Gout is a metabolic disorder characterized by the accumulation of uric acid salts in the joints, bones, kidneys, liver, or under the skin. What causes urate crystals to form in the body, and can they be treated?
Symptoms of Gout
While urates can affect all joints, from fingers to toes, the first signs of gout typically appear in the lower extremities. In cases of gout in the feet, the joints stiffened by urates become painful, swollen, and lose their mobility. Most people discover they have developed this condition after experiencing their first attack—a sudden pain in the big toe on one or both feet. A swollen and painful joint, sharp joint pain, redness of the smooth skin over the joint, and an increase in local temperature are all signs of gouty arthritis. Unlike rheumatoid arthritis, which does not announce itself as dramatically, gout is often accompanied by a distinctive smell reminiscent of sour milk due to the disruption of uric acid metabolism.
This condition was first described in 2600 B.C. in Ancient Egypt, and in the 5th century B.C., the ancient Greek physician and philosopher Hippocrates listed the clinical manifestations of this dangerous condition in his “Aphorisms,” noting that it was not typically found in eunuchs or women before menopause. He referred to the sharp pain in the big toe as gout, which translates from Latin as “trap on the foot.” The English physician Thomas Sydenham, writing in the 17th century, vividly described the pain of gouty arthritis in his “Treatise on Gout,” comparing it to “squeezing the foot in a press” or “a bite on the toe by a huge dog.”
A Dangerous Outlook
A hallmark of gout is the sudden onset and spontaneous resolution of symptoms. After a week, the intense pain in the joint subsides just as unexpectedly as it appeared. Discomfort in the joint can last from a few days to several weeks. Typically, a gout attack lasts from three to ten days, after which there is no trace of pain. The skin returns to its normal color, and the joint regains its function. Months or even years can pass before the next gout attack, but over time, these “clear” intervals become shorter. Attacks recur, and the disease progresses.
The inevitable progression leads to severe chronic arthritis and gouty arthropathy. The end result can be damage to internal organs due to the deposition of uric acid crystals, joint deformation, and limited joint function. If urates form a large stone, a coral-like formation can completely block the renal cavity. Gout complicates urine flow and can lead to chronic kidney failure. Hydronephrotic changes occur when the kidney turns into a “bag of urine,” losing its function.
Causes of Gout
The Roman philosopher and physician Aulus Cornelius Celsus suggested that alcohol consumption and kidney dysfunction contribute to the development of gout. The ancient Roman surgeon and philosopher Galen, in 150 A.D., identified “indulgence, debauchery, and heredity” as conditions that lead to gout. Gouty lesions often arise against a backdrop of an unhealthy lifestyle or poor diet: fasting, alcohol consumption, and foods that increase blood uric acid levels. Additionally, factors such as overheating or chilling, stress, physical exertion, injuries, and medication abuse (long-term use of aspirin, anti-tuberculosis, and antiviral drugs can be particularly harmful) can trigger a gout attack.
Relief is impossible without the patient quitting smoking, reducing alcohol intake (especially beer), limiting the consumption of high-purine foods, maintaining a healthy lifestyle, managing comorbidities, and gradually losing weight. Rapid weight loss, defined as losing more than 10% of body weight in a month, worsens uric acid metabolism due to an imbalance in the breakdown of organic compounds and increased protein breakdown in the body. Gout patients should avoid saunas, baths, and excessive heat: profuse sweating exacerbates uric acid metabolism issues, further impairing kidney function. Moderate physical activity (walking, swimming), limiting diuretic use, and adhering to a low-purine diet are recommended.
Treatment of Gout
Monitoring the progression of gouty arthritis falls under the purview of a rheumatologist. If a diagnosis has not yet been established, tests should be ordered during the initial examination by a therapist. Gout diagnosis is conducted through urine and venous blood tests. During an exacerbation, changes in the leukocyte formula and elevated uric acid levels are detected. In asymptomatic phases, the analysis becomes less informative, and X-rays of the joints may be indicated. Patients with newly diagnosed gout or those experiencing an exacerbation are typically admitted for inpatient treatment in a specialized rheumatology department.
The duration of inpatient treatment, with effective therapy selection, is typically one to two weeks. The goal of the doctors is to improve clinical and laboratory indicators, achieving uric acid levels within the range of 315–365 units (with a critical lower limit of 180). Modern gout treatment may involve outpatient surgery under local anesthesia to remove foreign contents through an incision in the affected area. Timely removal of gouty formations helps prevent arthritic joint deformities. Unfortunately, current pharmacology does not offer a universal medication for treating gout, and completely curing this chronic condition remains impossible.
Diet for Gout
Severe pain and deformation in the area of the big toe signal the need for a low-purine diet. This diet involves minimal consumption of meat and meat products, red fish, caviar from salmon or sturgeon, shrimp, and shellfish, as well as mushrooms and certain plants—such as asparagus, lentils, soy, beans, kidney beans, and peas. Vitamins B1, B2, PP, C, potassium, and magnesium help lower blood uric acid levels. A low-purine diet does not restrict vegetables, fruits, nuts, cereals, pasta, bread, and dairy products. Milk is the most valuable component of the diet for gout, as it contains proteins (alpha-lactalbumin, beta-lactoglobulin, casein) that reduce blood uric acid levels by promoting its excretion through urine.
Due to the negative impact of ethanol on uric acid excretion, gout patients should avoid alcohol. The diet for gout should exclude alcoholic and mixed beverages. Beer and red wine are sources of purines. Non-alcoholic drinks often contain high levels of fructose, which can contribute to hyperuricemia. In addition to plain drinking water, the gout diet should include alkaline mineral water, milk (if there is no individual intolerance), unsweetened juices (especially cherry), compotes (from cherries, sweet cherries, cranberries, dried fruits), and fruit drinks. It is essential to drink 1.5–2 liters of fluid daily. Birch leaves and bearberry herb, as well as infusions of linden, mint, and rosehip broth, can aid in the excretion of uric acid from the body.
Home Remedies for Gout
To alleviate pain and reduce the growth of salt “bumps,” baths, ointments, compresses, decoctions, tinctures, and teas can be helpful.
Butter Ointment
A grandmother’s recipe for combating pain during a gout attack involves making an ointment from two ingredients: unsalted homemade butter and alcohol. Melt the butter over heat until it foams, then add alcohol (1:1), carefully ignite it, and allow the alcohol to burn off. The resulting ointment is collected in a separate container and stored in the refrigerator. Apply the ointment to the affected area during an attack.
Iodine Ointment
Dissolve 5 tablets of acetylsalicylic acid in 10 ml of iodine. Use the resulting colorless liquid to rub the affected joints at night, keeping them warm with socks or gloves.
Foot Baths
During a gout flare-up, foot baths with iodine can help relieve pain in the ankle. Dissolve 10 drops of iodine and 3 teaspoons of baking soda in 3 liters of warm water. Soak your feet as soon as pain appears. Regularity of the procedure is key to reducing salt bumps.
Onion Decoction for Gout
Boil three medium onions with their skins in a liter of water until completely softened. Strain the decoction and take it three times a day before meals for two weeks.
Lilac Tincture
During lilac blooming season, gather flowers and fill a half-liter bottle without compressing the contents. Pour in a glass of vodka (this will press the flowers down and prevent spillage). Let the mixture steep in a dark place for a week, shaking it occasionally. During a gout flare-up, take 50 drops of lilac tincture three times a day before meals.
Chickweed Tea for Gout
Pour boiling water over 2 teaspoons of chickweed herbal mixture and drink it like tea after a few minutes.
Chamomile Compress
Mix pharmacy chamomile in equal parts with black elderflower, pour boiling water over it, and heat without boiling. Turn off the heat, let it cool, and soak a cotton pad in the infusion, applying the compress to the inflamed bump on the joint. Additionally, you can make baths for gout using a decoction of chamomile (10 g of flowers per liter of water) and 200 g of salt.
Combined Dry Mixture
Take 5 parts of peony flowers, cornflowers, marigolds, buckthorn bark, and juniper berries. Add 10 parts of black elderflower and stinging nettle, and 20 parts of field horsetail, birch leaves, and willow bark. Pour 1 tablespoon of this dry mixture with a glass of boiling water, wrap it in a towel, and let it steep for half an hour. Drink the entire decoction at once and repeat its consumption every two hours until pain relief is achieved.
Pine Nuts with Honey
Mix pine nut kernels with honey in a 1:1 ratio and take 1 tablespoon three times a day as a preventive measure against salt deposits.
Despite being considered the most complex type of arthritis, with the support of phytotherapy, homeopathic remedies, and homemade preparations, it is possible to learn to live “in harmony” with gout.