Gaby
Gout is a metabolic disorder marked by the buildup of urate crystals (uric acid salts) in joints, bones, kidneys, the liver, or under the skin. What makes urate crystals form in the body, and can they be treated?
Symptoms of Gout
While urate deposits can affect any joint from fingers to toes, the first signs of gout usually show up in the lower extremities. In gout of the feet, joints stiffened by urate deposits become painful, swollen, and lose mobility. Most people realize they have the condition after their first attack—a sudden, severe pain in the big toe on one or both feet. A swollen, painful joint; sharp pain; reddened skin over the joint; and local warmth are all classic signs of gouty arthritis. Unlike rheumatoid arthritis, which usually appears more gradually, gout can be dramatic and is sometimes accompanied by a sour-milk–like smell caused by disrupted uric acid metabolism.
This condition was described as early as 2600 B.C. in Ancient Egypt. In the 5th century B.C., the Greek physician Hippocrates listed the clinical features of the disease in his “Aphorisms,” noting that it was rare in eunuchs and women before menopause. He used the term gout—literally “a trap on the foot” in Latin—to describe the sharp pain in the big toe. In the 17th century, the English physician Thomas Sydenham described gout’s pain in vivid terms in his “Treatise on Gout,” comparing it to “squeezing the foot in a press” or “a bite on the toe by a huge dog.”
A Dangerous Outlook
A hallmark of gout is the sudden onset of symptoms and their spontaneous resolution. Intense joint pain can subside just as quickly as it began. Discomfort may last from a few days to several weeks, though a typical gout attack lasts three to ten days before the pain fades. The skin returns to its normal color and joint function usually recovers. Months or even years can pass before the next flare, but over time those symptom-free intervals often become shorter and attacks recur.
If gout is not managed, it can progress to chronic arthritis and gouty arthropathy. Over time, uric acid crystal deposits can damage internal organs, deform joints, and limit joint function. Large urate stones can form coral-like masses that block the renal pelvis. Gout can complicate urine flow and contribute to chronic kidney failure. Hydronephrosis can develop, with the kidney becoming distended and losing function.
Causes of Gout
The Roman physician Aulus Cornelius Celsus linked alcohol use and kidney problems to gout, and the physician Galen later associated indulgence, debauchery, and heredity with the disease. Today, gout often appears against a background of an unhealthy lifestyle or diet: fasting, alcohol use, and foods that raise blood uric acid. Triggers for a gout attack can include overheating or chilling, stress, heavy physical exertion, injuries, and certain medications—long-term use of aspirin, some anti-tuberculosis drugs, and some antiviral drugs can be particularly problematic.
Relief is unlikely without quitting smoking, cutting alcohol (especially beer), limiting high-purine foods, adopting a healthier lifestyle, managing other medical conditions, and losing weight gradually. Rapid weight loss—more than 10% of body weight in a month—can worsen uric acid metabolism by increasing protein breakdown. Avoid saunas, hot baths, and excessive heat: heavy sweating can aggravate uric acid problems and further affect kidney function. Maintain moderate physical activity (walking, swimming), limit diuretic use when possible, and follow a low-purine diet.
Treatment of Gout
Monitoring gout progression is the role of a rheumatologist. If a diagnosis hasn’t been made, a primary care physician should order initial tests. Diagnosis uses urine and blood tests. During a flare, changes in white blood cell counts and elevated blood uric acid levels are common. In asymptomatic phases, tests may be less informative, and X-rays of the joints may be indicated. Patients with newly diagnosed gout or severe flares are sometimes admitted for inpatient treatment in a rheumatology department.
With effective therapy, inpatient treatment typically lasts one to two weeks. Doctors aim to improve clinical and laboratory markers and reach target uric acid levels—about 315–365 µmol/L (with a critical lower limit around 180 µmol/L). Modern treatment can include outpatient procedures under local anesthesia to remove gouty deposits through a small incision in the affected area. Timely removal of gouty deposits can help prevent joint deformity. There is no single medication that cures gout; the condition is chronic and is managed rather than completely eliminated.
Diet for Gout
Severe pain and deformity around the big toe are a sign to follow a low-purine diet. Limit meat and meat products, red fish, salmon or sturgeon caviar, shrimp and shellfish, mushrooms, and certain plants such as asparagus, lentils, soy, beans, kidney beans, and peas. Vitamins B1, B2, B3 (niacin), vitamin C, potassium, and magnesium can help lower blood uric acid. A low-purine diet does not restrict vegetables, fruits, nuts, grains, pasta, bread, or dairy. Milk is especially valuable for people with gout because milk proteins (alpha-lactalbumin, beta-lactoglobulin, casein) can help promote uric acid excretion.
Because alcohol interferes with uric acid excretion, avoid alcoholic and mixed drinks. Beer and some wines are higher in purines. Many nonalcoholic beverages contain high levels of fructose, which can contribute to hyperuricemia. In addition to plain water, include alkaline mineral water, milk (if tolerated), unsweetened juices (especially cherry), compotes (from cherries, cranberries, or dried fruit), and fruit drinks. Drink about 1.5–2 liters of fluid daily. Herbal supports such as birch leaf and bearberry (uva-ursi), plus infusions of linden, mint, and rosehip, can help promote uric acid excretion.
Home Remedies for Gout
To ease pain and reduce the size of urate deposits, baths, ointments, compresses, decoctions, tinctures, and teas are often used alongside medical treatment.
Butter Ointment
Melt two parts unsalted homemade butter over heat until it foams. Add an equal part alcohol, carefully ignite it, and let the alcohol burn off. Collect the remaining ointment, cool it, and store it in the refrigerator. Apply the ointment to the affected area during an attack.
Iodine Ointment
Dissolve five aspirin (acetylsalicylic acid) tablets in 10 ml of iodine. Rub the resulting colorless liquid into the affected joints at night and keep the area warm with socks or gloves.
Foot Baths
Dissolve 10 drops of iodine and 3 teaspoons of baking soda in 3 liters of warm water. Soak the feet as soon as pain appears. Repeat the procedure regularly to help reduce urate bumps.
Onion Decoction for Gout
Boil three medium onions with their skins in one liter of water until the onions are completely softened. Strain the decoction and take it three times a day before meals for two weeks.
Lilac Tincture
During lilac bloom, fill a half-liter bottle with flowers without packing them down. Pour in a glass of vodka to cover the flowers. Let the bottle steep in a dark place for a week, shaking occasionally. During a flare, take 50 drops of the lilac tincture three times a day before meals.
Chickweed Tea for Gout
Pour boiling water over 2 teaspoons of dried chickweed and steep for a few minutes. Drink like tea.
Chamomile Compress
Mix dried chamomile with black elderflower in equal parts. Pour boiling water over the mixture and heat briefly without boiling. Turn off the heat, let it cool slightly, soak a cotton pad in the infusion, and apply the compress to the inflamed bump on the joint. You can also make baths using a chamomile decoction (10 g of flowers per liter of water) with 200 g of salt.
Combined Dry Mixture
Combine 5 parts peony flowers, cornflowers, marigolds, buckthorn bark, and juniper berries; add 10 parts black elderflower and stinging nettle; and add 20 parts field horsetail, birch leaves, and willow bark. Pour a glass of boiling water over 1 tablespoon of this dry mixture, wrap it in a towel, and let it steep for half an hour. Drink the entire decoction at once and repeat every two hours until the pain subsides.
Pine Nuts with Honey
Mix pine nut kernels with honey in a 1:1 ratio. Take 1 tablespoon three times a day as a preventive measure against urate deposits.
Although gout is one of the more complex forms of arthritis, many people learn to live with it through medical care, phytotherapy, home remedies, and lifestyle changes.
