What is Gout? Gout describes a number of disorders in which crystals of monosodium urate monohydrate derived from hyperuricaemic body fluids give rise to inflammatory arthritis (swollen and inflamed joints), tenosynovitis (swelling of muscle tendon and its covering sheath), bursitis (swelling in the spaces of joints) or cellulites (swelling with redness and fluid collection), urolithiasis (kidney stones) and kidney disease.
Gout is a collection of disease, mainly affecting small joints. It is also related with disorders of kidney.
It is predominantly seen in males (above sixteen years) and is seldom seen in females before menopause. It is the most common cause of inflammatory joint disease in men over 40 years.
Uric acid concentration in the body fluids depends upon balance between purine synthesis and uric acid elimination through the kidneys and intestine.
Various genetic and environmental factors lead to increased uric acid levels in the blood, either by decreasing he excretion of uric acid or by increasing its production. In about 75 % of patients, genetic deformity contributes to increased uric acid levels by decreased uric acid excretion through urine.
In about 25 % of patients, increased uric acid production is the cause for gout. In such patients, if the kidneys are normal, they excrete more and more uric acid through urine.
Factors influencing gout and increased uric acid levels in the blood:
- Renal failure.
- Drugs like diuretics, Pyrazinamide, and aspirin
- Lead poisoning
- Hyper parathyroidism (increased parathyroid hormone)
- Down’s syndrome
- lactic acidosis by alcohol, exercise, starvation, vomiting and toxaemia in pregnancy.
Symptoms of gout:
Acute gout (sudden onset): the joint of the great toe, (metatarsophalangeal joint) is the site of first acute gout attack in 70 % of cases. In the rest of cases, it affects ankle, knee, small joints of feet and hand in the decreasing order of frequency. sometimes the onset may be very sudden, waking up the patient from sleep. The affected joint looks red, hot, swollen with prominent veins, with severe pain. In some cases, it is preceded by nausea, lack of taste etc. If left untreated, it may last for a few days or weeks, and may also get healed by itself. But sometimes, this self-healing may lead to itching and desquamation of skin at the place (joint) of gout attack.
Some patients may have only one attack in their entire life time, and many may have repeated attack after several months or years. Acute attack usually presents with features like cellulites, synovitis, bursitis and tenosynovitis.
Acute gout attacks may happen repeatedly due to sudden rise in serum urate following alcohol, severe dietary restrictions, diuretic drugs. Acute gout attacks may also be provoked by trauma, unusual physical exercise, surgery or severe systemic illness.
Usually , one acute gout attack may not lead to disability.
Recurrent gout attacks lead to chronic gout. It leads to erosion of cartilage and bones. Severe joint deformities are also seen.
Urate urolithiasis (formation of urate kidney stones):
This is seen in 10-15 % of people, usually in Gout patients from hot climates. Formation of urate stones is favoured by increased uric acid in the urine, purine over production, excessive purine intake in blood, low urine pH, as in chronic diarrhea.
Chronic urate nephropathy: Gout and hyper uric acid levels in blood are associated with kidney disorder. This occurs due to urate stone formation, kidney tube obstruction, and increased blood pressure.
Other disease manifestation:
Gout and increased uric acid levels in blood often associated with high BP, obesity, diabetes mellitus, ischemic heart diseases etc.
Serum urate level increase is appreciable. But it is not only the diagnostic criterion. The clinical symptoms should also be taken into consideration.
There are many joint related disorders explained in Ayurvedic text books, of which, grossly Vatarakta signs and symptoms can be co related with Gout.
Ayurvedic herbal remedies for Gout:
Indian Tinospora (giloya) Most of the Ayurvedic medicines for Gout contain this herb.
Guduchyaaha swarasam choornam kalkam kwathameva va |
Peetwa kwatham asrugvatam kramaat sarvaangagam jayet || - Bhaishjya ratnavai – 27/10
Giloya in the form of water decoction, powder, juice etc shouldbe used to treat Vatarakta (also called as Asrug vata).
Study conducted at department of pharmacology nagpur, has proved the immunomodulatory effect of indian tinospora. Guduchi is also a proven anti inflammatory agent . click to read.
Terminalia Chebula is used as an ingredient for many gout herbal remedies. A study conducted in pharmacology division of Visakapattanam has revealed the reno protective (kidney – protective) activity of Hareetaki. Click to read.
It is a proven anti inflammatory and anti arthritic drug. It acts specifically over affected joints to bring about quick relief from pain and inflammation. click to read.
Guggulu - It has potent anti- inflammatory action and is used in Ayurveda for arthritis conditions including Gouty arthritis.
Diet for gout:
Low purine intake, no alcohol, gradual steps to decrease weight, helps in fall of uric acid levels. But severe dietary restrictions are best avoided.
Gout foods to avoid:
Purine rich foods - Beer, other alcoholic beverages, Anchovies, sardines in oil, fish roes, herring, Yeast, Organ meat (liver, kidneys, sweetbreads), Legumes (dried beans, peas), Meat extracts, consommé, gravies, Mushrooms, spinach, cauliflower.
Gout: food to have –
Low purine diet for gout – Rice, eggs (limited intake), Nuts and peanut butter ( limited intake), fat-free cheeses and ice cream, Milk: skim or 1% (limited intake), soups made without meat extract or broth,Vegetables not on the lists above, Fruits and juices, Breads and cereals: low fiber, white flour, or refined grain types, Pasta and macaroni. Rice, Soda, Coffee, dark berries,and tea.
Home remedies for Gout:
Green gram soup,
kashayayam abhayaanaam vaa paayayet ghritabharjitam | – Ashtanga Sangraha ckikitsashana – 22/12
Decoction of Abhaya (hareetaki – Terminalia Chebula ), fried in ghee should be consumed follwed by drinking of milk.
Dashamoola shataksheeram sadyaha shoolanivaranam |
Parisheke anila praaye tadwat koshnena sarpishaa || - Ashtanga Sangraha ckikitsashana – 22/23.
Milk boiled with dashamoola (group of ten herbs) , poured warm, over the affected joints gives quick relief from pain.
Similarly ghee, processed with Dashamoola.
Ayurvedic Panchakarma therapies for Gout: virechana and basti