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natural home remedies for gout attack

home remedies for gout, gout treatment, gout diet, gout symptoms, Another extremely popular natural remedy for gout pain is baking soda. 1. Fenugreek Seeds Fenugreek is an herb with light green leaves and small white flowers. · 2. Garlic Garlic is an incredible cure for gout. · 3. Ginger compress: Boil ginger and then soak a small towel in the ginger water. · Ginger paste: You can mash ginger root and combine with water to.

Natural home remedies for gout attack -

Chinese herbal medicine for gout: a review of the clinical evidence and pharmacological mechanisms

Chinese Medicinevolume 15, Article number: 17 () Cite this article

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Abstract

Gout is a common arthritis condition due to disorders of purine metabolism and decreased uric acid excretion. Although researchers have carried out various studies on this disease, there are no effective drugs for patients with gout. In traditional Chinese medicine (TCM), gout pertains the category of Bi pattern due to qi stagnation in the meridians and collaterals. Chinese herbal medicinals has been employed to treat Bi patterns since the ancient China. In recent decades, classical TCM formulas and agents isolated from some Chinese herbal medicinals have been applied to treat gout and have achieved satisfactory effect. In this review, we focus on recent studies of gout in which TCM formulas were applied to treat animal models or to treat patients, and summarize the mechanism of gout from TCM perspective, the clinical application, pharmacological mechanism and the chemical compounds of TCM formulas in treating gout. In conclusion, through this study, we summarized the application principle of TCM formulas in gout treatment and some key issues of current research, and we hope this study will provide some references for applying TCM formulas to treat gout and will lay a foundation for the development of novel formulas for gout treatments.

Background

Gout is a common arthritis condition due to deposition of monosodium urate (MSU), and is closely related to hyperuricemia [1]. Because of disorders of purine metabolism or impaired renal excretion [2, 3], serum uric acid levels rise to be abnormally high, and finally there would be the deposition of uric acid and acute persistent inflammatory reactions in the joints [4]. The most common clinical manifestations of gout are acute burning sensation and swelling of the joints. In some cases, clinical manifestations such as joint damage and renal dysfunction are often present [5]. Gout affects a significant portion of the population worldwide annually [6], and according to the estimates of World Health Organization (WHO), % of people worldwide are suffering from gout [7]. The acute onset of arthritis, joint malformations, chronic joint injuries and the formation of renal calculus not only reduce the quality of life, but also lead to disability [8].

Currently, although researchers have carried out various studies on this disease, there are no effective drugs for patients with gout. Drugs like colchicines, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have been applied to treat acute onset of gout [9]. These drugs show good effect in the short term, but when used for a long time, gastrointestinal reactions, rashes, systemic vacuities and even renal failure would occur [10, 11]. Besides, such drugs could not prevent, halt or reverse the progression of this complicated disease. Therefore, therapies or drugs which can intervene the development of gout are greatly needed in clinic.

Traditional Chinese medicine (TCM) has been applied to treat gout since the ancient China [12]. In TCM, gout is classified as Bi pattern usually due to qi stagnation in the meridians and collaterals. Under the guidance of pattern differentiation, classical TCM formulas and agents isolated from some herbs have been applied to treat gout with satisfactory effect [5]. Some chemical ingredients isolated from these formulas or Chinese herbal medicinals are of multi-target and low toxicity, showing advantages and good prospects in the prevention and treatment of gout (Fig. 1). In this review, the clinical application and pharmacological mechanism of TCM formulas in the treatment of gout are summarized, so as to develop novel formulas for gout treatments (Table 1).

The commonly used ingredients isolated from TCM formulas or Chinese herbal medicinals for the treatment of Gout. Eight herbs have been frequently used for gout treatment with low toxicity and excellent effect under the principle of syndrome differentiation and treatment

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Gout and Bi syndrome patterns

In TCM, gout pertains the category of Bi pattern [13]. In general, the manifestations of Bi pattern are mainly characterized as pain, numbness and heaviness of muscles, tendons and joints or swelling of joints with hot sensation and limitation of movement [14]. According to TCM, the primary causes are the deficiency of healthy qi and the invasion of pathogenic factors like wind, cold, dampness or heat [12]. It is recorded in Treatise on Blood Trouble that the transportation and transformation function of spleen is closely related to the disease mechanism of gout. The deficiency of spleen qi could cause obstruction in the digestion system and lead to the buildup of waste products like uric acid in the blood. In addition, the evidences from clinical trials suggested that the dampness accumulation and blood stasis in the meridian would result in the swelling and pain of joint and the buildup of uric acid in the blood [13]. Because of the individual difference of body constitution and different pathogenic factors, there are various types of Bi pattern. For example, people with yang-deficiency constitution are usually affected by the combined invasion of wind, cold and dampness, and therefore there would be a Bi pattern of cold-dampness type, while people with yang-predominance constitution or yin-deficiency and yang-hyperactivity constitution are usually affected by the combined invasion of wind, dampness and heat, and finally there would be Bi pattern of damp-heat type. Among those factors, dampness and heat are the most common external causes of acute gout, while the deficiency of healthy qi and the invasion of dampness are the most common external causes for gout during remission.

The clinical application of TCM formula in the treatment of gout

In the early stage of Bi pattern, the therapeutic principles are expelling pathogenic factors, for example, dispelling wind, dispersing cold, clearing away heat, eliminating dampness and dredging meridians and collaterals [15]. For the patient suffering from Bi pattern for long time or the patient with weak body constitution, in addition to the therapy for expelling pathogenic factors, tonifying the spleen, liver, kidneys and nourishing blood should also be applied. For patients with gout complicated by phlegm and blood stasis, activating blood circulation, dissipating blood stasis and masses and eliminating phlegm should also be applied (Fig. 2) [16].

The main different types of and the therapeutic principles of gout. There are three different types of gout based on syndrome differentiation

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The clinical application of TCM formula in treating acute gout

In recent years, TCM formulas are often modified or combined with chemical drugs to treat gout with fewer side effects, and have been regarded as the promising treatments [17]. Among these, Simiao Powder as well as the modified ones like Jiawei Simiao Powder, Tongfeng Decoction, Danxi Tongfeng Decoction are widely used for gout of damp-heat type. Chen et al. [17] found that the TCM formulas combined with chemical drugs showed better effect than chemical drugs applied alone. Similarly, the research from Huang et al. [18] suggested that the improvement of symptom score in the group treated with oral administration of Jiawei Simiao Powder and external application of Jinhuang Cream was more significant than that in the group treated with chemical drugs alone. In the group treated with TCM formula, the effective rate was higher than that in the group treated with chemical drugs, and the adverse reaction rate was significantly lower than that in the group treated with chemical drugs. Based on Simiao Powder, Tongfeng Decoction is invented and widely used. Wu et al. [19] found that after the administration of Tongfeng Decoction and celecoxib capsule, the acute inflammatory indicators in the blood sample of the gout patients were reduced, the inflammatory response was inhibited, the uric acid content was reduced, and the side effects were also reduced. In another clinical study, it was also found that the Danxi Tongfeng Decoction (the modified Simiao Powder) was better than celecoxib capsules in reducing the erythrocyte sedimentation rate (ESR) and serum uric acid (SUA) and prolonging the pain relieving time [20]. The above three TCM formulas with the effect of clearing away heat and draining dampness, and dredging the collaterals to stop pain, are modified from Simiao Powder.

Wuwei Xiaodu Decoction is an effective formula with the effect of clearing heat and detoxifying for treating patients with joint pain and obvious swelling. Yu et al. [21] applied modified Wuwei Xiaodu Decoction combined with colchicine tablets to treat the gout arthritis of damp-heat type, and found that the effective rate (%) was higher than that in the control group (%). Meanwhile, the combined application could effectively relieve acute joint pain, reduce swelling, relieve pain and improve joint function. Besides, the combined application of Guizhi Fuling Pill and Wuwei Xiaodu Decoction showed better effect than the combined application of meloxicam tablets and sodium bicarbonate tablets [22]. They have found that the effective rate was % in the group treated with TCM formulas, which was higher than that in the group treated with chemical drugs, and in the group treated with TCM formulas the pain degree was significantly reduced, the swelling score, SUA and C-reactive protein (CRP) levels were lower than those in the group treated with chemical drugs.

Patients with acute attack of gout usually show severe joint pain, high skin temperature, thirsty sensation, white or yellow coating on the tongue, and there are various therapeutic methods or formulas in TCM. Among them, Zhuye Shigao Decoction with the function of clearing away heat and nourishing yin, invigorating the spleen and draining dampness, is of good efficacy on these patients. In a clinical study by Li et al. [23], Zhuye Shigao Decoction combined with colchicine tablets and celecoxib capsules showed better effect than celecoxib capsules, the effective rate was increased from % to %, and the gastrointestinal reactions such as nausea, vomiting and diarrhea were reduced.

In another clinical reports, it is also illustrated that combined application of Qingre Chubi Decoction and etoricoxib tablets was better than etoricoxib tablets used alone to treat acute gout [24, 25]. Qingre Chubi Decoction, with the function of dispelling wind and draining dampness, and dredging the collaterals to stop pain, has good effect for patients with gout affected by the combined invasion of wind, dampness and heat [24, 25]. There are two formulas named as Qingre Chubi Decoction which are of different compositions and similar effects. One Qingre Chubi Decoction composed of Herba Aristolochiae Mollissimae, Caulis Sinomenii, Radix Cudraniae Cochinchinensi, Rhizoma Atractylodis Lanceae and Rhizoma Anemarrhenae, could relieve the clinical symptoms and signs effectively, and improve inflammation indexes more obviously than the chemical drugs. Another Qingre Chubi Decoction, composed of Caulis Sinomenii, Caulis Piperis Kadsura, Ramulus Mori, Radix Stephaniae Tetrandrae, Herba Lycopi Hirti, Radix et Rhizoma Clematidis, Rhizoma Smilacis Glabrae and Lumbricus, has a good therapeutic effect for gout and low incidence of adverse reactions [26, 27].

Wen et al. [28] proposed that the increased level of SUA was due to water-dampness and phlegm-dampness blocking the meridians and collaterals, and dysfunction of qi and blood from TCM perspective. He found that Tongfengshu Capsule could promote blood circulation and urination to reduce SUA with a total effective rate of %. Tang et al. [29] found that in patients treated with Tongfengshu Capsule combined with chemical drugs, symptoms and signs were relieved more obviously than in patients treated with chemical drugs alone, and the recurrence rate was lower than that in patients treated with chemical drugs 4 or 8 weeks after the treatment.

In the Synopsis of Golden Chamber the therapeutic principles for gout were dispelling cold and draining dampness, and clearing away heat and nourishing yin. Guizhi Shaoyao Zhimu Decoction is applied in clinic guided by those principle. Zhu et al. [30] found that the pain relieving time, number of relapses within 6 months and the TCM syndrome score in patients treated with the combined application of Guizhi Shaoyao Zhimu Decoction, celecoxib capsules and colchicine tablets, were lower than those treated with chemical drugs alone. He et al. [31] compared the modified Guizhi Shaoyao Zhimu Decoction with celecoxib capsules, and found that the pain and swelling were obviously relieved, and the activity restriction scores were significantly improved. Liu et al. [32] used Tongfengan Mixture according to the method of softening hard lumps and dispelling nodes to treat acute gout and found that this combination could reduce SUC, the severity and frequency of attacks. In conclusion, TCM formulas has better clinical efficacy and higher safety than chemical drugs in the treatment of gout.

The clinical application of TCM formulas in the treatment of gout during the remission stage

During the remission stage of gout, the disease mechanism of TCM usually involves spleen deficiency with dampness accumulation. From TCM perspective, the abnormal production and excretion of uric acid is related to the dysfunctional of spleen, and tends to result in the increased content of SUA [33]. Qin et al. [34] used Tongyang Mizhuo Decoction, composed of Lizhong Pills and Wuling Powder to treat gout during the remission stage and found that the total effective rate was % and the SUA level was significantly reduced after the treatment. Emerging evidences from clinical observations indicated that patients during the remission stage were characterized by spleen deficiency with dampness accumulation. Quzhuo Tongbi Decoction is often used to treat spleen deficiency with dampness accumulation pattern and therefore it is suitable to treat gout during remission stage [33].

According to the TCM theory of “treating disease before its onset”, Peiyuan Huazhuo Decoction, is mainly used to prevent renal damage in patients with gout. TCM doctors found that the symptoms and the renal damage were relieved after the combination therapy, suggesting that the application of Peiyuan Huazhuo Decoction had the function of strengthening healthy qi and inducing diuresis [35].

In conclusion, TCM formulas commonality is promoting the body resistance and eliminating pathogenic factors. Different TCM formulas are applied to achieve the relative equilibrium of yin-yang based on the heterogeneity of body constitution and pathogenic factors.

The pharmacological mechanism of TCM formulas in the treatment of gout

Emerging evidences have suggested that gout caused by monosodium urate deposition is related to disorders of purine metabolism and reduced uric acid excretion, so it is classified as a metabolic rheumatism. However, in recent studies it has been found that the pathogenesis is closely related to the mechanism of “metabolism-inflammation-immunity” [36]. TCM treatment for gout, especially the formulas from Synopsis of Golden Chamber could interfere the mechanism of “metabolism-inflammation-immunity” [37].

The pharmacological mechanism of Simiao Powder and it’s modification in the treatment of gout

Simiao Powder is composed of Cortex Phellodendri Amurensis, Semen Coicis, Radix Achyranthis Bidentatae and Rhizoma Atractylodis Lanceae. All the herbs in the Simiao Powder are also the major ingredients in the Jiawei Simiao Powder, Tongfeng Decoction and Danxi Tongfeng Decoction. According to TCM theory, Cortex Phellodendri Amurensis is bitter in flavor and has curative effects on the kidneys, bladder and large intestine. The main medicinal components of Cortex Phellodendri Amurensis are alkaloids such as berberine, lipoid and sterol [38], with the function of anti-inflammation, bacteriostasis, cellular immune regulation, anti-gout and inhibiting the apoptosis of articular chondrocytes [39]. Rhizoma Atractylodis Lanceae is pungent and bitter in flavor, and usually works on the kidneys, bladder and large intestine. It has the function of anti-bacterium, anti-inflammation, reducing blood glucose level and suppressing central nervous system [40]. Satoh et al. [41] found that Rhizoma Atractylodis Lanceae could inhibit the activity of sodium–potassium-ATPase, prevent the absorption of water and sodium ions, and thus to promote urination and excretion.

Radix Achyranthis Bidentatae is sweet in flavor, has the function of reinforcing liver and kidneys, strengthening muscles and bones, and promoting urination, and usually works on the liver and kidneys. It is reported that Radix Achyranthis Bidentatae could promote the excretion of uric acid, improve the cellular and humeral immunity as well as the non-specific immune function [42].

The combination of Cortex Phellodendri Amurensis, Radix Achyranthis Bidentatae and Rhizoma Atractylodis Lanceae can reduce the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 in synovial tissue. Having the function of anti-inflammatory and inhibiting cyclooxygenase-2 (COX-2), Semen Coicis Albais could works on regulating purine metabolism and reducing uric acid formation [43]. After Semen Coicis Albais is added, this combination of four herbs becomes Simiao Powder, which has good effect on the patient with gout of dampness-heat type [44]. Wang et al. [45] suggested that modified Sanmiao Powder could inhibit the content of inflammatory factors in the joint fluid of rats with acute gout arthritis.

Although Jiawei Simiao Powder, Tongfeng Decoction and Danxi Tongfeng Decoction are all invented based on Simiao Powder, the pharmacological mechanisms of these TCM formulas are different. Oral administration of Jiawei Simiao Powder and combined with external application of Jinhuang Cream could relieve the inflammation by reducing the levels of ESR, CRP and IL-8 [18]. Tongfeng Decoction could effectively reduce SUA, inhibit inflammatory response, halt the progression of the disease, and have the function of reducing uric acid [19]. Danxi Tongfeng Decoction could reduce ESR and SUA levels, and has a good analgesic effect [20].

The pharmacological mechanism of Wuwei Xiaodu Decoction in the treatment of gout

Wuwei Xiaodu Decoction, composed of Flos Lonicerae, Flos Dendranthematis Indici, Herba Taraxaci Mongolici, Herba Violae Philippicae and Nudicaulous Grounsel Herb, is firstly recorded in Golden Mirror of the Medical Tradition. It is recorded that Flos Lonicerae, Flos Dendranthematis Indici and Nudicaulous Grounsel Herb have the function of anti-inflammation and immunomodulation [46,47,48]. Some researchers find that Herba Taraxaci Mongolici has the function of anti-bacteria, anti-oxidation, anti-inflammation, diuresis, anti-allergy, promoting immunity, and is beneficial for the stomach [49]. Because of its strong effect of anti-pathogenic microorganisms, Herba Violae Philippicae is often used in the treatment of ulcers and carbuncle with symptoms like swelling and pain [50]. It is believed that Wuwei Xiaodu Decoction can enhance the immunity of diseased mice and reduce the IL to the normal level [51]. Besides, another report also illustrates that Wuwei Xiaodu Decoction could increase the phagocyte index and phagocyte rate of macrophages, adjust the balance of flora and thus enhance the immune function [52].

The pharmacological mechanism of Zhuye Shigao Decoction in the treatment of gout

Zhuye Shigao Decoction is composed of Folium Phyllostachydis Henonis, Gypsum Fibrosum, Rhizoma Pinelliae Praeparatum, Radix Ginseng, Radix Ophiopogonis, Oryza Sativa L., Radix Ophiopogonis Japonicir and Radix et Rhizoma Glycyrrhizae. Wang et al. [53] held that gout was caused by dampness accumulation and heat blocking the meridians and collaterals, so he adopted the methods of clearing heat and resolving dampness, unblocking the collaterals and relieving pain, and applied Zhuye Shigao Decoction for the treatment. Chen et al. [54] found that after being treated with modified Zhuye Shigao Decoction, serum levels of IL-1β and caspase-1 were reduced, and the expression levels of pro-IL-1 and pro-caspase-1 were down-regulated, suggesting that the modified Zhuye Shigao Decoction could inhibit the inflammation induced by sodium urate crystals, which may be related to the intervention of IL-1 signaling pathway.

The pharmacological mechanism of Qingre Chubi Decoction in the treatment of gout

There are two formulas named as Qingre Chubi Decoction which are of different compositions and similar effects. In one Qingre Chubi Decoction, the ingredients include Herba Aristolochiae Mollissimae, Caulis Sinomenii, Radix Cudraniae Cochinchinensi, Rhizoma Atractylodis Lanceae, and Rhizoma Anemarrhenae. Another Qingre Chubi Decoction is composed of Caulis Sinomenii, Caulis Piperis Kadsura, Ramulus Mori, Radix Stephaniae Tetrandrae Herba Lycopi Hirtiaa, Radix et Rhizoma Clematidis, Rhizoma Smilacis Glabrae and Lumbricus. Wang et al. [55] confirmed that the first Qingre Chubi Decoction could relieve the symptoms of patients such as feverish sensation, joint swelling and pain, and reduce the inflammatory indicators such as ESR and CRP. Some studies suggested that Qingre Chubi Decoction might inhibit the release of IL-1β and TNF-α to ameliorate the acute inflammatory response of gout [56]. Additionally, Qingre Chubi Decoction inhibited the proliferation of THP-1 cells stimulated by MSU crystals. The inhibition of monocyte activity and IL-1β may be one of the anti-inflammatory mechanisms of Qingre Chubi Decoction [57].

The pharmacological mechanism of Tongfengshu Capsule in the treatment of gout

Tongfengshu Capsule, composed of Radix et Rhizoma Rhei Palmati, Semen Plantaginis, Rhizoma Alismatis, Radix Achyranthis Bidentatae and Radix Stephaniae Tetrandrae, is a Chinese patent medicine. Rheum emodin, one chemical component from Radix et Rhizoma Rhei Palmati, could inhibit the expression of NOD-like receptor family pyrin domain-containing 3 (NLRP3) and IL-1 mRNAs [58] and inhibit the activation of extra cellular signal–regulated kinases 1 and 2 (ERK1/2) and p38 nitrogen-activated protein kinases (p38 MAPK) signaling pathways by inhibiting the expression of ERK1/2 nucleus and p38MAPK, thereby reducing the release of inflammatory factors [59]. Semen Plantaginis and Rhizoma Alismatis could promote urination, and reduce swelling and pain. Among them, Semen Plantaginis, rich in mullein glycolic anhydride, could promote uric acid secretion, reduce the creatinine level, scavenge reactive oxygen species (ROS) and improve renal function [60]. In addition, it is reported that the ethanol extract of Rhizoma Alismatis could reduce SUA level without damaging renal function [61]. Radix Stephaniae Tetrandrae has the function of dispelling wind, relieving pain and inducing diuresis to alleviate edema. Tetrandrine, the active ingredient of Radix Stephaniae Tetrandrae could inhibit the inflammatory response of cells, and this anti-inflammation mechanism may be related to inhibiting nuclear factors such as NF-κB, reducing IL-6 and TNF-α levels, and promoting the expression of anti-inflammatory cytokines such as IL [62]. It is also reported that Radix Achyranthis Bidentatae could increase superoxide dismutase (SOD) activity, reduce serum lipid peroxide level, and regulate immunity and metabolism of the body [63]. Based on the previous study, the anti-inflammation mechanism of Tongfengshu Capsule may be related to inhibiting the synthesis or release of prostaglandin E2 (PGE2), reducing the production of inflammatory cytokines like TNF-α and resisting lipid peroxidation [64]. It was also found that Tongfengshu capsule could significantly relieve symptoms of joints in rats with acute gout arthritis, suggesting the mechanism might be related to reducing IL-1β and TNF-α levels, inhibiting the expression of malonic dialdehyde (MDA) and nitrogen oxide (NO), and promoting the release of SOD [65]. Besides, some researchers proposed that the therapeutic mechanism of Tongfengshu Capsule in the treatment of gout arthritis was related to the down-regulation of serum levels of high mobility group protein 1 (HMGB l) and receptor for advanced glycosylation end-products (RAGE) in patients with gout [65].

The pharmacological mechanism of Guizhi Shaoyao Zhimu Decoction in the treatment of gout

Guizhi Shaoyao Zhimu Decoction, firstly recorded in the TCM classics, Synopsis of the Golden Chamber, is composed of Herba Ephedrae Sinicae, Ramulus Cinnamomi, Radix Saposhnikoviae, Largehead Atractylodes Rhizome, Radix Aconiti Lateralis Praeparata, Rhizoma Anemarrhenae, Radix Paeoniae Alba, Radix et Rhizoma Glycyrrhizae and Rhizoma Zingiberis Recens. Herba Ephedrae Sinicae, could scavenge ROS and had significant antioxidant effects [65]. In addition to anti-bacterium, anti-virus and anti-inflammation effects [66, 67], Ramulus Cinnamomi and Radix Saposhnikoviae can also stimulate the secretion of saliva and gastric juice and stimulate sweat glands to dissipate heat [68]. Largehead Atractylodes Rhizome and Radix Aconiti Lateralis Praeparata have the function of warming channels to dispel coldness. It is recorded that Rhizoma Anemarrhenae and Radix Paeoniae Alba could nourish yin and clear heat. It took the researchers 5 years to find that Guizhi Shaoyao Zhimu Decoction has the function of relieving pain, anti-inflammation and healing bone injury. Besides, it also could induce apoptosis of synovial cell, regulate immunity, and promote uric acid excretion, and protect renal function to treat gout arthritis [69]. Some researchers proposed that the mechanism underlying the Guizhi Shaoyao Zhimu Decoction in the treatment of gout arthritis was related to reducing the expression of Toll-like receptor (TRL)-2, TRL-4, NLRP3 receptor, myeloid differentiation factor (MyD)88 and apoptosis-associated speck-like protein (ASC), increasing the expression of peroxisome proliferator-activated receptor (PPAR)-γ and inhibitor-κB (IκB)-α, inhibiting the differentiation and maturation of IL-1β and the activation of NF-κB [70].

The pharmacological mechanism of Tongfengan Mixture in the treatment of gout

Tongfengan Mixture, composed of Herba Lysimachiae, Semen Sinapis, Thallus Ulvae Fasciata, Spora Lygodii, Rhizoma Smilacis Glabrae, Flos Carthami, Radix Paeoniae Rubra, Pseudobullbus Cremastrae, Rhizoma Alismatis and Rhizoma Corydalis, has the function of softening hardness and dissipating mass. It is found that in the rat models, Tongfengan Mixture can relieve the swelling, reduce the level of MSU crystals in the ankle joints, and reduce the inflammatory reaction, which may be achieved by reducing the inflammatory reaction in the blood [71]. Liu et al. [32] suggested that Tongfeng Mixture could inhibit the secretion of inflammatory factors like IL-1β, TNF-α and NF-κB in the synovial tissue of the ankle joint of rats by clearing away urate crystals, and reducing the inflammation.

The pharmacological mechanism of Quzhuo Tongbi Decoction in the treatment of gout

There are two formulas name as Quzhuo Tongbi Decoction which are of different compositions and similar effects. In one Quzhuo Tongbi Decoction, the ingredients include Rhizoma Smilacis Glabrae, Rhizoma Dioscoreae, Stigma Maydis, Semen Coicis, Rhizoma Curcumae Longae, Herba Taxilli Chinensis, Rhizoma Corydalis, Folium Pyrrosiae and Semen Plantaginis. Another Quzhuo Tongbi Decoction is composed of Radix Aconiti, Rhizoma Smilacis Glabrae, Radix Bupleuri Chinensi, Largehead Atractylodes Rhizome, Radix Astragali, Caulis Lonicerae and Radix Paeoniae Rubra. It has been documented that some intestinal bacteria could cause abnormal uric acid metabolism [72]. Zhu et al. [73] found that the medium and high dosage of the first Quzhuo Tongbi Decoction can reduce the level of uric acid, serum creatinine and xanthine oxidase (XOD). Besides, it could also relieve inflammation symptoms, inhibit the production of PGE2, relieve pain sensation by blocking the sensation of peripheral nerves to pain stimuli [74].

The pharmacological mechanism of Peiyuan Huazhuo Decoction in the treatment of gout

Peiyuan Huazhuo Decoction is composed of Rhizoma Polygonatum Sibirici, Semen Cuscutae, Radix Astragali, Rhizoma Smilacis Glabrae, Semen Coicis and Rhizoma Corydalis. Yang et al. [75] found that Radix Astragali could increase the glomerular filtration rate. It was also found that Rhizoma Polygonatum Sibirici not only had a good effect of lowering SUA levels, but also reduced blood lipid and glucose [35]. The herbs in this formula work together to treat lipid metabolism disorders, inhibit inflammatory reactions, prevent gout attack, and prevent renal damage in patients with gout.

Conclusions and perspective

The etiology of gout is complex and there are various hypotheses about its pathogenesis. According to the disease mechanism of TCM, therapeutic principles like dispelling wind and cold, clearing away heat and dampness, and dredging meridians and collaterals are often applied to treat acute gout [16]. During the remission stage, benefiting qi, nourishing blood and tonifying spleen and kidney are often applied (Fig. 3) [44]. Inhibiting inflammatory factors in joint fluid, reducing blood uric and promotion of uric acid excretion, enhancing immune function and blocking the sensation of peripheral nerve are the main mechanism underly TCM treatment for gout (Fig. 4).

The main pharmacological mechanisms of the treatment of acute gout and gout during the remission. The disease of gout consists of the attack stage and remission stage, which should be treated differently based on disease mechanism of TCM

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The main TCM formulas and the underlying pharmacological mechanisms of the treatment of gout. There are two ways to reduce the SUA level: one is to promote uric acid excretion, and the other is to reduce uric acid production

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Compared with chemical drugs like colchicine, eloricoxib and celecoxib, TCM herbs have advantages in slowing down the severity and frequency of attacks, reducing the concentration of uric acid in blood with fewer side effects. Although TCM has a strong advantage in the treatment of gout, the application of TCM herbs or formulas should follow the principle of syndrome differentiation and treatment from TCM perspective.

In this review, we focus on the research data from animal and clinical studies in recent years, and summarize the TCM theory of gout, the clinical application, pharmacological mechanism and the chemical compounds of TCM formulas for gout treatment. By doing this we hope to help the researchers on exploring the mechanism of TCM treatment for gout and to develop agents more effectively for gout treatment.

Availability of data and materials

All the data used to support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

Monosodium urate

Non-steroidal anti-inflammatory drugs

Traditional Chinese medicine

Tumor necrosis factor

Interleukin

Erythrocyte sedimentation rate

C-reaction protein CRP

NOD-like receptor family pyrin domain-containing 3

Mitogen-activated protein kinase

Reactive oxygen species

Superoxide dismutase

Malonic dialdehyde

Nitrogen oxide

High mobility group protein 1

Receptor for advanced glycosylation end-products

Serum uric acid

Toll-like receptor

Myeloid differentiation

Apoptosis-associated speck-like protein

Peroxisome proliferator-activated receptor

Prostaglandin E2

Xanthine oxidase

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Источник: mynewextsetup.us

What is gout?

Gout is a very painful form of arthritis caused by crystals that form in and around the joints.

It’s the most common type of inflammatory arthritis. It’s more common in men and you’re more likely to get it as you get older.

Gout occurs in people who have high levels of urate in their blood, but having urate in your blood doesn’t mean you’ll develop gout. It’s normal and healthy to have some urate in your bloodstream.

Urate is created every day when our bodies break down purines. Purines are chemicals that are naturally created in our body, but they are also present in certain foods.

People used to think that gout was caused by overeating and drinking too much alcohol. While this can make attacks of gout more likely, it’s not the whole story.

In any day, about three-quarters of the urate in our bodies comes from the breakdown of purines produced within our body, while only about a quarter comes from the breakdown of purines in food and drink we consume.

As urate levels build up, your body gets rid of any extra through your kidneys and in your wee. But if your body is making too much urate, or your kidneys are unable to get rid of enough of it, then levels start to rise.

If urate levels stay too high, urate crystals can slowly start forming. They mainly occur in and around firm joint tissues, such as the cartilage. But crystals can also appear under your skin and may even occur in your internal organs, such as the kidneys.

Symptoms

Attacks

When you have gout, urate crystals can build up in your joints for years without you knowing they are there. When there are a lot of crystals in your joints, some of them can spill out from the cartilage into the space between the two bones in a joint.

The tiny, hard, sharp crystals can rub against the soft lining of the joint, called the synovium, causing a lot of pain swelling and inflammation. When this happens, it’s known as an attack or flare of gout.

The urate crystals sit within the cartilage of the joint which causes the pain of gout.

During an attack of gout the affected joint becomes:

  • very painful
  • tender
  • red
  • hot
  • swollen.

The skin over the joint often appears shiny and may peel off a little as the attack settles.

Attacks usually come on very quickly, often during the night. Doctors describe this sudden development of symptoms as ‘acute’.

The attack usually settles after about five to seven days, but it can go on for longer.

If gout is left untreated, attacks can become more common and may spread to new joints.

Attacks typically affect the joint at the base of the big toe and often start in the early hours of the morning. The symptoms develop quickly and are at their worst within just 12 to 24 hours of first noticing that anything is wrong.

Any light contact with the affected joint is very painful – even the weight of a bedsheet or wearing a sock can be unbearable.

Although gout most often affects the big toe, other joints may also be affected, including:

  • other joints in your feet
  • ankles
  • knees
  • elbows
  • wrists
  • fingers.

It’s possible for several joints to be affected at the same time. It’s not common to have gout in joints towards the centre of your body, such as the spine, shoulders or hips.

Gout attacks are especially common in joints at the ends of your legs and arms, such as in your fingers and toes. This is probably because these parts of the body are cooler, and low temperatures make it more likely for crystals to form.

Similar attacks can be caused by a condition called acute calcium pyrophosphate crystal arthritis. This is also known as acute CPP crystal arthritis, which used to be called ‘pseudogout’.

Tophi

Urate crystals can also collect outside of the joints and can be seen under the skin, forming small, firm lumps called tophi. You can sometimes see the white colour of the urate crystals under the skin.

The most common areas for tophi are:

  • over the top of the toes
  • back of the heel
  • front of the knee
  • backs of the fingers and wrists
  • around the elbow
  • the ears.

Tophi aren’t usually painful, but they can get in the way of normal daily activities. They can sometimes become inflamed, break down and leak pus-like fluid with gritty white material - these are the urate crystals.

Tophi can also grow within your joints and cause damage to your cartilage and bone. This can lead to more regular, daily pain when you use the affected joints.

Causes

There are two different types of gout. When you have it and there’s no single cause, it’s called primary gout. When you have it and it’s caused by something else, it’s known as secondary gout. Secondary gout can be caused by either:

  • chronic kidney disease
  • long-term use of medications that affect how well your kidneys can remove urate from your body.

Risk factors

Family history

Even though your kidneys can be completely healthy, sometimes the genes you’ve inherited make it more likely that your kidneys don’t flush urate out as well as they should. This is the most common cause of primary gout, especially when several family members are affected, such as your parents or grandparents.

Being overweight

Gout is much more common in people who are overweight. The more overweight you are, the more urate your body produces, and this may be more than your kidneys can cope with.

Being overweight also makes it more likely that you’ll have:

  • high blood pressure
  • type 2 diabetes
  • high cholesterol
  • fats in your blood.

These conditions can all lower how much urate is filtered out by your kidneys.

Gender and age

Gout is about four times more common in men than women. It can affect men of any age, but the risk is greater as you get older.

Women rarely develop gout before the menopause. This is because the female hormone oestrogen increases how much urate is filtered out by the kidneys. But after the menopause, oestrogen levels go down and urate levels go up.

Taking certain medications

Some medications can reduce your kidneys’ ability to get rid of urate properly. These include diuretics, also known as water tablets, and several tablets for high blood pressure, including beta-blockers and ACE inhibitors.

Other conditions

Several different conditions are linked to raised urate levels. This could be because they affect the way the kidneys filter urate, or because they cause more urate to be produced in the first place.

For some conditions, the link with gout is less clear, and may be due to many different factors.

Common conditions associated with gout include:

  • chronic kidney disease
  • high cholesterol and fats in the blood
  • high blood pressure
  • type 2 diabetes
  • osteoarthritis.

What can trigger a gout attack?

Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:

  • a knock or injury to the joint
  • an illness that may make you feverish
  • having an operation
  • having an unusually large meal, especially a fatty meal
  • drinking too much alcohol
  • dehydration
  • starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.

Diagnosis

Diagnosing gout is usually straightforward, especially if you have typical symptoms of the condition - for example, if you have an attack in your big toe.

But gout can sometimes be more difficult to diagnose. Your doctor will need to know about the symptoms you’ve been having and will probably need to perform some tests.

Blood tests

Blood tests to measure your urate levels can be helpful to support a diagnosis of gout, but aren’t enough on their own to confirm it.

High urate levels in blood tests can suggest that you have gout, but this will need to be considered alongside your symptoms. It’s possible to have high levels of urate, but not have any other symptoms of the condition.

Imaging tests

Ultrasound and CT scans can be good at spotting joint damage, crystals in the joints and early signs of gout. X-rays are generally used to pick up the bone and joint damage caused by having gout for a long time.

Synovial fluid examinations

These are a good way to rule out other crystal conditions and make a diagnosis.

They’re done by taking a sample of your synovial fluid through a needle inserted into one of your joints. The fluid is then examined under a microscope for urate crystals. If you have tophi, doctors can take a sample from one of those instead.

Take a look at our survey

How will gout affect me?

Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.

Without medication attacks tend to happen more often and other joints can become affected.

Having high urate levels and gout for a long time can lead to other health problems, including:

  • narrowing of the arteries - which can lead to an increased risk of stroke or heart attacks or other heart problems
  • osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
  • an increased risk of developing kidney disease or worsening of the condition if you already have it
  • kidney stones
  • an increased risk of some cancers, especially prostate cancer
  • mental health problems, including depression
  • underactive thyroid
  • erectile dysfunction in men.

If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.

Treatments

Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:

  • treating the acute attack
  • treatments to prevent future attacks.

Treating a gout attack

Treating an attack of gout doesn’t lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.

The most commonly used drug treatments for attacks of gout are:

Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration – many people with gout quickly learn what works best for them.

In cases where one drug doesn’t seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.

If you’ve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.

The earlier you start treatment, the better.

NSAIDs aren’t suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.

NSAIDs aren’t usually prescribed for a long period of time, as they can cause problems with your digestive system. To reduce the risk of this happening and to protect your stomach, your doctor will also prescribe a proton pump inhibitor.

Colchicine

Colchicine isn’t a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.

As with NSAIDs, colchicine tablets should be taken as soon as you notice an attack coming on, or it may not work as well. Your doctor will probably recommend keeping a supply at home.

Colchicine can interact with several other drugs, including statins taken for high cholesterol. Your doctor will advise whether you’d be better off using an NSAID instead, or adjusting your other medications while you’re taking colchicine.

You should avoid taking colchicine if you have chronic kidney disease.

Colchicine tablets can cause diarrhoea or stomach aches.

Steroids

If colchicine or NSAIDs haven’t worked for you, or if you’re at risk of side effects from these drugs, your doctor may prescribe steroids.

They are usually taken as a short course of tablets, lasting a few days.

However, they can also be taken as an injection into a muscle or joint affected by gout. This can be particularly helpful if gout is affecting only one joint.

Check out our steroids and steroid injection pages for more information.

Tips for managing an attack at home

  • Keep the area cool – an ice pack, or a bag of frozen peas wrapped in a tea towel, can be particularly good at reducing some of the pain and swelling.
  • Rest the affected joint.
  • Think about getting yourself a bed cage. These support the bedsheets above your feet so that your affected joint can rest without the strain of the sheets.

Treatments to prevent gout attacks

There are drugs available that can lower urate levels, prevent new crystals from forming and dissolve away the crystals in your joints. They are called urate lowering therapies or ULTs for short.

Treatment with ULTs is generally started after an attack of gout has completely gone.

There’s no single fixed dose of a ULT, and different people need different doses to get to the right blood urate level.

It can take a few months or years for the drugs to completely clear your body of urate crystals. But once they’re gone, you will no longer have attacks of gout, tophi or risk of joint damage due to gout.

It’s important to remember that ULTs won’t stop attacks of gout straight away. You could actually have more attacks within the first six months of starting them.

Don’t stop taking your ULTs if this happens to you, as this is actually a sign that the drugs are working. As the drugs start dissolving the crystals, they become smaller and are more likely to get into the joint cavity, triggering an attack.

Your doctor might suggest taking a low dose of colchicine or NSAID as a precaution against attacks during the first six months of starting ULTs.

ULTs are usually life-long treatments and require yearly check-ups to monitor your urate levels. If your symptoms aren’t getting under control, talk to your doctor about your urate level, as you might need to be on a higher dose.

Try not to miss or skip any of your doses, especially in the first year or two of starting treatment. This could cause your urate levels to go up and down, which could trigger an attack.

Allopurinol

Allopurinol is the most commonly used ULT. It’s a very effective treatment for most people with gout.

It works by reducing the amount of urate that your body makes.

You’ll start on a low dose of allopurinol, which can be gradually increased until you are on the right dose.

Gradually building up the dose means it’s less likely to trigger an attack and also makes sure you’ll have the lowest dose needed to get your gout under control.

Allopurinol is broken down and removed from the body through your kidneys, so if you have a problem with your kidneys, it may not be suitable for you. Your doctor might decide to start you on an even lower dose and increase slowly, or suggest that you try febuxostat instead.

Febuxostat

Febuxostat is a newer drug that reduces the amount of urate made in the body in the same way that allopurinol does.

You won’t be prescribed febuxostat as your first ULT, unless your doctor has said that you can’t take allopurinol.

It works in a similar way to allopurinol but, instead of being broken down by the kidneys, it’s broken down by your liver. It’s useful if you have kidney problems and can’t take a high enough dose of allopurinol.

Febuxostat is more likely to trigger gout attacks than allopurinol when you first start treatment. So, as a precaution, it’s likely you’ll be prescribed a low-dose NSAID or colchicine to take on a daily basis for the first six months of starting febuxostat.

There are just two doses of febuxostat, so if your urate levels haven’t lowered enough after a month on the low dose, you may need to go on to the higher dose.

Uricosuric drugs

Uricosuric drugs, which include sulfinpyrazone, benzbromarone and probenecid, work by flushing out more urate than normal through your kidneys.

They’re not used much in the UK, as they’re not widely available. They’ll only be prescribed by a rheumatologist if allopurinol and febuxostat haven’t worked or aren’t suitable for you.

It’s unlikely you’ll be able to take these drugs if you’ve had severe problems with your kidneys or had kidney stones. This is because, by encouraging your kidneys to filter more urate, they also increase the risk of developing kidney stones.

Uricosuric drugs are usually used on their own. But in rare cases, where you’ve tried several ULTs and none have worked for you, uricosurics can be used in combination with other ULTs, like allopurinol or febuxostat.

If you’re unable to take allopurinol, febuxostat or a uricosuric, or if they don’t work for you, you’ll need to see a rheumatologist for advice.

Treatment for joint damage

If your gout has caused damage to your joints, then the treatments available will be the same as those used for osteoarthritis. They include:

  • exercising regularly
  • reducing the strain on your affected joints
  • staying at a healthy weight
  • taking painkillers
  • in more severe cases, joint replacement surgery.

Visit our osteoarthritis page to find out more about treatments available for joint damage.

Malcolm's story: improving treatment for gout

Managing symptoms

Lifestyle choices are not the main reason why most people get gout.

However, if you have a healthy lifestyle and also take prescribed medication, you’ll have the best chance of lowering your urate levels. This will then decrease the chances of you having attacks of gout.

Exercise

Exercise is extremely important, not only to reduce the chances of an attack, but also for your general health and wellbeing.

It doesn’t matter how much exercise you do - a little is better than none at all.

Start off slowly and gradually build up how much you do until you’re doing regular sessions.

As your confidence increases, you can increase the length and intensity of what you’re doing.

Exercises that get you out of breath are particularly good for burning calories. You could try dancing, walking in hilly countryside or doubles tennis.

It helps to find a sport or exercise which you enjoy and will keep doing. Some people find joining a leisure centre or sports club to be really fun and motivational. Have a look around and see what’s available in your area.

You should avoid exercising during a flare up of gout, as it could make your pain worse. It’s important to rest and recover and begin exercising after the pain and swelling has gone down.

Diet

You should try to have a well-balanced diet that is low in fats and added sugars, but high in vegetables and fibre.

Extreme weight loss or starvation diets increase cell breakdown in your body, which can raise urate levels. However, you should be OK to do some daytime fasting - for example, during Ramadan.

We don’t recommend Atkins-type weight-loss diets, as they include a lot of meat and are high in purines.

If you’re overweight, weight loss should be gradual combined with daily exercise.

The NHS has a good diet and exercise plan which can help you lose weight in a healthy way over 12 weeks.

Food to have in moderation

You should try to avoid eating large quantities of foods that are high in purines. But there’s no need to remove them completely from your diet.

These include:

  • red meat, game and offal - such as venison, kidneys, rabbit and liver
  • seafood, particularly oily fish and shellfish - such as anchovies, fish roe, herring, mussels, crab and sardines
  • foods rich in yeast extracts - such as Marmite, Bovril and Vegemite
  • processed foods and drinks.

Protein is an important part of your diet, but you can get it from sources other than just meat and fish. You could try replacing a portion of meat with other protein-rich foods like soybeans, eggs, pulses or dairy products.

The UK Gout Society has a detailed food list of foods high in purines. Check out their diet factsheet for more information.

What about drink?

If you have gout and a history of kidney stones, you should try to drink at least two litres of water a day to decrease the chance of stones forming.

Sweetened soft drinks should be avoided, as they contain large amounts of sugar and can increase the risk of getting gout.

While fruit and fresh fruit juices contain sugar, the benefits of eating fruit are likely to far outweigh any negatives. Reducing how much sugar you consume from other sources is a heathier option than cutting out some of your five a day.

Alcohol

Drinking too much alcohol, especially beer and spirits, can increase your urate levels and your chances of triggering a gout attack. Beer is particularly bad, as it contains a lot of purines.

However, drinking a bit of wine doesn’t appear to increase the risk of triggering an attack.

As a rule of thumb, try to stick to the government guidelines of drinking no more than 14 units a week. This is equivalent to about 6 pints of beer or 6 glasses of wine. But don’t save these units up and drink them all in one go - it’s better to spread them out over the course of the week.

Your doctor might also advise a lower limit.

You can find out more about government drinking guidelines at drinkaware.

Vitamin C

Research has shown that vitamin C may slightly reduce uric acid levels in people with gout. This is another reason to make sure your diet includes plenty of fruit and vegetables. But if you’re considering taking vitamin C supplements, talk to your doctor first, as there’s a very slight risk that vitamin C supplements could interact with other medications.

Cherries

Research has shown that cherries may reduce the risk of having an acute attack of gout, particularly when taken with allopurinol.

Skimmed milk and low-fat yoghurt

Research suggests drinking skimmed milk and eating low-fat yoghurt may help to prevent attacks of gout.

Complementary and alternative treatments

If you decide to try complementary and alternative treatments, you should be critical of whether they are making a difference to your condition.

They should never replace your prescribed gout medication.

Don’t worry about fish oil supplements raising your urate levels. While some may contain purines, the amount is likely to be so small that it won’t make a difference to your condition.

Similarly, even though the supplement glucosamine is made from the outer shells of shellfish, it doesn’t contain purines. However, there’s no evidence that glucosamine can prevent or treat gout.

Caring for yourself

The emotional effects of gout can have just as much impact as the physical symptoms. Long term damage and severe pain from the attacks of gout can affect your daily life, disturb your sleep and affect your mood. From time to time, your gout may get on top of you. If you’re feeling low, talk to your GP, who can signpost you to the appropriate services. You can also call our helpline on , who will listen and offer emotional support.

Working with gout

Work can provide a sense of purpose, a supportive social network, and help you financially. Most people with gout can continue working, but you may need some time off when you have an attack.

If gout is affecting your ability to work, speak to your employer’s occupational health service if they have one. Your employer has a duty to make reasonable adjustments so that you can do your job.

Your local Jobcentre Plus can also put you in touch with Disability Employment Advisors, who can arrange workplace assessments.

Access to Work is a scheme in Scotland, England and Wales that gives extra help to people with disabilities or physical and mental health conditions. There is a separate scheme available in Northern Ireland.

Access to Work provides funded or partly-funded grants to help people start work, stay in work, or move into self-employment, and can be used to pay for equipment, support workers, or transport, among other things.

Research and new developments

Research is greatly increasing our understanding of what triggers gout and how new therapies may be developed to treat it.

Our research has found a more successful way of treating people with gout. We funded a clinical trial in which nurses, trained in gout and its management, delivered a package of care tailored to patients. It provided information on gout and its treatment options, and involved patients in decision making.

The results proved that:

  • when fully informed almost % of people with gout want ULTs
  • 95% of patients were still continuing with their treatment after two years
  • after two years, more than 9 out of 10 patients were having fewer gout attacks, tophi were greatly reduced and quality of life was improved compared to patients who continued with their standard treatment.

Versus Arthritis is also currently funding a research project to help design a full-scale clinical trial looking at whether omega-3 fatty acids, which are found in fish oils, can be used alongside ULTs to prevent gout attacks.

The results could reduce gout attacks and overcome the unwanted side effects that some people experience when starting on ULTs.

Neil’s story

At its worst, my gout was so bad I couldn’t walk for three months.

I couldn’t even play with my daughter Hannah, who was toddling at the time. The only way I could get around was on all fours and crawl. I was only a year into my thirties.

When I was diagnosed with gout my doctor didn’t prescribe me anything for it. And to be honest, I didn’t take much notice. I put it to the back of my mind and carried on as I always had.

Everything changed about a year later, when I had my first proper experience of a gout attack.

It happened after a game of football. I couldn’t believe how painful and swollen my foot had become.

My ankle was so puffy that my foot looked like a joint of meat. Even the weight of the bed sheets was enough to keep me up at night.

The worst part was not being able to sleep.

The next morning, exhausted, I’d dose up on painkillers before going to work.

At the time I was on my 12th year of doing deliveries for the Royal Mail. Getting my round done every morning was becoming a struggle. To my colleagues it was all a big joke.

I tried ibuprofen but it wasn’t touching it. So, I went back to my doctor.

He said that drugs like allopurinol can be bad for you and that I’d be better off controlling it with my diet.

He gave me the impression that having gout was my fault.

I was prescribed a high dose of ibuprofen and sent on my way.

I followed his advice, changed my diet and gave up alcohol completely.

But nothing changed. In fact, it got worse. It spread to my hands, wrists and elbows.

On bad days the pain was so excruciating I couldn’t touch the gearstick of my car. It’s scary how you take these things for granted.

After another 10 years of walking the beat for the Royal Mail, I decided It was time to get a desk job.

Soon after this I had to make another trip to the doctors for my hands. They thought I’d developed arthritis, so I was being referred to a specialist.

When I met them, they couldn’t hold back their shock. They were appalled that I’d never been on any gout medication.

They said I’d be fine once I was on allopurinol. I’ll be honest - I was sceptical as I’d been in so much pain for so long. It was pretty much miraculous how quickly it all stopped. The last four years have been fantastic.

If you have gout, my advice would be don’t panic, do your research and find out everything you can. And if you’re not getting the help you need, go somewhere else. You can always find someone who’ll help.

Источник: mynewextsetup.us

Top 10 Natural Home Remedies for Gout

Gout is a type of arthritis that can affect different body parts like the ankles, knees, hands, wrists but mainly affects the big toe. Symptoms include acute pain, inflammation in the joints causing swelling and tenderness. Many gout sufferers have experimented with natural home remedies. What is a the true definition of a home remedy? It’s simply a medicine made with ingredients available at home.

Here are the most popular natural home remedies voted by gout sufferers:

1. Apple Cider Vinegar: ACV is considered king when it comes to a gout natural home remedy and it’s my most popular post voted by social media. ACV helps your body become more alkaline and the acidity may help relieve acute gout pain. Many gout sufferers report drinking  tablespoons of raw unfiltered and organic apple cider vinegar in a glass of at least 8 ounces of water. Some will drink this times a day for better results. ACV can also be used as topical treatment. You you can soak your foot for about 30 minutes in a bucket full of 4 cups of hot water and 1 cup of apple cider vinegar. You can also soak a clean, dry cloth in apple cider vinegar and wrap it around the affected area for about 15 minutes.

2. Baking Soda: Another extremely popular natural home remedy for gout sufferers is baking soda. Like apple cider vinegar, it makes your body more alkaline. Many consume ½ a teaspoon in a glass of 8 oz. mynewextsetup.us will repeat this throughout the day until they have consumed at least 3 teaspoons of baking soda. It may help lower uric acid providing with relief from the pain at the same time. Avoid this home remedy if suffering from high blood pressure and try to limit salt intake in your meals during the day when taking baking soda. Baking soda is very high in sodium. The maximum recommended dose is 4 teaspoons throughout the day.

3. Cherries: Whether sweet or sour, cherries have been known to be extremely effective and may help treat gout and support healthy uric acid due to their high antioxidant properties. In one study conducted with people suffering from gout, it was concluded that eating half a cup serving of cherries daily ( cherries) resulted in a 35% reduced risk of a successive gout attack. For those eating 2 or even 3 servings in a day, their risk dropped to 50%! But that is too much sugar as well which can cause other health ailments. Best recommendation is to use a tart cherry extract supplement and avoid the sugar intake if you can!

4. Ginger and/or Turmeric: The powerful anti-inflammatories present in ginger root and turmeric may be very helpful in easing gout pain and inflammation. I basically chop off a little piece the size of an inch and boil it for about 20 minutes and drink it as tea. You can also add ginger root and/or turmeric in cooking recipes. Some may also eat a small piece raw daily. Others use it topically to reduce swelling by making a paste of ginger root with water and then apply it to the affected area, leaving it on for about 30 minutes.

 

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5. Water: Very simple, we all have it and it’s usually free. Drink plenty of it since it may help flush excess uric acid out of your body. Staying hydrated is one effective way that may limit gout flares. Drink at least 8 glasses of water a day but if you can, why not strive for 12?! Make sure a water bottle is with you everywhere you go, I carry a bottle with me from morning to night and keep refilling it all day long.

6. Lemon Juice: Another natural home remedy that may help alkalize your body and may support healthy uric acid in the blood, is drinking lemon juice. Many gout sufferers squeeze half a lemon in a glass of 8 oz. of water and drink it up to three times a day. Others will combine it with ½ a teaspoon of baking soda. Remember lemon juice is also high in vitamin C which may also help gout.

7. Celery Seeds: Another popular natural home remedy that may help support healthy uric acid according to many gout sufferers is celery seed extract. Celery seed simply stimulates your kidneys and may cause your kidneys to excrete more uric acid out of the body. Thus it causes you to visit the bathroom and urinate more.

8. Epsom Salt: There is no better topical treatment to treat a gout attack than epsom salt, widely used by many to relax muscles, aches and pains. The presence of magnesium which is an alkaline mineral in epsom salt also may help to treat gout. Before taking a bath, simply add 1 to 2 cups of Epsom salt in your bath and soak your entire body or affected joint, for at least 30 minutes.

9. Bromelain: Bromelain is a compound found in pineapples. The enzymes within it are frequently recommended for gout sufferers since it may help support healthy uric acid and may ease inflammation caused by gout. Again, bromelain is loaded with vitamin C as well which is also good for your gout. Bromelain is also considered a natural pain killer for many other ailments.

Vitamin C: A very popular vitamin with gout sufferers, let’s not forget vitamin C. Numerous studies have shown how vitamin C is effective, supporting healthy uric acid levels in your blood.

Finally, don’t forget to rest your affected joint(s) when suffering from gout as much as you can and do not overuse it so you can heal faster. Minimize the time spent on your joints.  You can also ice your joints if you like for some temporary pain relief. Apply an ice-pack to help ease pain and inflammation several times a day for about 20 to 30 minutes each time. Elevating your foot also helps ease the pain causing the blood to flow to that particular area of the body. Don’t be shy and use a cane to walk around thus avoiding unnecessary pressure onto the affected joint(s). Yes I admit it, I walked around with a cane during my first gout attack since it striked my big toe and knee at the same time. You can do it too!

Posted by Spiro Koulouris

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Источник: mynewextsetup.us

Blending Traditional Pharmacy
With Natural Medicine

FACTS:

  • Gout is one the most painful forms of arthritis. It occurs when too much uric acid builds up in the body (tiny crystals deposit in joints & soft tissue).
  • There is no real cure for gout. Treatment is aimed at controlling symptoms and preventing future attacks.
  • All humans and different cultures can be impacted by gout. However, it is rarely seen in men before adolescence or women before menopause. Men are at higher risk of developing gout than women. About 25% of gout sufferers have a family history of the condition (genetics).
  • Elevated uric acid levels do not always means that a person has gout. Uric acid levels can be normal during a gout attack. Most accurate way to diagnose gout is by looking for crystals in the joint fluid.
  • Gout attacks can be brought on by stressful events, certain drugs (thiazide diuretics; low dose aspirin; cyclosporine, levodopa or some antibiotics), alcohol, another illness or by taking the vitamin niacin.
  • Foods high in purine (a basic building block of DNA) content should be avoided by anyone at risk for a gout attack. The body metabolises purine and produces uric acid as a waste product.
  • Early gout attacks usually get better within 3 to 10 days, even without treatment. The early the intervention the better the results.
  • Gout can damage the kidneys if left unchecked. % of primary gout sufferers (no known reason for high uric acid) and 42% of secondary gout sufferers (result of some underlying disorder) will develop kidney stones.

TREATMENT:

Traditional medicines used to treat acute attacks of gout include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen or indomethacin
  • Corticosteroids, such as prednisone
  • The old and now very expensive Colchicine, which works best when taken within the first 12 hours of an acute attack
  • To help prevent future attacks, doctors often prescribe NSAIDs or colchicine in small daily doses or daily doses of allopurinol to help reduce the production of uric acid

Non-traditional and natural medicine treatment options include:

Excessive uric acid can develop in the body due to a state known as acidosis,  where the body's pH is too acidic (ideal blood pH level is or slightly alkaline; is neutral: below 7 is acidic and above 7 is alkaline; pH level can be easily tested by low cost Litmus paper (urine or saliva).

Mixing lemon juice and baking soda together creates a nearly perfect pH of 7 and may stop a gout attack immediately by alkalizing the blood. Pour 2 tablespoonful of lemon juice (mildly acidic and high in potassium & citrate) in a glass with 1/2 teaspoonful of baking soda (highly alkaline; caution: use of baking soda could raise blood pressure). Allow the mix to foam and fizz until it is flat - about 2 minutes. Then add 8oz. water and drink immediately.

Black cherries (tart cherries) contain natural anti-oxidants and anti-inflammatories that help neutralize uric acid in the bloodstream. Cherry juice supplements and black cherry concentrate (10 to 15 cherries a day or the juice equivalent) can be taken daily or at the time of the attack to reduce the length and severity of the episode.

A natural sulfur supplement (MSM or Methyl Sulonyl Methane) is often taken by gout sufferers alone or with cherry juice to help repair connective tissue and to reduce pain and inflammation. MSM (in either pill or powder form) takes a few weeks to months to build up to optimum levels in the body.

Old cultures have long used an Apple Cider Vinegar formula daily to manage gout or during an acute gout attack. Add 1 tablespoonful of raw honey to 1 or more tablespoonful of warm distilled water. Then mix with 1 tablespoonful of Apple Cider Vinegar and drink twice a day after meals.

PREVENTION:

Drink 8 glasses of water a day to remain hydrated. Water can dilute the uric acid levels in the body and therefore reduce the chances of crystals forming. Increase to 16 glasses of water daily during an attack.

Keep yourself warm. Exposure to cold weather is a direct trigger of gout and the resulting buildup of uric acid crystals.

Avoid alcoholic beverages especially during an acute attack. Alcohol tends to thin the blood and complicates the healing of the joint damage that is caused by the uric acid crystal formation. Also, your body requires high levels of uric acid in order to digest alcohol.

Test your blood pH often. Try to maintain an alkaline pH. Excessive intake of tea, coffee, alcohol, carbonated drinks, protein, vitamin C, aspirin and foods that have high chorine, sulfur or phosphorus can lower the bodies pH levels. Uric acid is then more soluble in the blood and gout attacks are more likely.

Keep your immune system strong. Take a multi-vitamin supplement daily with high dose vitamin C (try to avoid niacin). Some studies suggest that 70 mg. of folic acid daily can help lower uric acid levels.

Control what you eat. Speak with a dietitian for tips. Keep a journal to help identify what specific foods may be triggering your gout attacks.

Eat a moderate amount of protein from healthy sources like eggs, tofu and other low fat sources. Increase your intake of dark fruits, vegetables, whole grains, nuts, peanut butter, pudding, rice, pasta, gelatin, coffee/most teas, foods with vitamin C, and fat-free milk products

Try to avoid foods that are high in purine content especially during an acute attack. Red and dark meats including turkey and sausages require high levels of uric acid to digest. Many fish foods can cause major problems including shellfish, salmon, trout, herring, fish roe and dark fillet. Poultry can cause problems and so can beans, peas, asparagus and spinach.

Exercising regularly and keeping excess weight off is essential to preventing acute gout attacks. By consistently moving and straining your joints you can break up uric acid crystals before they get too big and cause major attacks. Gout is more prevalent in the obese and overweight.

Источник: mynewextsetup.us

Using Natural Remedies for Gout

Gout is a type of arthritis characterized by sudden, intense pain, redness, heat, swelling, and tenderness in the joints. Gout usually affects the large joint of the big toe, but symptoms can occur in your feet, ankles, knees, hands, and wrists. Attacks typically last about five to 10 days. Gout is more common in men than in women.

Gout is caused by the accumulation of uric acid crystals, a waste product that's formed from the breakdown of purines—substances found naturally in the body and in foods such as organ meats, asparagus, anchovies, herring, and mushrooms.

So far, scientific support for the claim that any natural remedy can treat gout is limited.

Vitamin C

Some evidence suggests that vitamin C may help to reduce uric acid levels. In one well-designed study, people took either vitamin C supplements ( milligrams per day) or a placebo.

After two months, uric acid levels were significantly reduced in people taking vitamin C but not in the people taking the placebo. Although this study suggests that vitamin C may help prevent or treat gout, many more studies are needed before we can conclude this.

People with kidney disease should consult their healthcare provider before taking vitamin C supplements. Vitamin C increases the absorption of some types of iron from foods, so people with hemochromatosis should not take vitamin C supplements.

Vitamin C in doses over 2, milligrams per day may cause diarrhea, gas, digestive upset, or interfere with the absorption of vitamin B

Vitamin C supplements may raise blood levels of aspirin and acetaminophen. There have been rare reports of vitamin C interfering with the effectiveness of the medication warfarin (Coumadin).

Vitamin C may also increase the effects of furosemide (classified as a loop diuretic) and the antibiotic tetracycline. If taken together, vitamin C may decrease the absorption of propranolol, a medication for high blood pressure and heart conditions.

Speak with your healthcare provider first before combining any medications with vitamin C supplements.

Cherries

Cherries are a popular home remedy for gout. The amount usually recommended is anywhere between half a cup and one pound of cherries a day.

They are either eaten or blended and then diluted with water to make a juice. Cherry extracts are also available at some health food stores.

Although cherries are a fairly well-known remedy for gout, there is almost no evidence that it can help. One very small study examined the consumption of cherries on uric acid levels and inflammation.

Ten women consumed two servings ( grams) of Bing cherries after an overnight fast. Three hours after eating the cherries, there was a significant decrease in uric acid levels. There was also a decrease, although not statistically significant, in inflammation.

Diet

Although most uric acid in the body is made from the metabolism of naturally occurring purine, eating foods rich in purines may also contribute to elevated uric acid levels in the body.

The Third National Health and Nutrition Examination Survey, which used data from 14, people in the United States, found increased uric acid levels among people who had high intakes of meat and seafood.

On the other hand, total protein intake was not associated with increased uric acid levels.

Dairy intake was associated with lower uric acid levels. Specifically, people who drank milk one or more times per day, or who had yogurt at least once every other day, had lower uric acid levels than people who didn't consume yogurt or milk.

Another study involving 47, men with gout also found that the intake of meat and seafood was associated with an increased risk of gout.

Total protein intake and consumption of purine-rich vegetables, such as asparagus, were not associated with an increased risk. Dairy was associated with a decreased risk.

What to Eat When You Have Gout

Using Natural Remedies for Gout

Due to a lack of supporting research, it's too soon to recommend any alternative medicine for gout. 

Supplements haven't been tested for safety and due to the fact that dietary supplements are largely unregulated, the content of some products may differ from what is specified on the product label.

Also keep in mind that the safety of alternative medicine in pregnant women, nursing mothers, children, and those with medical conditions or who are taking medications has not been established.

You can get tips on using supplements, but if you're considering the use of any form of alternative medicine, talk with your primary care provider first. Self-treating a condition and avoiding or delaying standard care may have serious consequences.

For some guidance on talking with a medical professional about your gout, use our Doctor Discussion Guide below. It can help you start a conversation with your healthcare provider about symptoms, treatment options, and more.

Gout Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Download PDF

Thanks for your feedback!

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Huang HY, Appel LJ, Choi MJ, Gelber AC, Charleston J, Norkus EP, Miller ER 3rd. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum. (): doi/art

  2. Jacob RA, Spinozzi GM, Simon VA, Kelley DS, Prior RL, Hess-Pierce B, Kader AA. Consumption of cherries lowers plasma urate in healthy women. J Nutr. (): doi/jn/

  3. Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. (): doi/art

  4. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. (): doi/NEJMoa

Additional Reading
  • Choi HK. Dietary risk factors for rheumatic diseases. Curr Opin Rheumatol. (): doi/ccoc

  • Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther. 8 Suppl 1 (): S2. doi/ar

  • Schlesinger N. Dietary factors and hyperuricaemia. Curr Pharm Des. (): doi/

Источник: mynewextsetup.us

10 home remedies for gout

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Gout is a form of inflammatory arthritis that causes pain and discomfort, often in the toes, ankles, and knees. There is no cure for gout, so a combination of medications and home remedies can help keep gout in remission.

Gout occurs when the body builds up too much uric acid. This acid is a by-product from when the body breaks down purines found in foods.

Making some dietary changes can help a person reduce their purine levels and the likelihood of having a gout flare.

Home remedies for gout include:

1. Drinking plenty of water

When a person has gout, they can experience significant swelling and inflammation. One of the ways to reduce swelling is by drinking more water.

Increasing fluid consumption can kick-start a person’s kidneys to release excess fluid, which can reduce swelling in a person with gout.

Water is best, but other clear fluids, such as broths and herbal teas are also good choices. People should avoid alcohol and sodas, which are high in purines.

However, anyone with congestive heart failure or kidney disease should talk to their doctor before increasing their fluid intake.

2. Applying ice to affected joints

Applying a cloth-covered ice pack to the joint can help reduce gout-related inflammation.

Try applying an ice pack wrapped in a thin towel for 10–15 minutes at a time to help relieve pain.

If gout is affecting the feet, a person can also use a pack of frozen vegetables covered with a washcloth, as this may drape more easily over the feet.

3. Reducing stress

Heightened stress can worsen a person’s gout symptoms. While it is not always possible to eliminate all sources of stress, the following tips might help:

  • exercising, such as taking a brief walk, if the pain does not limit movement
  • asking for time off from work
  • journaling or reading a favorite book
  • listening to music
  • meditating

Getting enough rest can also help a person feel less stressed.

4. Elevating the affected joints

Gout can cause pain and swelling, especially in the feet, hands, knees, and ankles.

One way to reduce swelling is by elevating the affected joints. This encourages blood and fluid to move away from the joint and back toward the heart.

A person can also use an ice-pack in combination with elevation to reduce their gout symptoms.

5. Taking over-the-counter pain relievers

While over-the-counter (OTC) anti-inflammatory medications, such as ibuprofen (Advil) and naproxen sodium (Aleve), may not be “natural,” they are excellent options for treating pain and discomfort due to gout.

People should never take more than the recommended dose and always ask a doctor about whether OTC medicines might interfere with their other medications.

If OTC pain-relievers do not help, ask a doctor about stronger prescription medications.

6. Drinking coffee

Some people think drinking coffee may decrease the risk of experiencing gout.

A review and meta-analysis showed that those who drank more coffee were less likely to have gout. This may be because coffee can lower uric acid levels.

However, just because the study showed a correlation between higher coffee consumption and lower risk of gout, this does not mean that coffee caused the lower risk.

7. Eating more cherries

A research study published in the journal found increasing cherry intake over 2-days decreased the risk for gout attacks by 35 percent in those with previously diagnosed gout.

Cherries contain high levels of anthocyanins, which are anti-inflammatory compounds. The researchers found there were symptom-reducing benefits for those eating whole cherries or cherry juice, as well as people taking cherry extract supplements.

They also discovered a 75 percent risk reduction for gout attacks when a person consumed cherries in addition to taking a gout medication.

Cherries and cherry juice are available in many supermarkets. People can also buy cherry extract supplements in health food stores and online.

8. Drinking lemon water

The authors of a study found that adding the juice of two freshly squeezed lemons to 2 liters of water each day reduced uric acid in people with gout.

The researchers concluded that lemon water helps to neutralize uric acid in the body, thus helping to reduce levels.

Avoiding high-purine meats

Some meats also contain high amounts of purines. Avoiding meats that contain high levels of purine might help to reduce a person’s gout symptoms.

Meats and fish that are high in purines include:

  • bacon
  • turkey
  • veal
  • venison
  • organ meats, such as liver
  • anchovies
  • sardines
  • mussels
  • herring
  • cod
  • haddock
  • trout
  • scallops

Talk to a doctor about medications

Some medications, such as diuretics, can increase the risks of a uric acid buildup and gout flare.

It is essential that people do not stop taking their medication before speaking to a doctor about possible alternatives. In some cases, the benefits of the medication outweigh the side effects.

A doctor can also discuss which medications are available to help reduce gout symptoms.

Summary

Gout flare-ups can be painful and exhausting. Treatments, including home remedies, can reduce symptoms and help prevent future flare-ups.

Maintaining a healthy weight and exercising regularly can also help a person manage their condition.

If a person’s flare-ups do not start to improve after 48 hours, they should call their doctor to determine if they need further medical treatments.

Источник: mynewextsetup.us

Natural support for gout

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By Mike Ventresca, Vital Choice Healthstore

Gout is one of the most painful forms of arthritis. Symptoms include intense joint pain, inflammation and redness lasting a few days to a few weeks. It usually affects the big toe, but can occur in other parts of the body.

This painful condition is often diet related. The main culprit is an unhealthy build-up of uric acid that forms crystals in the joint tissue leading to tremendous inflammation. Uric acid is a by-product of purine metabolism. Purines are found in many foods, but in higher concentrations in meat. Alcohol, especially beer, also increases uric acid production.

Another often overlooked factor is kidney function. Because the kidneys are responsible for filtering out uric acid, if the kidneys are not performing optimally, a build-up of uric acid can occur.

While avoiding purine rich foods, drinking more water and less beer can also help to prevent gout attacks. I’m often asked if there are any natural remedies that can help reduce the pain of a gout attack as well as prevent future events. The answer is, yes.

The most effective product I’ve found is Gouch by Redd Remedies. What I like about Gouch is it not only addresses the short-term inflammation, it also includes ingredients that support overall kidney function, providing long-term benefit as well.

Two primary ingredients in the formula are cherry extract and quercetin. Both have demonstrated natural anti-inflammatory compounds as well as the ability to block the conversion of purines to uric acid. Further enhancing the inflammation support is ginger extract.

In addition, Gouch adds the herb boerhaavia. Research shows boerhaavia helps by supporting overall kidney function and encouraging proper uric acid removal.

Mike Ventresca is the owner of Vital Choice Health Store located at Sprague Road in North Royalton’s Timber Ridge Plaza. The phone number is or mynewextsetup.us

This information is not intended to diagnose, treat, cure or prevent any disease.

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Natural home remedies for gout attack -

10 Steps to Ease a Gout Attack

Many Risk Factors May Contribute to Gout and Gout Flare-Ups

Women can develop gout too, especially later in life after menopause.

Other risk factors and conditions for developing gout include:

RELATED: Gout Complications and Related Conditions

Your Point Plan: Easing a Gout Attack

During a gout attack, the affected joint becomes swollen, warm to the touch, and appears very red. Even the slightest pressure on the joint can be very painful. The attacks more often occur in the middle of the night; about 50 percent start in the big toe, according to the Alliance for Gout Awareness.

Want to get ahead of the intense pain? Make sure you have a plan:

1. Get a Diagnosis

If this is the first time you have had an attack, see your doctor immediately. “Gout is one of the most underdiagnosed diseases because data on how to treat high uric acid has been lacking. We have better information now. If you are experiencing a flare, you should have an action plan in place, created with your doctor,” says Payam Shakouri, MD, nephrologist with Advanced Kidney Care of Hudson Valley in New York, and medical advisor for gout to CreakyJoints. The sooner you start treatment and pain management, the more quickly you will be back on your feet.

RELATED: Gout Symptoms and Diagnosis

2. Take the Right Anti-Inflammatory Medications

There are three different kinds that are effective: over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or naproxen sodium; prescription steroids; or a prescription anti-inflammatory called colchicine, which influences the way your body reacts to uric acid crystals. “Your doctor will figure out which is the best for your unique needs. NSAIDs, for example, are not appropriate if you have renal disease, and steroids could make your blood sugars worse if you have diabetes,” points out Dr. Fitzgerald.

3. Free the Joint! 

The least pressure on the affected area can be very painful. People report they can’t even bear to be under a bedsheet. Make sure there are no constraints on the joint when it is flaring up.

4. Rest and Elevate

Stay off the affected joint and keep it elevated as much as possible.

RELATED: The Importance of Resting Joints

5. Apply Ice — if You Can Bear It

“Apply ice if you can do so comfortably without creating pain,” says Fitzgerald.

6. Watch Your Diet

You can lower uric acid levels by limiting foods high in purines (like red meat, organ meat, and seafood), and alcohol intake (particularly beer and hard liquor).

7. Stay Hydrated

Drinking water can help flush the uric acid crystals that cause gout out of your system. “A well-hydrated patient should drink enough to urinate every two to three hours,” says Dr. Shakouri.

RELATED: 6 Unusual Signs of Dehydration You Should Know About

8. Practice Mindfulness and Meditation

The good news: A gout attack is self-limited and will clear in time. In the meantime, according to the Arthritis Foundation,meditation, yoga breathing, mindfulness, and guided imagery can help you deal with the pain.

RELATED: Why You Want to Elicit the Relaxation Response If You Have Rheumatoid Arthritis

9. Create a Support Network

Many patients suffer in silence because of the stigma around gout. Let trusted friends and family know that you have this disease, and reach out for support when you are having a flare.

RELATED: 6 Ways to Stop Rheumatoid Arthritis Isolation and Loneliness

If You Are Having Repeated Attacks, See Your Doctor

Some patients can go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some won't have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about escalating treatment. “People think it’s normal to have flares every now and then, but it’s not. The gout can be doing damage to your joints. It means you still have too much uric acid,” says Shakouri. In particular, ask about allpurinol. It won’t help with an acute attack but will help prevent future attacks by reducing uric acid production.

RELATED: Sleep Apnea Increases the Risk for Gout, Research Suggests

Источник: mynewextsetup.us

Chinese herbal medicine for gout: a review of the clinical evidence and pharmacological mechanisms

Chinese Medicinevolume 15, Article number: 17 () Cite this article

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Abstract

Gout is a common arthritis condition due to disorders of purine metabolism and decreased uric acid excretion. Although researchers have carried out various studies on this disease, there are no effective drugs for patients with gout. In traditional Chinese medicine (TCM), gout pertains the category of Bi pattern due to qi stagnation in the meridians and collaterals. Chinese herbal medicinals has been employed to treat Bi patterns since the ancient China. In recent decades, classical TCM formulas and agents isolated from some Chinese herbal medicinals have been applied to treat gout and have achieved satisfactory effect. In this review, we focus on recent studies of gout in which TCM formulas were applied to treat animal models or to treat patients, and summarize the mechanism of gout from TCM perspective, the clinical application, pharmacological mechanism and the chemical compounds of TCM formulas in treating gout. In conclusion, through this study, we summarized the application principle of TCM formulas in gout treatment and some key issues of current research, and we hope this study will provide some references for applying TCM formulas to treat gout and will lay a foundation for the development of novel formulas for gout treatments.

Background

Gout is a common arthritis condition due to deposition of monosodium urate (MSU), and is closely related to hyperuricemia [1]. Because of disorders of purine metabolism or impaired renal excretion [2, 3], serum uric acid levels rise to be abnormally high, and finally there would be the deposition of uric acid and acute persistent inflammatory reactions in the joints [4]. The most common clinical manifestations of gout are acute burning sensation and swelling of the joints. In some cases, clinical manifestations such as joint damage and renal dysfunction are often present [5]. Gout affects a significant portion of the population worldwide annually [6], and according to the estimates of World Health Organization (WHO), % of people worldwide are suffering from gout [7]. The acute onset of arthritis, joint malformations, chronic joint injuries and the formation of renal calculus not only reduce the quality of life, but also lead to disability [8].

Currently, although researchers have carried out various studies on this disease, there are no effective drugs for patients with gout. Drugs like colchicines, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have been applied to treat acute onset of gout [9]. These drugs show good effect in the short term, but when used for a long time, gastrointestinal reactions, rashes, systemic vacuities and even renal failure would occur [10, 11]. Besides, such drugs could not prevent, halt or reverse the progression of this complicated disease. Therefore, therapies or drugs which can intervene the development of gout are greatly needed in clinic.

Traditional Chinese medicine (TCM) has been applied to treat gout since the ancient China [12]. In TCM, gout is classified as Bi pattern usually due to qi stagnation in the meridians and collaterals. Under the guidance of pattern differentiation, classical TCM formulas and agents isolated from some herbs have been applied to treat gout with satisfactory effect [5]. Some chemical ingredients isolated from these formulas or Chinese herbal medicinals are of multi-target and low toxicity, showing advantages and good prospects in the prevention and treatment of gout (Fig. 1). In this review, the clinical application and pharmacological mechanism of TCM formulas in the treatment of gout are summarized, so as to develop novel formulas for gout treatments (Table 1).

The commonly used ingredients isolated from TCM formulas or Chinese herbal medicinals for the treatment of Gout. Eight herbs have been frequently used for gout treatment with low toxicity and excellent effect under the principle of syndrome differentiation and treatment

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Gout and Bi syndrome patterns

In TCM, gout pertains the category of Bi pattern [13]. In general, the manifestations of Bi pattern are mainly characterized as pain, numbness and heaviness of muscles, tendons and joints or swelling of joints with hot sensation and limitation of movement [14]. According to TCM, the primary causes are the deficiency of healthy qi and the invasion of pathogenic factors like wind, cold, dampness or heat [12]. It is recorded in Treatise on Blood Trouble that the transportation and transformation function of spleen is closely related to the disease mechanism of gout. The deficiency of spleen qi could cause obstruction in the digestion system and lead to the buildup of waste products like uric acid in the blood. In addition, the evidences from clinical trials suggested that the dampness accumulation and blood stasis in the meridian would result in the swelling and pain of joint and the buildup of uric acid in the blood [13]. Because of the individual difference of body constitution and different pathogenic factors, there are various types of Bi pattern. For example, people with yang-deficiency constitution are usually affected by the combined invasion of wind, cold and dampness, and therefore there would be a Bi pattern of cold-dampness type, while people with yang-predominance constitution or yin-deficiency and yang-hyperactivity constitution are usually affected by the combined invasion of wind, dampness and heat, and finally there would be Bi pattern of damp-heat type. Among those factors, dampness and heat are the most common external causes of acute gout, while the deficiency of healthy qi and the invasion of dampness are the most common external causes for gout during remission.

The clinical application of TCM formula in the treatment of gout

In the early stage of Bi pattern, the therapeutic principles are expelling pathogenic factors, for example, dispelling wind, dispersing cold, clearing away heat, eliminating dampness and dredging meridians and collaterals [15]. For the patient suffering from Bi pattern for long time or the patient with weak body constitution, in addition to the therapy for expelling pathogenic factors, tonifying the spleen, liver, kidneys and nourishing blood should also be applied. For patients with gout complicated by phlegm and blood stasis, activating blood circulation, dissipating blood stasis and masses and eliminating phlegm should also be applied (Fig. 2) [16].

The main different types of and the therapeutic principles of gout. There are three different types of gout based on syndrome differentiation

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The clinical application of TCM formula in treating acute gout

In recent years, TCM formulas are often modified or combined with chemical drugs to treat gout with fewer side effects, and have been regarded as the promising treatments [17]. Among these, Simiao Powder as well as the modified ones like Jiawei Simiao Powder, Tongfeng Decoction, Danxi Tongfeng Decoction are widely used for gout of damp-heat type. Chen et al. [17] found that the TCM formulas combined with chemical drugs showed better effect than chemical drugs applied alone. Similarly, the research from Huang et al. [18] suggested that the improvement of symptom score in the group treated with oral administration of Jiawei Simiao Powder and external application of Jinhuang Cream was more significant than that in the group treated with chemical drugs alone. In the group treated with TCM formula, the effective rate was higher than that in the group treated with chemical drugs, and the adverse reaction rate was significantly lower than that in the group treated with chemical drugs. Based on Simiao Powder, Tongfeng Decoction is invented and widely used. Wu et al. [19] found that after the administration of Tongfeng Decoction and celecoxib capsule, the acute inflammatory indicators in the blood sample of the gout patients were reduced, the inflammatory response was inhibited, the uric acid content was reduced, and the side effects were also reduced. In another clinical study, it was also found that the Danxi Tongfeng Decoction (the modified Simiao Powder) was better than celecoxib capsules in reducing the erythrocyte sedimentation rate (ESR) and serum uric acid (SUA) and prolonging the pain relieving time [20]. The above three TCM formulas with the effect of clearing away heat and draining dampness, and dredging the collaterals to stop pain, are modified from Simiao Powder.

Wuwei Xiaodu Decoction is an effective formula with the effect of clearing heat and detoxifying for treating patients with joint pain and obvious swelling. Yu et al. [21] applied modified Wuwei Xiaodu Decoction combined with colchicine tablets to treat the gout arthritis of damp-heat type, and found that the effective rate (%) was higher than that in the control group (%). Meanwhile, the combined application could effectively relieve acute joint pain, reduce swelling, relieve pain and improve joint function. Besides, the combined application of Guizhi Fuling Pill and Wuwei Xiaodu Decoction showed better effect than the combined application of meloxicam tablets and sodium bicarbonate tablets [22]. They have found that the effective rate was % in the group treated with TCM formulas, which was higher than that in the group treated with chemical drugs, and in the group treated with TCM formulas the pain degree was significantly reduced, the swelling score, SUA and C-reactive protein (CRP) levels were lower than those in the group treated with chemical drugs.

Patients with acute attack of gout usually show severe joint pain, high skin temperature, thirsty sensation, white or yellow coating on the tongue, and there are various therapeutic methods or formulas in TCM. Among them, Zhuye Shigao Decoction with the function of clearing away heat and nourishing yin, invigorating the spleen and draining dampness, is of good efficacy on these patients. In a clinical study by Li et al. [23], Zhuye Shigao Decoction combined with colchicine tablets and celecoxib capsules showed better effect than celecoxib capsules, the effective rate was increased from % to %, and the gastrointestinal reactions such as nausea, vomiting and diarrhea were reduced.

In another clinical reports, it is also illustrated that combined application of Qingre Chubi Decoction and etoricoxib tablets was better than etoricoxib tablets used alone to treat acute gout [24, 25]. Qingre Chubi Decoction, with the function of dispelling wind and draining dampness, and dredging the collaterals to stop pain, has good effect for patients with gout affected by the combined invasion of wind, dampness and heat [24, 25]. There are two formulas named as Qingre Chubi Decoction which are of different compositions and similar effects. One Qingre Chubi Decoction composed of Herba Aristolochiae Mollissimae, Caulis Sinomenii, Radix Cudraniae Cochinchinensi, Rhizoma Atractylodis Lanceae and Rhizoma Anemarrhenae, could relieve the clinical symptoms and signs effectively, and improve inflammation indexes more obviously than the chemical drugs. Another Qingre Chubi Decoction, composed of Caulis Sinomenii, Caulis Piperis Kadsura, Ramulus Mori, Radix Stephaniae Tetrandrae, Herba Lycopi Hirti, Radix et Rhizoma Clematidis, Rhizoma Smilacis Glabrae and Lumbricus, has a good therapeutic effect for gout and low incidence of adverse reactions [26, 27].

Wen et al. [28] proposed that the increased level of SUA was due to water-dampness and phlegm-dampness blocking the meridians and collaterals, and dysfunction of qi and blood from TCM perspective. He found that Tongfengshu Capsule could promote blood circulation and urination to reduce SUA with a total effective rate of %. Tang et al. [29] found that in patients treated with Tongfengshu Capsule combined with chemical drugs, symptoms and signs were relieved more obviously than in patients treated with chemical drugs alone, and the recurrence rate was lower than that in patients treated with chemical drugs 4 or 8 weeks after the treatment.

In the Synopsis of Golden Chamber the therapeutic principles for gout were dispelling cold and draining dampness, and clearing away heat and nourishing yin. Guizhi Shaoyao Zhimu Decoction is applied in clinic guided by those principle. Zhu et al. [30] found that the pain relieving time, number of relapses within 6 months and the TCM syndrome score in patients treated with the combined application of Guizhi Shaoyao Zhimu Decoction, celecoxib capsules and colchicine tablets, were lower than those treated with chemical drugs alone. He et al. [31] compared the modified Guizhi Shaoyao Zhimu Decoction with celecoxib capsules, and found that the pain and swelling were obviously relieved, and the activity restriction scores were significantly improved. Liu et al. [32] used Tongfengan Mixture according to the method of softening hard lumps and dispelling nodes to treat acute gout and found that this combination could reduce SUC, the severity and frequency of attacks. In conclusion, TCM formulas has better clinical efficacy and higher safety than chemical drugs in the treatment of gout.

The clinical application of TCM formulas in the treatment of gout during the remission stage

During the remission stage of gout, the disease mechanism of TCM usually involves spleen deficiency with dampness accumulation. From TCM perspective, the abnormal production and excretion of uric acid is related to the dysfunctional of spleen, and tends to result in the increased content of SUA [33]. Qin et al. [34] used Tongyang Mizhuo Decoction, composed of Lizhong Pills and Wuling Powder to treat gout during the remission stage and found that the total effective rate was % and the SUA level was significantly reduced after the treatment. Emerging evidences from clinical observations indicated that patients during the remission stage were characterized by spleen deficiency with dampness accumulation. Quzhuo Tongbi Decoction is often used to treat spleen deficiency with dampness accumulation pattern and therefore it is suitable to treat gout during remission stage [33].

According to the TCM theory of “treating disease before its onset”, Peiyuan Huazhuo Decoction, is mainly used to prevent renal damage in patients with gout. TCM doctors found that the symptoms and the renal damage were relieved after the combination therapy, suggesting that the application of Peiyuan Huazhuo Decoction had the function of strengthening healthy qi and inducing diuresis [35].

In conclusion, TCM formulas commonality is promoting the body resistance and eliminating pathogenic factors. Different TCM formulas are applied to achieve the relative equilibrium of yin-yang based on the heterogeneity of body constitution and pathogenic factors.

The pharmacological mechanism of TCM formulas in the treatment of gout

Emerging evidences have suggested that gout caused by monosodium urate deposition is related to disorders of purine metabolism and reduced uric acid excretion, so it is classified as a metabolic rheumatism. However, in recent studies it has been found that the pathogenesis is closely related to the mechanism of “metabolism-inflammation-immunity” [36]. TCM treatment for gout, especially the formulas from Synopsis of Golden Chamber could interfere the mechanism of “metabolism-inflammation-immunity” [37].

The pharmacological mechanism of Simiao Powder and it’s modification in the treatment of gout

Simiao Powder is composed of Cortex Phellodendri Amurensis, Semen Coicis, Radix Achyranthis Bidentatae and Rhizoma Atractylodis Lanceae. All the herbs in the Simiao Powder are also the major ingredients in the Jiawei Simiao Powder, Tongfeng Decoction and Danxi Tongfeng Decoction. According to TCM theory, Cortex Phellodendri Amurensis is bitter in flavor and has curative effects on the kidneys, bladder and large intestine. The main medicinal components of Cortex Phellodendri Amurensis are alkaloids such as berberine, lipoid and sterol [38], with the function of anti-inflammation, bacteriostasis, cellular immune regulation, anti-gout and inhibiting the apoptosis of articular chondrocytes [39]. Rhizoma Atractylodis Lanceae is pungent and bitter in flavor, and usually works on the kidneys, bladder and large intestine. It has the function of anti-bacterium, anti-inflammation, reducing blood glucose level and suppressing central nervous system [40]. Satoh et al. [41] found that Rhizoma Atractylodis Lanceae could inhibit the activity of sodium–potassium-ATPase, prevent the absorption of water and sodium ions, and thus to promote urination and excretion.

Radix Achyranthis Bidentatae is sweet in flavor, has the function of reinforcing liver and kidneys, strengthening muscles and bones, and promoting urination, and usually works on the liver and kidneys. It is reported that Radix Achyranthis Bidentatae could promote the excretion of uric acid, improve the cellular and humeral immunity as well as the non-specific immune function [42].

The combination of Cortex Phellodendri Amurensis, Radix Achyranthis Bidentatae and Rhizoma Atractylodis Lanceae can reduce the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 in synovial tissue. Having the function of anti-inflammatory and inhibiting cyclooxygenase-2 (COX-2), Semen Coicis Albais could works on regulating purine metabolism and reducing uric acid formation [43]. After Semen Coicis Albais is added, this combination of four herbs becomes Simiao Powder, which has good effect on the patient with gout of dampness-heat type [44]. Wang et al. [45] suggested that modified Sanmiao Powder could inhibit the content of inflammatory factors in the joint fluid of rats with acute gout arthritis.

Although Jiawei Simiao Powder, Tongfeng Decoction and Danxi Tongfeng Decoction are all invented based on Simiao Powder, the pharmacological mechanisms of these TCM formulas are different. Oral administration of Jiawei Simiao Powder and combined with external application of Jinhuang Cream could relieve the inflammation by reducing the levels of ESR, CRP and IL-8 [18]. Tongfeng Decoction could effectively reduce SUA, inhibit inflammatory response, halt the progression of the disease, and have the function of reducing uric acid [19]. Danxi Tongfeng Decoction could reduce ESR and SUA levels, and has a good analgesic effect [20].

The pharmacological mechanism of Wuwei Xiaodu Decoction in the treatment of gout

Wuwei Xiaodu Decoction, composed of Flos Lonicerae, Flos Dendranthematis Indici, Herba Taraxaci Mongolici, Herba Violae Philippicae and Nudicaulous Grounsel Herb, is firstly recorded in Golden Mirror of the Medical Tradition. It is recorded that Flos Lonicerae, Flos Dendranthematis Indici and Nudicaulous Grounsel Herb have the function of anti-inflammation and immunomodulation [46,47,48]. Some researchers find that Herba Taraxaci Mongolici has the function of anti-bacteria, anti-oxidation, anti-inflammation, diuresis, anti-allergy, promoting immunity, and is beneficial for the stomach [49]. Because of its strong effect of anti-pathogenic microorganisms, Herba Violae Philippicae is often used in the treatment of ulcers and carbuncle with symptoms like swelling and pain [50]. It is believed that Wuwei Xiaodu Decoction can enhance the immunity of diseased mice and reduce the IL to the normal level [51]. Besides, another report also illustrates that Wuwei Xiaodu Decoction could increase the phagocyte index and phagocyte rate of macrophages, adjust the balance of flora and thus enhance the immune function [52].

The pharmacological mechanism of Zhuye Shigao Decoction in the treatment of gout

Zhuye Shigao Decoction is composed of Folium Phyllostachydis Henonis, Gypsum Fibrosum, Rhizoma Pinelliae Praeparatum, Radix Ginseng, Radix Ophiopogonis, Oryza Sativa L., Radix Ophiopogonis Japonicir and Radix et Rhizoma Glycyrrhizae. Wang et al. [53] held that gout was caused by dampness accumulation and heat blocking the meridians and collaterals, so he adopted the methods of clearing heat and resolving dampness, unblocking the collaterals and relieving pain, and applied Zhuye Shigao Decoction for the treatment. Chen et al. [54] found that after being treated with modified Zhuye Shigao Decoction, serum levels of IL-1β and caspase-1 were reduced, and the expression levels of pro-IL-1 and pro-caspase-1 were down-regulated, suggesting that the modified Zhuye Shigao Decoction could inhibit the inflammation induced by sodium urate crystals, which may be related to the intervention of IL-1 signaling pathway.

The pharmacological mechanism of Qingre Chubi Decoction in the treatment of gout

There are two formulas named as Qingre Chubi Decoction which are of different compositions and similar effects. In one Qingre Chubi Decoction, the ingredients include Herba Aristolochiae Mollissimae, Caulis Sinomenii, Radix Cudraniae Cochinchinensi, Rhizoma Atractylodis Lanceae, and Rhizoma Anemarrhenae. Another Qingre Chubi Decoction is composed of Caulis Sinomenii, Caulis Piperis Kadsura, Ramulus Mori, Radix Stephaniae Tetrandrae Herba Lycopi Hirtiaa, Radix et Rhizoma Clematidis, Rhizoma Smilacis Glabrae and Lumbricus. Wang et al. [55] confirmed that the first Qingre Chubi Decoction could relieve the symptoms of patients such as feverish sensation, joint swelling and pain, and reduce the inflammatory indicators such as ESR and CRP. Some studies suggested that Qingre Chubi Decoction might inhibit the release of IL-1β and TNF-α to ameliorate the acute inflammatory response of gout [56]. Additionally, Qingre Chubi Decoction inhibited the proliferation of THP-1 cells stimulated by MSU crystals. The inhibition of monocyte activity and IL-1β may be one of the anti-inflammatory mechanisms of Qingre Chubi Decoction [57].

The pharmacological mechanism of Tongfengshu Capsule in the treatment of gout

Tongfengshu Capsule, composed of Radix et Rhizoma Rhei Palmati, Semen Plantaginis, Rhizoma Alismatis, Radix Achyranthis Bidentatae and Radix Stephaniae Tetrandrae, is a Chinese patent medicine. Rheum emodin, one chemical component from Radix et Rhizoma Rhei Palmati, could inhibit the expression of NOD-like receptor family pyrin domain-containing 3 (NLRP3) and IL-1 mRNAs [58] and inhibit the activation of extra cellular signal–regulated kinases 1 and 2 (ERK1/2) and p38 nitrogen-activated protein kinases (p38 MAPK) signaling pathways by inhibiting the expression of ERK1/2 nucleus and p38MAPK, thereby reducing the release of inflammatory factors [59]. Semen Plantaginis and Rhizoma Alismatis could promote urination, and reduce swelling and pain. Among them, Semen Plantaginis, rich in mullein glycolic anhydride, could promote uric acid secretion, reduce the creatinine level, scavenge reactive oxygen species (ROS) and improve renal function [60]. In addition, it is reported that the ethanol extract of Rhizoma Alismatis could reduce SUA level without damaging renal function [61]. Radix Stephaniae Tetrandrae has the function of dispelling wind, relieving pain and inducing diuresis to alleviate edema. Tetrandrine, the active ingredient of Radix Stephaniae Tetrandrae could inhibit the inflammatory response of cells, and this anti-inflammation mechanism may be related to inhibiting nuclear factors such as NF-κB, reducing IL-6 and TNF-α levels, and promoting the expression of anti-inflammatory cytokines such as IL [62]. It is also reported that Radix Achyranthis Bidentatae could increase superoxide dismutase (SOD) activity, reduce serum lipid peroxide level, and regulate immunity and metabolism of the body [63]. Based on the previous study, the anti-inflammation mechanism of Tongfengshu Capsule may be related to inhibiting the synthesis or release of prostaglandin E2 (PGE2), reducing the production of inflammatory cytokines like TNF-α and resisting lipid peroxidation [64]. It was also found that Tongfengshu capsule could significantly relieve symptoms of joints in rats with acute gout arthritis, suggesting the mechanism might be related to reducing IL-1β and TNF-α levels, inhibiting the expression of malonic dialdehyde (MDA) and nitrogen oxide (NO), and promoting the release of SOD [65]. Besides, some researchers proposed that the therapeutic mechanism of Tongfengshu Capsule in the treatment of gout arthritis was related to the down-regulation of serum levels of high mobility group protein 1 (HMGB l) and receptor for advanced glycosylation end-products (RAGE) in patients with gout [65].

The pharmacological mechanism of Guizhi Shaoyao Zhimu Decoction in the treatment of gout

Guizhi Shaoyao Zhimu Decoction, firstly recorded in the TCM classics, Synopsis of the Golden Chamber, is composed of Herba Ephedrae Sinicae, Ramulus Cinnamomi, Radix Saposhnikoviae, Largehead Atractylodes Rhizome, Radix Aconiti Lateralis Praeparata, Rhizoma Anemarrhenae, Radix Paeoniae Alba, Radix et Rhizoma Glycyrrhizae and Rhizoma Zingiberis Recens. Herba Ephedrae Sinicae, could scavenge ROS and had significant antioxidant effects [65]. In addition to anti-bacterium, anti-virus and anti-inflammation effects [66, 67], Ramulus Cinnamomi and Radix Saposhnikoviae can also stimulate the secretion of saliva and gastric juice and stimulate sweat glands to dissipate heat [68]. Largehead Atractylodes Rhizome and Radix Aconiti Lateralis Praeparata have the function of warming channels to dispel coldness. It is recorded that Rhizoma Anemarrhenae and Radix Paeoniae Alba could nourish yin and clear heat. It took the researchers 5 years to find that Guizhi Shaoyao Zhimu Decoction has the function of relieving pain, anti-inflammation and healing bone injury. Besides, it also could induce apoptosis of synovial cell, regulate immunity, and promote uric acid excretion, and protect renal function to treat gout arthritis [69]. Some researchers proposed that the mechanism underlying the Guizhi Shaoyao Zhimu Decoction in the treatment of gout arthritis was related to reducing the expression of Toll-like receptor (TRL)-2, TRL-4, NLRP3 receptor, myeloid differentiation factor (MyD)88 and apoptosis-associated speck-like protein (ASC), increasing the expression of peroxisome proliferator-activated receptor (PPAR)-γ and inhibitor-κB (IκB)-α, inhibiting the differentiation and maturation of IL-1β and the activation of NF-κB [70].

The pharmacological mechanism of Tongfengan Mixture in the treatment of gout

Tongfengan Mixture, composed of Herba Lysimachiae, Semen Sinapis, Thallus Ulvae Fasciata, Spora Lygodii, Rhizoma Smilacis Glabrae, Flos Carthami, Radix Paeoniae Rubra, Pseudobullbus Cremastrae, Rhizoma Alismatis and Rhizoma Corydalis, has the function of softening hardness and dissipating mass. It is found that in the rat models, Tongfengan Mixture can relieve the swelling, reduce the level of MSU crystals in the ankle joints, and reduce the inflammatory reaction, which may be achieved by reducing the inflammatory reaction in the blood [71]. Liu et al. [32] suggested that Tongfeng Mixture could inhibit the secretion of inflammatory factors like IL-1β, TNF-α and NF-κB in the synovial tissue of the ankle joint of rats by clearing away urate crystals, and reducing the inflammation.

The pharmacological mechanism of Quzhuo Tongbi Decoction in the treatment of gout

There are two formulas name as Quzhuo Tongbi Decoction which are of different compositions and similar effects. In one Quzhuo Tongbi Decoction, the ingredients include Rhizoma Smilacis Glabrae, Rhizoma Dioscoreae, Stigma Maydis, Semen Coicis, Rhizoma Curcumae Longae, Herba Taxilli Chinensis, Rhizoma Corydalis, Folium Pyrrosiae and Semen Plantaginis. Another Quzhuo Tongbi Decoction is composed of Radix Aconiti, Rhizoma Smilacis Glabrae, Radix Bupleuri Chinensi, Largehead Atractylodes Rhizome, Radix Astragali, Caulis Lonicerae and Radix Paeoniae Rubra. It has been documented that some intestinal bacteria could cause abnormal uric acid metabolism [72]. Zhu et al. [73] found that the medium and high dosage of the first Quzhuo Tongbi Decoction can reduce the level of uric acid, serum creatinine and xanthine oxidase (XOD). Besides, it could also relieve inflammation symptoms, inhibit the production of PGE2, relieve pain sensation by blocking the sensation of peripheral nerves to pain stimuli [74].

The pharmacological mechanism of Peiyuan Huazhuo Decoction in the treatment of gout

Peiyuan Huazhuo Decoction is composed of Rhizoma Polygonatum Sibirici, Semen Cuscutae, Radix Astragali, Rhizoma Smilacis Glabrae, Semen Coicis and Rhizoma Corydalis. Yang et al. [75] found that Radix Astragali could increase the glomerular filtration rate. It was also found that Rhizoma Polygonatum Sibirici not only had a good effect of lowering SUA levels, but also reduced blood lipid and glucose [35]. The herbs in this formula work together to treat lipid metabolism disorders, inhibit inflammatory reactions, prevent gout attack, and prevent renal damage in patients with gout.

Conclusions and perspective

The etiology of gout is complex and there are various hypotheses about its pathogenesis. According to the disease mechanism of TCM, therapeutic principles like dispelling wind and cold, clearing away heat and dampness, and dredging meridians and collaterals are often applied to treat acute gout [16]. During the remission stage, benefiting qi, nourishing blood and tonifying spleen and kidney are often applied (Fig. 3) [44]. Inhibiting inflammatory factors in joint fluid, reducing blood uric and promotion of uric acid excretion, enhancing immune function and blocking the sensation of peripheral nerve are the main mechanism underly TCM treatment for gout (Fig. 4).

The main pharmacological mechanisms of the treatment of acute gout and gout during the remission. The disease of gout consists of the attack stage and remission stage, which should be treated differently based on disease mechanism of TCM

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The main TCM formulas and the underlying pharmacological mechanisms of the treatment of gout. There are two ways to reduce the SUA level: one is to promote uric acid excretion, and the other is to reduce uric acid production

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Compared with chemical drugs like colchicine, eloricoxib and celecoxib, TCM herbs have advantages in slowing down the severity and frequency of attacks, reducing the concentration of uric acid in blood with fewer side effects. Although TCM has a strong advantage in the treatment of gout, the application of TCM herbs or formulas should follow the principle of syndrome differentiation and treatment from TCM perspective.

In this review, we focus on the research data from animal and clinical studies in recent years, and summarize the TCM theory of gout, the clinical application, pharmacological mechanism and the chemical compounds of TCM formulas for gout treatment. By doing this we hope to help the researchers on exploring the mechanism of TCM treatment for gout and to develop agents more effectively for gout treatment.

Availability of data and materials

All the data used to support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

Monosodium urate

Non-steroidal anti-inflammatory drugs

Traditional Chinese medicine

Tumor necrosis factor

Interleukin

Erythrocyte sedimentation rate

C-reaction protein CRP

NOD-like receptor family pyrin domain-containing 3

Mitogen-activated protein kinase

Reactive oxygen species

Superoxide dismutase

Malonic dialdehyde

Nitrogen oxide

High mobility group protein 1

Receptor for advanced glycosylation end-products

Serum uric acid

Toll-like receptor

Myeloid differentiation

Apoptosis-associated speck-like protein

Peroxisome proliferator-activated receptor

Prostaglandin E2

Xanthine oxidase

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Top 10 Natural Home Remedies for Gout

Gout is a type of arthritis that can affect different body parts like the ankles, knees, hands, wrists but mainly affects the big toe. Symptoms include acute pain, inflammation in the joints causing swelling and tenderness. Many gout sufferers have experimented with natural home remedies. What is a the true definition of a home remedy? It’s simply a medicine made with ingredients available at home.

Here are the most popular natural home remedies voted by gout sufferers:

1. Apple Cider Vinegar: ACV is considered king when it comes to a gout natural home remedy and it’s my most popular post voted by social media. ACV helps your body become more alkaline and the acidity may help relieve acute gout pain. Many gout sufferers report drinking  tablespoons of raw unfiltered and organic apple cider vinegar in a glass of at least 8 ounces of water. Some will drink this times a day for better results. ACV can also be used as topical treatment. You you can soak your foot for about 30 minutes in a bucket full of 4 cups of hot water and 1 cup of apple cider vinegar. You can also soak a clean, dry cloth in apple cider vinegar and wrap it around the affected area for about 15 minutes.

2. Baking Soda: Another extremely popular natural home remedy for gout sufferers is baking soda. Like apple cider vinegar, it makes your body more alkaline. Many consume ½ a teaspoon in a glass of 8 oz. mynewextsetup.us will repeat this throughout the day until they have consumed at least 3 teaspoons of baking soda. It may help lower uric acid providing with relief from the pain at the same time. Avoid this home remedy if suffering from high blood pressure and try to limit salt intake in your meals during the day when taking baking soda. Baking soda is very high in sodium. The maximum recommended dose is 4 teaspoons throughout the day.

3. Cherries: Whether sweet or sour, cherries have been known to be extremely effective and may help treat gout and support healthy uric acid due to their high antioxidant properties. In one study conducted with people suffering from gout, it was concluded that eating half a cup serving of cherries daily ( cherries) resulted in a 35% reduced risk of a successive gout attack. For those eating 2 or even 3 servings in a day, their risk dropped to 50%! But that is too much sugar as well which can cause other health ailments. Best recommendation is to use a tart cherry extract supplement and avoid the sugar intake if you can!

4. Ginger and/or Turmeric: The powerful anti-inflammatories present in ginger root and turmeric may be very helpful in easing gout pain and inflammation. I basically chop off a little piece the size of an inch and boil it for about 20 minutes and drink it as tea. You can also add ginger root and/or turmeric in cooking recipes. Some may also eat a small piece raw daily. Others use it topically to reduce swelling by making a paste of ginger root with water and then apply it to the affected area, leaving it on for about 30 minutes.

 

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5. Water: Very simple, we all have it and it’s usually free. Drink plenty of it since it may help flush excess uric acid out of your body. Staying hydrated is one effective way that may limit gout flares. Drink at least 8 glasses of water a day but if you can, why not strive for 12?! Make sure a water bottle is with you everywhere you go, I carry a bottle with me from morning to night and keep refilling it all day long.

6. Lemon Juice: Another natural home remedy that may help alkalize your body and may support healthy uric acid in the blood, is drinking lemon juice. Many gout sufferers squeeze half a lemon in a glass of 8 oz. of water and drink it up to three times a day. Others will combine it with ½ a teaspoon of baking soda. Remember lemon juice is also high in vitamin C which may also help gout.

7. Celery Seeds: Another popular natural home remedy that may help support healthy uric acid according to many gout sufferers is celery seed extract. Celery seed simply stimulates your kidneys and may cause your kidneys to excrete more uric acid out of the body. Thus it causes you to visit the bathroom and urinate more.

8. Epsom Salt: There is no better topical treatment to treat a gout attack than epsom salt, widely used by many to relax muscles, aches and pains. The presence of magnesium which is an alkaline mineral in epsom salt also may help to treat gout. Before taking a bath, simply add 1 to 2 cups of Epsom salt in your bath and soak your entire body or affected joint, for at least 30 minutes.

9. Bromelain: Bromelain is a compound found in pineapples. The enzymes within it are frequently recommended for gout sufferers since it may help support healthy uric acid and may ease inflammation caused by gout. Again, bromelain is loaded with vitamin C as well which is also good for your gout. Bromelain is also considered a natural pain killer for many other ailments.

Vitamin C: A very popular vitamin with gout sufferers, let’s not forget vitamin C. Numerous studies have shown how vitamin C is effective, supporting healthy uric acid levels in your blood.

Finally, don’t forget to rest your affected joint(s) when suffering from gout as much as you can and do not overuse it so you can heal faster. Minimize the time spent on your joints.  You can also ice your joints if you like for some temporary pain relief. Apply an ice-pack to help ease pain and inflammation several times a day for about 20 to 30 minutes each time. Elevating your foot also helps ease the pain causing the blood to flow to that particular area of the body. Don’t be shy and use a cane to walk around thus avoiding unnecessary pressure onto the affected joint(s). Yes I admit it, I walked around with a cane during my first gout attack since it striked my big toe and knee at the same time. You can do it too!

Posted by Spiro Koulouris

apple cider vinegarbaking sodacelery seedschanca piedracherriesepsom saltgingergout treatmentturmericwater



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Natural support for gout

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By Mike Ventresca, Vital Choice Healthstore

Gout is one of the most painful forms of arthritis. Symptoms include intense joint pain, inflammation and redness lasting a few days to a few weeks. It usually affects the big toe, but can occur in other parts of the body.

This painful condition is often diet related. The main culprit is an unhealthy build-up of uric acid that forms crystals in the joint tissue leading to tremendous inflammation. Uric acid is a by-product of purine metabolism. Purines are found in many foods, but in higher concentrations in meat. Alcohol, especially beer, also increases uric acid production.

Another often overlooked factor is kidney function. Because the kidneys are responsible for filtering out uric acid, if the kidneys are not performing optimally, a build-up of uric acid can occur.

While avoiding purine rich foods, drinking more water and less beer can also help to prevent gout attacks. I’m often asked if there are any natural remedies that can help reduce the pain of a gout attack as well as prevent future events. The answer is, yes.

The most effective product I’ve found is Gouch by Redd Remedies. What I like about Gouch is it not only addresses the short-term inflammation, it also includes ingredients that support overall kidney function, providing long-term benefit as well.

Two primary ingredients in the formula are cherry extract and quercetin. Both have demonstrated natural anti-inflammatory compounds as well as the ability to block the conversion of purines to uric acid. Further enhancing the inflammation support is ginger extract.

In addition, Gouch adds the herb boerhaavia. Research shows boerhaavia helps by supporting overall kidney function and encouraging proper uric acid removal.

Mike Ventresca is the owner of Vital Choice Health Store located at Sprague Road in North Royalton’s Timber Ridge Plaza. The phone number is or mynewextsetup.us

This information is not intended to diagnose, treat, cure or prevent any disease.

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What is gout?

Gout is a very painful form of arthritis caused by crystals that form in and around the joints.

It’s the most common type of inflammatory arthritis. It’s more common in men and you’re more likely to get it as you get older.

Gout occurs in people who have high levels of urate in their blood, but having urate in your blood doesn’t mean you’ll develop gout. It’s normal and healthy to have some urate in your bloodstream.

Urate is created every day when our bodies break down purines. Purines are chemicals that are naturally created in our body, but they are also present in certain foods.

People used to think that gout was caused by overeating and drinking too much alcohol. While this can make attacks of gout more likely, it’s not the whole story.

In any day, about three-quarters of the urate in our bodies comes from the breakdown of purines produced within our body, while only about a quarter comes from the breakdown of purines in food and drink we consume.

As urate levels build up, your body gets rid of any extra through your kidneys and in your wee. But if your body is making too much urate, or your kidneys are unable to get rid of enough of it, then levels start to rise.

If urate levels stay too high, urate crystals can slowly start forming. They mainly occur in and around firm joint tissues, such as the cartilage. But crystals can also appear under your skin and may even occur in your internal organs, such as the kidneys.

Symptoms

Attacks

When you have gout, urate crystals can build up in your joints for years without you knowing they are there. When there are a lot of crystals in your joints, some of them can spill out from the cartilage into the space between the two bones in a joint.

The tiny, hard, sharp crystals can rub against the soft lining of the joint, called the synovium, causing a lot of pain swelling and inflammation. When this happens, it’s known as an attack or flare of gout.

The urate crystals sit within the cartilage of the joint which causes the pain of gout.

During an attack of gout the affected joint becomes:

  • very painful
  • tender
  • red
  • hot
  • swollen.

The skin over the joint often appears shiny and may peel off a little as the attack settles.

Attacks usually come on very quickly, often during the night. Doctors describe this sudden development of symptoms as ‘acute’.

The attack usually settles after about five to seven days, but it can go on for longer.

If gout is left untreated, attacks can become more common and may spread to new joints.

Attacks typically affect the joint at the base of the big toe and often start in the early hours of the morning. The symptoms develop quickly and are at their worst within just 12 to 24 hours of first noticing that anything is wrong.

Any light contact with the affected joint is very painful – even the weight of a bedsheet or wearing a sock can be unbearable.

Although gout most often affects the big toe, other joints may also be affected, including:

  • other joints in your feet
  • ankles
  • knees
  • elbows
  • wrists
  • fingers.

It’s possible for several joints to be affected at the same time. It’s not common to have gout in joints towards the centre of your body, such as the spine, shoulders or hips.

Gout attacks are especially common in joints at the ends of your legs and arms, such as in your fingers and toes. This is probably because these parts of the body are cooler, and low temperatures make it more likely for crystals to form.

Similar attacks can be caused by a condition called acute calcium pyrophosphate crystal arthritis. This is also known as acute CPP crystal arthritis, which used to be called ‘pseudogout’.

Tophi

Urate crystals can also collect outside of the joints and can be seen under the skin, forming small, firm lumps called tophi. You can sometimes see the white colour of the urate crystals under the skin.

The most common areas for tophi are:

  • over the top of the toes
  • back of the heel
  • front of the knee
  • backs of the fingers and wrists
  • around the elbow
  • the ears.

Tophi aren’t usually painful, but they can get in the way of normal daily activities. They can sometimes become inflamed, break down and leak pus-like fluid with gritty white material - these are the urate crystals.

Tophi can also grow within your joints and cause damage to your cartilage and bone. This can lead to more regular, daily pain when you use the affected joints.

Causes

There are two different types of gout. When you have it and there’s no single cause, it’s called primary gout. When you have it and it’s caused by something else, it’s known as secondary gout. Secondary gout can be caused by either:

  • chronic kidney disease
  • long-term use of medications that affect how well your kidneys can remove urate from your body.

Risk factors

Family history

Even though your kidneys can be completely healthy, sometimes the genes you’ve inherited make it more likely that your kidneys don’t flush urate out as well as they should. This is the most common cause of primary gout, especially when several family members are affected, such as your parents or grandparents.

Being overweight

Gout is much more common in people who are overweight. The more overweight you are, the more urate your body produces, and this may be more than your kidneys can cope with.

Being overweight also makes it more likely that you’ll have:

  • high blood pressure
  • type 2 diabetes
  • high cholesterol
  • fats in your blood.

These conditions can all lower how much urate is filtered out by your kidneys.

Gender and age

Gout is about four times more common in men than women. It can affect men of any age, but the risk is greater as you get older.

Women rarely develop gout before the menopause. This is because the female hormone oestrogen increases how much urate is filtered out by the kidneys. But after the menopause, oestrogen levels go down and urate levels go up.

Taking certain medications

Some medications can reduce your kidneys’ ability to get rid of urate properly. These include diuretics, also known as water tablets, and several tablets for high blood pressure, including beta-blockers and ACE inhibitors.

Other conditions

Several different conditions are linked to raised urate levels. This could be because they affect the way the kidneys filter urate, or because they cause more urate to be produced in the first place.

For some conditions, the link with gout is less clear, and may be due to many different factors.

Common conditions associated with gout include:

  • chronic kidney disease
  • high cholesterol and fats in the blood
  • high blood pressure
  • type 2 diabetes
  • osteoarthritis.

What can trigger a gout attack?

Several things can cause the crystals to shake loose into your joint cavity, triggering an attack. These include:

  • a knock or injury to the joint
  • an illness that may make you feverish
  • having an operation
  • having an unusually large meal, especially a fatty meal
  • drinking too much alcohol
  • dehydration
  • starting urate lowering therapy, especially at a high dose, or not taking your treatment regularly each day.

Diagnosis

Diagnosing gout is usually straightforward, especially if you have typical symptoms of the condition - for example, if you have an attack in your big toe.

But gout can sometimes be more difficult to diagnose. Your doctor will need to know about the symptoms you’ve been having and will probably need to perform some tests.

Blood tests

Blood tests to measure your urate levels can be helpful to support a diagnosis of gout, but aren’t enough on their own to confirm it.

High urate levels in blood tests can suggest that you have gout, but this will need to be considered alongside your symptoms. It’s possible to have high levels of urate, but not have any other symptoms of the condition.

Imaging tests

Ultrasound and CT scans can be good at spotting joint damage, crystals in the joints and early signs of gout. X-rays are generally used to pick up the bone and joint damage caused by having gout for a long time.

Synovial fluid examinations

These are a good way to rule out other crystal conditions and make a diagnosis.

They’re done by taking a sample of your synovial fluid through a needle inserted into one of your joints. The fluid is then examined under a microscope for urate crystals. If you have tophi, doctors can take a sample from one of those instead.

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How will gout affect me?

Attacks can vary from person to person. Some people only have an attack every few years, while others have attacks every few months.

Without medication attacks tend to happen more often and other joints can become affected.

Having high urate levels and gout for a long time can lead to other health problems, including:

  • narrowing of the arteries - which can lead to an increased risk of stroke or heart attacks or other heart problems
  • osteoarthritis, which occurs when the urate crystals and hard tophi cause joint damage.
  • an increased risk of developing kidney disease or worsening of the condition if you already have it
  • kidney stones
  • an increased risk of some cancers, especially prostate cancer
  • mental health problems, including depression
  • underactive thyroid
  • erectile dysfunction in men.

If you take medication to lower your urate levels, and have a healthy diet and lifestyle, most of the damage and complications caused by gout can be stopped.

Treatments

Treatments for gout are incredibly successful. There are two main parts to treating gout, which are:

  • treating the acute attack
  • treatments to prevent future attacks.

Treating a gout attack

Treating an attack of gout doesn’t lower your urate levels or stop future attacks. The treatment helps you to manage your symptoms when an attack happens.

The most commonly used drug treatments for attacks of gout are:

Some people will be better suited to NSAIDS, while others will be suited to colchicine. But your preference is also taken into consideration – many people with gout quickly learn what works best for them.

In cases where one drug doesn’t seem to be working on its own, your doctor might suggest a combination of NSAIDs with either colchicine or steroids.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Attacks of gout are often treated with NSAID tablets, which can help with pain and reduce some of your inflammation. Ibuprofen, Naproxen and diclofenac are three NSAIDs you could be given.

If you’ve been prescribed NSAIDs to treat an attack, you should start taking them as soon as you notice signs of one coming on. Your doctor may let you keep a supply so you can start taking them at the first signs of an attack.

The earlier you start treatment, the better.

NSAIDs aren’t suitable for everyone, so talk to your doctor about them first if you have any other conditions. They can also interact with other drugs, so make sure you talk to a doctor before starting on any new medication.

NSAIDs aren’t usually prescribed for a long period of time, as they can cause problems with your digestive system. To reduce the risk of this happening and to protect your stomach, your doctor will also prescribe a proton pump inhibitor.

Colchicine

Colchicine isn’t a painkiller, but can be very effective at reducing the inflammation caused by urate crystals.

As with NSAIDs, colchicine tablets should be taken as soon as you notice an attack coming on, or it may not work as well. Your doctor will probably recommend keeping a supply at home.

Colchicine can interact with several other drugs, including statins taken for high cholesterol. Your doctor will advise whether you’d be better off using an NSAID instead, or adjusting your other medications while you’re taking colchicine.

You should avoid taking colchicine if you have chronic kidney disease.

Colchicine tablets can cause diarrhoea or stomach aches.

Steroids

If colchicine or NSAIDs haven’t worked for you, or if you’re at risk of side effects from these drugs, your doctor may prescribe steroids.

They are usually taken as a short course of tablets, lasting a few days.

However, they can also be taken as an injection into a muscle or joint affected by gout. This can be particularly helpful if gout is affecting only one joint.

Check out our steroids and steroid injection pages for more information.

Tips for managing an attack at home

  • Keep the area cool – an ice pack, or a bag of frozen peas wrapped in a tea towel, can be particularly good at reducing some of the pain and swelling.
  • Rest the affected joint.
  • Think about getting yourself a bed cage. These support the bedsheets above your feet so that your affected joint can rest without the strain of the sheets.

Treatments to prevent gout attacks

There are drugs available that can lower urate levels, prevent new crystals from forming and dissolve away the crystals in your joints. They are called urate lowering therapies or ULTs for short.

Treatment with ULTs is generally started after an attack of gout has completely gone.

There’s no single fixed dose of a ULT, and different people need different doses to get to the right blood urate level.

It can take a few months or years for the drugs to completely clear your body of urate crystals. But once they’re gone, you will no longer have attacks of gout, tophi or risk of joint damage due to gout.

It’s important to remember that ULTs won’t stop attacks of gout straight away. You could actually have more attacks within the first six months of starting them.

Don’t stop taking your ULTs if this happens to you, as this is actually a sign that the drugs are working. As the drugs start dissolving the crystals, they become smaller and are more likely to get into the joint cavity, triggering an attack.

Your doctor might suggest taking a low dose of colchicine or NSAID as a precaution against attacks during the first six months of starting ULTs.

ULTs are usually life-long treatments and require yearly check-ups to monitor your urate levels. If your symptoms aren’t getting under control, talk to your doctor about your urate level, as you might need to be on a higher dose.

Try not to miss or skip any of your doses, especially in the first year or two of starting treatment. This could cause your urate levels to go up and down, which could trigger an attack.

Allopurinol

Allopurinol is the most commonly used ULT. It’s a very effective treatment for most people with gout.

It works by reducing the amount of urate that your body makes.

You’ll start on a low dose of allopurinol, which can be gradually increased until you are on the right dose.

Gradually building up the dose means it’s less likely to trigger an attack and also makes sure you’ll have the lowest dose needed to get your gout under control.

Allopurinol is broken down and removed from the body through your kidneys, so if you have a problem with your kidneys, it may not be suitable for you. Your doctor might decide to start you on an even lower dose and increase slowly, or suggest that you try febuxostat instead.

Febuxostat

Febuxostat is a newer drug that reduces the amount of urate made in the body in the same way that allopurinol does.

You won’t be prescribed febuxostat as your first ULT, unless your doctor has said that you can’t take allopurinol.

It works in a similar way to allopurinol but, instead of being broken down by the kidneys, it’s broken down by your liver. It’s useful if you have kidney problems and can’t take a high enough dose of allopurinol.

Febuxostat is more likely to trigger gout attacks than allopurinol when you first start treatment. So, as a precaution, it’s likely you’ll be prescribed a low-dose NSAID or colchicine to take on a daily basis for the first six months of starting febuxostat.

There are just two doses of febuxostat, so if your urate levels haven’t lowered enough after a month on the low dose, you may need to go on to the higher dose.

Uricosuric drugs

Uricosuric drugs, which include sulfinpyrazone, benzbromarone and probenecid, work by flushing out more urate than normal through your kidneys.

They’re not used much in the UK, as they’re not widely available. They’ll only be prescribed by a rheumatologist if allopurinol and febuxostat haven’t worked or aren’t suitable for you.

It’s unlikely you’ll be able to take these drugs if you’ve had severe problems with your kidneys or had kidney stones. This is because, by encouraging your kidneys to filter more urate, they also increase the risk of developing kidney stones.

Uricosuric drugs are usually used on their own. But in rare cases, where you’ve tried several ULTs and none have worked for you, uricosurics can be used in combination with other ULTs, like allopurinol or febuxostat.

If you’re unable to take allopurinol, febuxostat or a uricosuric, or if they don’t work for you, you’ll need to see a rheumatologist for advice.

Treatment for joint damage

If your gout has caused damage to your joints, then the treatments available will be the same as those used for osteoarthritis. They include:

  • exercising regularly
  • reducing the strain on your affected joints
  • staying at a healthy weight
  • taking painkillers
  • in more severe cases, joint replacement surgery.

Visit our osteoarthritis page to find out more about treatments available for joint damage.

Malcolm's story: improving treatment for gout

Managing symptoms

Lifestyle choices are not the main reason why most people get gout.

However, if you have a healthy lifestyle and also take prescribed medication, you’ll have the best chance of lowering your urate levels. This will then decrease the chances of you having attacks of gout.

Exercise

Exercise is extremely important, not only to reduce the chances of an attack, but also for your general health and wellbeing.

It doesn’t matter how much exercise you do - a little is better than none at all.

Start off slowly and gradually build up how much you do until you’re doing regular sessions.

As your confidence increases, you can increase the length and intensity of what you’re doing.

Exercises that get you out of breath are particularly good for burning calories. You could try dancing, walking in hilly countryside or doubles tennis.

It helps to find a sport or exercise which you enjoy and will keep doing. Some people find joining a leisure centre or sports club to be really fun and motivational. Have a look around and see what’s available in your area.

You should avoid exercising during a flare up of gout, as it could make your pain worse. It’s important to rest and recover and begin exercising after the pain and swelling has gone down.

Diet

You should try to have a well-balanced diet that is low in fats and added sugars, but high in vegetables and fibre.

Extreme weight loss or starvation diets increase cell breakdown in your body, which can raise urate levels. However, you should be OK to do some daytime fasting - for example, during Ramadan.

We don’t recommend Atkins-type weight-loss diets, as they include a lot of meat and are high in purines.

If you’re overweight, weight loss should be gradual combined with daily exercise.

The NHS has a good diet and exercise plan which can help you lose weight in a healthy way over 12 weeks.

Food to have in moderation

You should try to avoid eating large quantities of foods that are high in purines. But there’s no need to remove them completely from your diet.

These include:

  • red meat, game and offal - such as venison, kidneys, rabbit and liver
  • seafood, particularly oily fish and shellfish - such as anchovies, fish roe, herring, mussels, crab and sardines
  • foods rich in yeast extracts - such as Marmite, Bovril and Vegemite
  • processed foods and drinks.

Protein is an important part of your diet, but you can get it from sources other than just meat and fish. You could try replacing a portion of meat with other protein-rich foods like soybeans, eggs, pulses or dairy products.

The UK Gout Society has a detailed food list of foods high in purines. Check out their diet factsheet for more information.

What about drink?

If you have gout and a history of kidney stones, you should try to drink at least two litres of water a day to decrease the chance of stones forming.

Sweetened soft drinks should be avoided, as they contain large amounts of sugar and can increase the risk of getting gout.

While fruit and fresh fruit juices contain sugar, the benefits of eating fruit are likely to far outweigh any negatives. Reducing how much sugar you consume from other sources is a heathier option than cutting out some of your five a day.

Alcohol

Drinking too much alcohol, especially beer and spirits, can increase your urate levels and your chances of triggering a gout attack. Beer is particularly bad, as it contains a lot of purines.

However, drinking a bit of wine doesn’t appear to increase the risk of triggering an attack.

As a rule of thumb, try to stick to the government guidelines of drinking no more than 14 units a week. This is equivalent to about 6 pints of beer or 6 glasses of wine. But don’t save these units up and drink them all in one go - it’s better to spread them out over the course of the week.

Your doctor might also advise a lower limit.

You can find out more about government drinking guidelines at drinkaware.

Vitamin C

Research has shown that vitamin C may slightly reduce uric acid levels in people with gout. This is another reason to make sure your diet includes plenty of fruit and vegetables. But if you’re considering taking vitamin C supplements, talk to your doctor first, as there’s a very slight risk that vitamin C supplements could interact with other medications.

Cherries

Research has shown that cherries may reduce the risk of having an acute attack of gout, particularly when taken with allopurinol.

Skimmed milk and low-fat yoghurt

Research suggests drinking skimmed milk and eating low-fat yoghurt may help to prevent attacks of gout.

Complementary and alternative treatments

If you decide to try complementary and alternative treatments, you should be critical of whether they are making a difference to your condition.

They should never replace your prescribed gout medication.

Don’t worry about fish oil supplements raising your urate levels. While some may contain purines, the amount is likely to be so small that it won’t make a difference to your condition.

Similarly, even though the supplement glucosamine is made from the outer shells of shellfish, it doesn’t contain purines. However, there’s no evidence that glucosamine can prevent or treat gout.

Caring for yourself

The emotional effects of gout can have just as much impact as the physical symptoms. Long term damage and severe pain from the attacks of gout can affect your daily life, disturb your sleep and affect your mood. From time to time, your gout may get on top of you. If you’re feeling low, talk to your GP, who can signpost you to the appropriate services. You can also call our helpline on , who will listen and offer emotional support.

Working with gout

Work can provide a sense of purpose, a supportive social network, and help you financially. Most people with gout can continue working, but you may need some time off when you have an attack.

If gout is affecting your ability to work, speak to your employer’s occupational health service if they have one. Your employer has a duty to make reasonable adjustments so that you can do your job.

Your local Jobcentre Plus can also put you in touch with Disability Employment Advisors, who can arrange workplace assessments.

Access to Work is a scheme in Scotland, England and Wales that gives extra help to people with disabilities or physical and mental health conditions. There is a separate scheme available in Northern Ireland.

Access to Work provides funded or partly-funded grants to help people start work, stay in work, or move into self-employment, and can be used to pay for equipment, support workers, or transport, among other things.

Research and new developments

Research is greatly increasing our understanding of what triggers gout and how new therapies may be developed to treat it.

Our research has found a more successful way of treating people with gout. We funded a clinical trial in which nurses, trained in gout and its management, delivered a package of care tailored to patients. It provided information on gout and its treatment options, and involved patients in decision making.

The results proved that:

  • when fully informed almost % of people with gout want ULTs
  • 95% of patients were still continuing with their treatment after two years
  • after two years, more than 9 out of 10 patients were having fewer gout attacks, tophi were greatly reduced and quality of life was improved compared to patients who continued with their standard treatment.

Versus Arthritis is also currently funding a research project to help design a full-scale clinical trial looking at whether omega-3 fatty acids, which are found in fish oils, can be used alongside ULTs to prevent gout attacks.

The results could reduce gout attacks and overcome the unwanted side effects that some people experience when starting on ULTs.

Neil’s story

At its worst, my gout was so bad I couldn’t walk for three months.

I couldn’t even play with my daughter Hannah, who was toddling at the time. The only way I could get around was on all fours and crawl. I was only a year into my thirties.

When I was diagnosed with gout my doctor didn’t prescribe me anything for it. And to be honest, I didn’t take much notice. I put it to the back of my mind and carried on as I always had.

Everything changed about a year later, when I had my first proper experience of a gout attack.

It happened after a game of football. I couldn’t believe how painful and swollen my foot had become.

My ankle was so puffy that my foot looked like a joint of meat. Even the weight of the bed sheets was enough to keep me up at night.

The worst part was not being able to sleep.

The next morning, exhausted, I’d dose up on painkillers before going to work.

At the time I was on my 12th year of doing deliveries for the Royal Mail. Getting my round done every morning was becoming a struggle. To my colleagues it was all a big joke.

I tried ibuprofen but it wasn’t touching it. So, I went back to my doctor.

He said that drugs like allopurinol can be bad for you and that I’d be better off controlling it with my diet.

He gave me the impression that having gout was my fault.

I was prescribed a high dose of ibuprofen and sent on my way.

I followed his advice, changed my diet and gave up alcohol completely.

But nothing changed. In fact, it got worse. It spread to my hands, wrists and elbows.

On bad days the pain was so excruciating I couldn’t touch the gearstick of my car. It’s scary how you take these things for granted.

After another 10 years of walking the beat for the Royal Mail, I decided It was time to get a desk job.

Soon after this I had to make another trip to the doctors for my hands. They thought I’d developed arthritis, so I was being referred to a specialist.

When I met them, they couldn’t hold back their shock. They were appalled that I’d never been on any gout medication.

They said I’d be fine once I was on allopurinol. I’ll be honest - I was sceptical as I’d been in so much pain for so long. It was pretty much miraculous how quickly it all stopped. The last four years have been fantastic.

If you have gout, my advice would be don’t panic, do your research and find out everything you can. And if you’re not getting the help you need, go somewhere else. You can always find someone who’ll help.

Источник: mynewextsetup.us

Blending Traditional Pharmacy
With Natural Medicine

FACTS:

  • Gout is one the most painful forms of arthritis. It occurs when too much uric acid builds up in the body (tiny crystals deposit in joints & soft tissue).
  • There is no real cure for gout. Treatment is aimed at controlling symptoms and preventing future attacks.
  • All humans and different cultures can be impacted by gout. However, it is rarely seen in men before adolescence or women before menopause. Men are at higher risk of developing gout than women. About 25% of gout sufferers have a family history of the condition (genetics).
  • Elevated uric acid levels do not always means that a person has gout. Uric acid levels can be normal during a gout attack. Most accurate way to diagnose gout is by looking for crystals in the joint fluid.
  • Gout attacks can be brought on by stressful events, certain drugs (thiazide diuretics; low dose aspirin; cyclosporine, levodopa or some antibiotics), alcohol, another illness or by taking the vitamin niacin.
  • Foods high in purine (a basic building block of DNA) content should be avoided by anyone at risk for a gout attack. The body metabolises purine and produces uric acid as a waste product.
  • Early gout attacks usually get better within 3 to 10 days, even without treatment. The early the intervention the better the results.
  • Gout can damage the kidneys if left unchecked. % of primary gout sufferers (no known reason for high uric acid) and 42% of secondary gout sufferers (result of some underlying disorder) will develop kidney stones.

TREATMENT:

Traditional medicines used to treat acute attacks of gout include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen or indomethacin
  • Corticosteroids, such as prednisone
  • The old and now very expensive Colchicine, which works best when taken within the first 12 hours of an acute attack
  • To help prevent future attacks, doctors often prescribe NSAIDs or colchicine in small daily doses or daily doses of allopurinol to help reduce the production of uric acid

Non-traditional and natural medicine treatment options include:

Excessive uric acid can develop in the body due to a state known as acidosis,  where the body's pH is too acidic (ideal blood pH level is or slightly alkaline; is neutral: below 7 is acidic and above 7 is alkaline; pH level can be easily tested by low cost Litmus paper (urine or saliva).

Mixing lemon juice and baking soda together creates a nearly perfect pH of 7 and may stop a gout attack immediately by alkalizing the blood. Pour 2 tablespoonful of lemon juice (mildly acidic and high in potassium & citrate) in a glass with 1/2 teaspoonful of baking soda (highly alkaline; caution: use of baking soda could raise blood pressure). Allow the mix to foam and fizz until it is flat - about 2 minutes. Then add 8oz. water and drink immediately.

Black cherries (tart cherries) contain natural anti-oxidants and anti-inflammatories that help neutralize uric acid in the bloodstream. Cherry juice supplements and black cherry concentrate (10 to 15 cherries a day or the juice equivalent) can be taken daily or at the time of the attack to reduce the length and severity of the episode.

A natural sulfur supplement (MSM or Methyl Sulonyl Methane) is often taken by gout sufferers alone or with cherry juice to help repair connective tissue and to reduce pain and inflammation. MSM (in either pill or powder form) takes a few weeks to months to build up to optimum levels in the body.

Old cultures have long used an Apple Cider Vinegar formula daily to manage gout or during an acute gout attack. Add 1 tablespoonful of raw honey to 1 or more tablespoonful of warm distilled water. Then mix with 1 tablespoonful of Apple Cider Vinegar and drink twice a day after meals.

PREVENTION:

Drink 8 glasses of water a day to remain hydrated. Water can dilute the uric acid levels in the body and therefore reduce the chances of crystals forming. Increase to 16 glasses of water daily during an attack.

Keep yourself warm. Exposure to cold weather is a direct trigger of gout and the resulting buildup of uric acid crystals.

Avoid alcoholic beverages especially during an acute attack. Alcohol tends to thin the blood and complicates the healing of the joint damage that is caused by the uric acid crystal formation. Also, your body requires high levels of uric acid in order to digest alcohol.

Test your blood pH often. Try to maintain an alkaline pH. Excessive intake of tea, coffee, alcohol, carbonated drinks, protein, vitamin C, aspirin and foods that have high chorine, sulfur or phosphorus can lower the bodies pH levels. Uric acid is then more soluble in the blood and gout attacks are more likely.

Keep your immune system strong. Take a multi-vitamin supplement daily with high dose vitamin C (try to avoid niacin). Some studies suggest that 70 mg. of folic acid daily can help lower uric acid levels.

Control what you eat. Speak with a dietitian for tips. Keep a journal to help identify what specific foods may be triggering your gout attacks.

Eat a moderate amount of protein from healthy sources like eggs, tofu and other low fat sources. Increase your intake of dark fruits, vegetables, whole grains, nuts, peanut butter, pudding, rice, pasta, gelatin, coffee/most teas, foods with vitamin C, and fat-free milk products

Try to avoid foods that are high in purine content especially during an acute attack. Red and dark meats including turkey and sausages require high levels of uric acid to digest. Many fish foods can cause major problems including shellfish, salmon, trout, herring, fish roe and dark fillet. Poultry can cause problems and so can beans, peas, asparagus and spinach.

Exercising regularly and keeping excess weight off is essential to preventing acute gout attacks. By consistently moving and straining your joints you can break up uric acid crystals before they get too big and cause major attacks. Gout is more prevalent in the obese and overweight.

Источник: mynewextsetup.us

Gout is a form of arthritis that results in sudden pain, swelling and tenderness in the joints. The big toe joint is most commonly affected, but gout pain can also occur in the knee and ankle joints.

Gout can strike when there is a high level of uric acid in the blood, which can be caused by a diet rich in red meat and alcohol consumption. Other factors contributing to gout include being overweight and chronic health issues such as diabetes and heart or kidney disease. 

While there is no cure for gout, certain lifestyle changes can help prevent future flare-ups, including staying hydrated, avoiding alcohol, eating less meat and maintaining a healthy weight.

In addition to these lifestyle changes, there are several natural remedies that could help relieve gout pain. 

Vitamin C

A number of studies have explored the effectiveness of vitamin C on reducing uric acid levels.

This study, for one, found that subjects who were randomized to the vitamin C arm of the study and supplemented with milligrams per day had significantly reduced serum uric acid levels after two months when compared to the group who took a placebo. 

What’s more, a review article reported on 13 randomized, controlled clinical trials to assess the effect of vitamin C on uric acid levels. The analysis found that supplementing with C significantly lowers uric acid levels. However, more studies are needed to determine to prevent gout or reduce gout pain.

Try: Nature Made Chewable C Tablets

Cherry Extract

Cherries have been reported to reduce uric acid levels in the body and are a popular home remedy for gout pain.

It is believed that antioxidants in cherries called anthocyanins are able to reduce inflammation. A article published in the Journal of Arthritis looked at three studies using cherry juice to prevent gout flare-ups and found that consuming cherry juice for four months or longer was effective in reduced gout-related inflammation.

Try: Futurebiotics Tart Cherry Maximum Strength Vegetarian Capsules

If you have gout, make sure to drink plenty of water on a daily basis to help reduce swelling, and limit soda and other sugary drinks.

Celery Seed Extract

Celery seed has been used in herbal medicine for thousands of years to treat ailments such as arthritis, indigestion and colds. Gout is a form of arthritis. If celery seed helps to improve gout pain, it may be due to its anti-inflammatory properties.

Celery seeds are rich in omega-6 fatty acids and 3-n-Butylpthalide, a diuretic oil that gives celery its distinctive smell and taste and also assists in cleansing the system and stimulating the kidneys to flush out uric acid and the crystals that causes gout in the first place.

A study on mice demonstrated lowered uric acid levels in the animals that consumed celery (Apium graveolens).

Try: Go-Out Plex Plus

Источник: mynewextsetup.us
natural home remedies for gout attack
natural home remedies for gout attack
natural home remedies for gout attack

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