Generic term for diseases with increased concentrations of uric acid in the body, re-occurring attacks of joint inflammation caused by crystallization of the synovial fluid, accumulation of uric acid in the joint cavities (tophi), and kidney problems.

True arthritis is also known as gout or podagra. The disease is caused by uric acid crystals precipitating - most often in articular cartilage around the joints but also in the arms and legs, bones, connective tissues, or in organs. The precipitation of uric acid may also cause kidney stones. The accumulation of uric acid can be caused by the kidneys not excreting enough uric acid.

The symptoms come in attacks, they often affect a specific joint which will become red and very painful like in the case of an inflammation. The inflammation can be caused by the immune system attacking the uric acid crystals, and fever and shivers might occur. The attack most often ceases in a couple of days.

Podagra
When the metatarsophalangeal joint of the big toe is affected it is called podagra. The first outbreak most often occurs after a good meal (rich in purine) in combination with alcohol.

True arthritis is included under the heading of lifestyle diseases even though it is possible to have a hereditary disposition. Too much food containing purine, such as meat - especially offal but also meat soup, and poultry, yeast, shellfish, mackerel, herrings, sardines, and anchovies aggravate the disease. The same goes for alcohol, fat, and sugar. Food with a low content of purine is, for example: eggs, cereals, nuts, olives, and fruit. Many podagra patients are overweight and suffer from blood pressure- and blood sugar problems.

These things can be present on their own or in a combination. Not nearly everyone who suffer from high levels of uric acid in their blood experience rheumatic attacks, e.g. podagra, but podagra can be a forewarning of gout.

The disease is absolutely mostly occuring in men; seldom before the age of 30 and most often around the age of 50. There is a hereditary tendency. The disease often starts suddenly, most often during the night, accompanied by pain, flushing, and swelling of one or more joints, most often in the legs and particularly often in the metatarsophalangeal joint of the big toe.

The attack is often provoked by alcohol, a large meal, medicine, damages, or surgical procedures. It can last from days to weeks after which it totally disappears. More than 50% have another attack within a year, but many years might also pass before the next attack occurs. Later attacks have a tendency to being linked, being severe and sustained and to being accompanied by fever. Gout and chronic polyarthritis, therefore, can be difficult to distinguish from one another.

The essential thing about gout is the elevated level of uric acid in the body. This might be caused by too large a production or a delayed excretion of uric acid (which is sparingly soluble) - or a combination of both.

When disregarding hereditary disturbances of the uric acid metabolism, diuretic treatment is one of the most important causes of too high a level of uric acid in the blood as a lack of fluid in the body - in connection with diuretic treatment - leads to a larger re-absorption and a decreased excretion of uric acid. Acetylsalicylic acid, nicotinic acid, and alcohol can also result in too much uric acid in the blood.

Suggestions

General advice on disease prevention and a healthy lifestyle can be found in the library article "General Advice - for healthy as well as for ill ones" in the VitaHealth section under Focus Articles. You can also test your health by taking our "Health Check".

Prevention first and foremost consists of a slow weight loss (a quick weight loss can trigger attacks) and avoiding the things in your diet that can cause too large a production of uric acid. The treatment consists in preventing accumulation of uric acid in joints, kidneys, and other places and in this way preventing complications. Moreover, it is a good idea to cleanse the body of this accumulation of acid, stop the attacks, prevent new ones, and relieve acute pain.

Strict temperance with alcohol, e.g. wine, spirits, and beer - which should actually be totally avoided - is recommended. It is important to drink a lot of water. Potato water has an antacid effect; both the juice from raw potatoes and the water from boiled potatoes. Vegetable juices can also be recommended.

It is also important to exercise daily. You should eat regularly and not too large meals. It is a good idea to eat vegetables of all kinds several times a day - not beans, lentils, or split peas, however.

Fish is a good thing, except for anchovies, mackerel, and herring. Only eat little meat, egg, cheese, butter, cream, and margarine. Avoid meat soup, meat extract, stock cubes, liver, and kidney which all contain a lot of purine which will turn into uric acid in the body. You can also consult an experienced dietician.

The following advice can also be tried out:
Mix 2 tbsp. of olive oil with 5 drops of juniper oil and massage the affected joint with this mixture several times a day.
Take a cold foot bath with 2½ litres of water and add 10 drops of juniper oil and 10 drops of rosemary oil.
Ice and cold water is good as first aid, but only for 20 minutes at a time.
Ground elder can be used as compress on the joint.

Avocado leaves and -bark, Persea americana, plus the seeds of smallage, Apium graveolens, reduce an elevated level of uric acid.
Bromelain: In case of acute arthritis: Take 500 mg. every three hours until the pain subsides. As a preventive measure: 500 mg. morning and evening. Works well with Quercetin.
Cat's claw, Uncaria tomentosa, reduces the level of uric acid.
Celery - as tablets or decoction made from the seeds - helps to discharge urates and other waste products. You can also add 25 g. of celery seeds to your food daily. Standardized celery extract (contains 85% 3-n-butyl phthalide): In this case the dosage is 75 - 150 mg. twice a day.
Cherry, Prunus, is a delicious but somewhat expensive cure for gout. You can combine cherry with blueberry and strawberry and season with turmeric and ginger.
Cone flower, Echinacea purpurea, increases resistance.
Devil's claw, Harpagophytum procumbens, lowers elevated levels of uric acid and has an anti-inflammatory effect. Most beneficial as capsules or tablets.
Garlic, Allium sativum, cleanses the blood and strenghtens the immune system.
Golden rod, Solidago virgaurea, cleanses the kidneys and has a diuretic effect.
Lemon, Citrus limon, has a generally reducing effect on the acidity.
Liquorice, Glycyrrhiza glabra, inhibits the production of uric acid. Do not drink more than 3 cups a day. Do not use liquorice if you suffer from elevated blood pressure.
Meadow-sweet, Filipendula ulmaria, reduces the acidity in the body.
Nettle, Urtica dioica, increases the discharge of uric acid if taken as an extract. It has a blood cleansing and analgesic effect.
Oats, Avena sativa, also is beneficial against uric acid as it contains quite a lot of silicon and has a diuretic effect.
Olive, Olea europea, has a diuretic effect and increases the discharge of uric acid from the body.
Pineapple, ananas comusus, inhibits swelling and inflammation.
Shiso, Perilla frutescens, inhibits the production of uric acid in the body.
St. John's wort oil, Hypericum perforatum, is good for smearing onto the skin overlying the painful joint.
Turmeric, Curcuma longa, has a cleansing, analgesic, and anti-inflammatory effect on the body. Can be taken in the form of capsules or by eating Indian curry dishes.
Willow, Salix alba, has analgesic and anti-inflammatory effects. It also increases the discharge of uric acid. Make a tea from 2 tsp. of pulverized dried bark to 1 cup of boiling water. Let the tea draw for 20 minutes, filter it, and drink it in small slurps.

Some homeopathic remedies can also be beneficial: E.g. Aconite (wolfsbane) 12 C, Belladonna 12 C, and Colchicum 12 C. Also Urtica urens 12 C (American recommendation).
It is also important to prevent kidney stones and sequelae such as obesity, too high levels of fat in the blood, poor kidney function, and too high blood pressure. Medical treament, however, does not render other kinds of prophylaxis superfluous.

Conventional treatment:
Attacks are most often treated with colchicine, indomethacin, or other substances of the ibuprofen group (NSAIDs). It is important that treatment is initiated as soon as possible. It should be continued 3 - 4 days after all signs of inflammation have disappeared.

It can also be necessary to take medicin which increases the discharge of uric acid. The substance allopurinol is most often used. It reduces the production of uric acid by stopping the break-down on the stage before uric acid and this substance is more easily soluble and more easy to discharge. Severe side effects are rare. The most frequently occurring are rashes, stomach pain, diarrhoea, and headache.

Warnings

If you have strong pains you should consult a doctor before starting self-treatment.

Remarks

Also see "Arthritis and rheumatic diseases in general", "Kidney stones", and "Osteoarthritis".

Relevant health litterature

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