Gout M10.0

Clinical manifestation of primary or secondary hyperuricemia in the form of acute and chronic arthritis and deposition of uric acid salts in the skin as such (see also uric acid, see also gout tophi).

I. Acute attack of gout: Occurs frequently after an opulent meal or abundant alcohol consumption, but also completely spontaneously without any recognizable cause. Sudden onset of highly painful monarthritis (usually of the metatarsophalangeal joint of the big toe, so-called podagra), more rarely of the metacarpophalangeal joint or the metacarpophalangeal joint of the thumb (so-called chiragra) with strong, continuous, spontaneous or pressure-induced pain combined with redness and swelling. In particularly severe cases, fever, chills and general signs of inflammation.

II Chronic stage: Chronic, progressive, mutating arthritis of the peripheral joints. On the skin there is gout tophi. The occurrence of gouty arthritis is rarely observed (Gaviria JL et al. 2015).

The following criteria (ARA criteria) are used to classify acute gouty arthritis (modified according to Wallace 1997):

A) Urate crystals in synovial fluid

B) Urate crystals in Tophus

C) Various

1. Recurrent acute arthritis
2. Ignition maximum within 24 hours
3. Monarticular infestation
4. redness of the metatarsophalangeal joint of the big toe
5. pain, swelling of the metatarsophalangeal joint of the big toe
6. Unilateral infestation of metatarsophalangeal joints of the toes
7. Unilateral infestation of the tarsal
8. Tophus
9. Hyperuricemia - uric acid i.S. increased ( > 6.4 mg/dl)
10. Asymmetrical swelling in the X-ray image
11. Subcortical cyst without erosion
12. Abacterial joint effusion

Arthritis can be classified as uric arthritis if at least one of criteria A, B, C is met, where C is considered to be met if 6 of the characteristics listed in 1-12 apply.

Acute gout attack: Indometacin (e.g. Amuno) 3 times 50 mg/day or acemetacin 120-180 mg/day (e.g. Rantudil forte 2-3 Kps./day). Alternatively, naproxen 500-1250 mg/day divided into 2-3 ED p.o. or colchicine (Colchicum Dispert Drg.) 1 mg hourly for 4 hrs, then 0.5-1 mg every 2 hrs until symptoms subside. Maximum daily dose 8 mg. Side effect: Diarrhea common (do not discontinue therapy, treat with Imodium). Improvement of arthritis under colchicine usually prompt. Repeat therapy the next day with half the dose. On the 3rd day 1.5 mg colchicine/day. Duration of treatment: 5 days. Lower dose in renal insufficiency.

Alternative: Ibuprofen (2x 600mg), if necessary combined with prednisolone orally (50mg); reduce descending dosage to 0 within 1 week.

Chronic stage: Allopurinol (e.g. Zyloric) 300-600 mg/day, possibly uricosurics such as probenecid.

Dietary therapy: Few sausages and meat, especially no poultry skin! and offal; no alcohol.

Cave: certain vegetables such as asparagus, spinach, Brussels sprouts, legumes, soy products, poppy seeds, dried fruits, shells and crustaceans, white flour products, sweet mueslis and pastries, processed cheese, porcini mushrooms, salsify, green peas, yeast!

In addition to acupuncture, mainly excretory procedures are used.

Acute gout attack: leeches, small phlebotomies

In acute gout attacks, therapies with the patient 's own blood as a mixed injection are also described: 2 ml of the patient's own blood with 2 ampoules of Traumeel® and 1 ampoule of Restructa per injectione on day 1, 2 and 4, then 2 x / week.

Autologous blood with heme activator: autologous blood with 1 ampoule of Traumeel and 1 ampoule of Restructa pro injectione on day 1, 2 and 5, and 2 x / week.

For chronic symptoms: own blood with heme activator (like acute gout attack) and Harpagophytum D3 DHU or with injection solution Ledum Pflüger and Harpagophytum D2 injection solution Pflüger.

Gouty tophi on the big toes: Cantharid plaster, see there: Authors are reluctant to this therapy!

Physical therapy:

Acute gout attack: hydrotherapy with cold compresses or water pours: cold water flowing over the painful joint until pain is reduced/freed, if necessary ice compresses - caution: danger of frostbite!

chronic complaints:

• Cold Kneipp treatments: Washes, casts, partial baths, sauna 1 x / week, mud packs of the affected joints, also hot compresses, e.g. with birch leaves.
• Exercise therapy: endurance gymnastics, metabolic gymnastics, swimming, cycling, walks, gardening, also massages.
• Balneotherapy: radium baths, sulfur baths, additionally drinking cure with sodium hydrogen carbonate (Bullrich acid bases balance tablets)
• Phytotherapy: Colchicine, see also under Internal therapy, Colchicum autumnale - Autumn crocus : e.g. Colchicum Dispert® Drg, Colchysat® Bürger drops. Cave maximum dose 8 mg/day, in case of diarrhea dose reduction!

A low-purine diet is recommended, e.g. dairy products such as milk, yoghurt and curd cheese, eggs, hard cheese, lots of vegetables (with the exception of purine-rich varieties such as cabbage, green beans, broccoli, spinach, asparagus).

Cereal products and flakes, potatoes, egg noodles, white bread and rice can also be used as low-purine foods.

It is important to drink at least two to three liters of water per day. Unsweetened herbal and fruit teas or coffee are also permitted.

Purine table: Foods that may be eaten in gout (values calculated as uric acid/100g)

• Milk 0 mg/100g
• Yogurt 0 mg/100g
• Curd cheese 0 mg/100g
• Tea 0 mg/100g
• Coffee 0 mg/100g
• Egg 5 mg/100g
• Cucumber 7 mg/100g
• Tomatoes 10 mg/100g
• Bell bell pepper 10 mg/100g
• Potatoes 15 mg/100g
• Apples 15 mg/100g
• Pear 15 mg/100g
• Honeydew melon 18 mg/100g
• Watermelon 20 mg/100g
• Cheese 20 mg/100g
• Zucchini 22 mg/100g
• Wheat flour 38 mg/100g

Purine table: Foods to avoid in gout (values calculated as uric acid/100g)

• Sprats 802 mg/100g
• Pork spleen 600 mg/100g
• Oil sardines 480 mg/100g
• Trout 345 mg/100g
• Calf's liver 288 mg/100g
• Goose meat 254 mg/100g
• Pork cutlet 211 mg/100g
• Tuna in oil 204 mg/100g
• Peas 180 mg/100g
• Brussels sprouts 170 mg/100g
• Lentils 160 mg/100g
• Cauliflower 45 mg/100g
• Asparagus 25 mg/100g
• Fillet of beef 153 mg/100g
• Beer, light with alcohol 15 mg/100g

1. Gaviria JL et al (2015) Unusual Dermatological Manifestations of Gout: Review of Literature and a Case Report. Plast Reconstr Surg Glob Open 3:e445
2. Richette P et al.(2016) 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2016 Jul 25. doi: 10.1136/annrheumdis-2016-209707.
3. Scherer M et al. (2016) Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract 17:68.
4. Tzeng HE et al.(2016) Gout increases risk of fracture: A nationwide population-based cohort study. Medicine (Baltimore) 95:e4669.
5. Wallace SL et al. (1977) Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum 20: 895-900.
6. Augustin M et al (1999) Practice guide to naturopathic medicine. S 569-571
7. https://www.helios-gesundheit.de/magazin/ernaehrung/news/ernaehrung-bei-gicht/