaluation.

X-ray examinations can only make a contribution to the diagnosis in the later stage of the disease, when more uric acid crystals have already deposited in the joints. They also serve to monitor the course, since changes in the bone substance and deformities of the joints are usually clearly visible here. Damage to the kidneys can be determined with the help of a laboratory examination of the urine and imaging methods such as ultrasound examinations, computer tomography and magnetic resonance imaging.

Therapy

The aim of the treatment is basically to normalize the uric acid level. Two different drug groups are available for this purpose, which either inhibit uric acid formation or promote its excretion. "Benzbromaron is the name of the active ingredient that increases uric acid excretion by the kidneys" and "the active ingredient allopurinol reduces the formation of uric acid in the body", explains the German Rheumatism League. In addition, the acute attacks are usually treated with so-called non-steroidal anti-inflammatory drugs NSAIDs, which have an anti-inflammatory and analgesic effect. The poison of the autumn timeless, the active ingredient colchicine, is also used to treat acute symptoms - however, due to the impending side effects, it is much less common today than in the past. Last but not least, the use of cortisone should be mentioned as an option for the medicinal treatment of an acute episode of illness.

Gout diet

In general, nutrition plays an important role in gout, since purines ingested from food are metabolized to uric acid in the body. According to the German Nutrition Society (DGE), a permanent change in diet is the basis for long-term successful treatment. "Consistently carried out nutritional therapy helps to save medication or can even make drug treatment superfluous", the DGE pointed out. The occurrence of renewed relapses can be effectively countered by adhering to a special nutritional plan. According to the DGE, this should include "a low-purine diet with plenty of grain products, potatoes, selected types of vegetables, lettuce and fresh fruit, low-fat milk and milk products, eggs in moderation as well as sufficient liquid and little alcohol, especially little beer". Existing overweight should be reduced as much as possible, but fasting is counterproductive, since protein is broken down more during fasting, which increases the uric acid level. In this way, even an acute attack can be provoked. Those affected can find more detailed information in the DGE information center "Eating and drinking for gout".

Naturopathic therapy

Nutritional therapy is also a key factor in the naturopathic treatment of gout diseases. By adhering to special diets, the formation of uric acid should be reduced or its excretion promoted. In addition, naturopathy knows various other treatment approaches with which drug therapy - especially in the case of minor forms of illness - can often be completely avoided. Naturopathic procedures can also be used to alleviate acute symptoms. Herbal medicine and hydrotherapy in particular are believed to have convincing effects. Homeopathy and other methods are also used to combat metabolic diseases.

All in all, naturopathy offers numerous starting points for the relief of symptoms and, last but not least, regulation of the acid-base balance often plays a significant role in naturopathic treatment in terms of prevention. Alkaline food is used to avoid acidification of the organism and thus counteract the occurrence of an acute attack of gout. Which naturopathic procedures are used depends in the end heavily on the individual symptoms of the patient and the methods described below only form part of the spectrum of possible treatment approaches.

Herbal medicine

Various medicinal plants combined with consistent nutritional therapy can contribute to the normalization of uric acid levels, so that drug therapy may not be necessary at all. Even when the course of the disease is severe, medicinal plants can often significantly reduce the amount of medication required, report Professor Dr. med. Wolfgang Exel and colleagues in their book "How to use naturopathy correctly". The medicinal plants stimulate the activity of the urinary organs and promote the excretion of uric acid. Accompanying should be drunk a lot of water. However, patients with impaired kidney function must be careful here and should only use medicinal plants in consultation with the doctor.

In her work "Health from God's Pharmacy", Maria Treben mentions medicinal plant treatment methods that have a particularly promising effect on metabolic diseases, in addition to full baths with added nettle and the consumption of fresh dandelion stems (five to six per day), as well as tea from club moss, honorary award, mustache, cowslips or coltsfoot. The tea blends can also be used as home remedies for the disease.

Blood purifying tea blend according to Maria Treben:
50 grams of cowslips
50 grams of young elderberries
15 grams of nettle leaves
15 grams of dandelion roots

A heaped teaspoon of 250 milliliters of boiling water is brewed from the tea mixture and the infusion should then steep for around three minutes. Two cups of the tea are drunk in sips during the day.

Other medicinal plants worth mentioning are juniper, birch leaves, goldenrod and field horsetail, which are mostly used for the preparation of herbal tea blends, but can also be consumed neat (e.g. juniper) or processed into special tinctures.

Hydrotherapy

As a special hydrotherapy treatment for acute gout attacks, Kneipp applications are a particularly promising method for pain relief and curbing inflammation. Cold Kneipp treatments in particular have a quick effect on the pain. According to Professor Dr. Wolfgang Exel and colleagues took the cold partial bath, whereby the water should be cooled down as much as possible with the added ice cubes. The patients then immerse the affected joint in the cold water for around 30 seconds. This can be repeated several times after a short break. However, there are some contraindications to the cold Kneipp treatments. For example, the cold partial bath should be avoided in the event of circulatory disorders. Caution should also be exercised in the case of cardiovascular diseases such as high blood pressure and a doctor should be consulted here before using hydrotherapy.

Homeopathy

Various remedies from the field of homeopathy have proven successful in the treatment of symptoms. Especially with Ledum palustre and Bryonia as a follow-up, the acute symptoms of a gout attack can be alleviated. Other homeopathic remedies also promise improvement, although the choice should be left to experienced therapists or doctors. The same applies to the use of Schüssler salt therapy. For example, the Schüssler salts No. 8 (sodium chloratum), No. 9 (sodium phosphoricum) or No. 11 (silicea) can be used here. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters, Barbara Schindewolf-Lensch

Swell:

  • Institute for Quality and Efficiency in Health Care (IQWiG): Gout (accessed: 16.08.2019), gesundheitsinformation.de
  • Deutsche Gicht-Liga e.V .: Information on the disease (accessed: August 16, 2019), gichtliga.de
  • German Society for Rheumatology (DGRh): S2e guideline for gouty arthritis - specialist medical care, as of April 2016, detailed view of guidelines
  • German Society for General Medicine and Family Medicine (DEGAM): S1 Gout guideline: Frequent gout attacks and chronic gout in primary care, as of September 2013, detailed view of guidelines
  • Gerd, Herold, Internal Medicine 2019, self-published, 2018

ICD codes for this disease: M10ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: GOUT, Causes, Signs and Symptoms, Diagnosis and Treatment. (August 2022).