A case of gout treated with individualised homoeopathy

Dr Anjum Fathima Warsi

Abstract: Gout is a purine metabolism disorder characterized by sudden, severe attacks of inflammatory arthritis, resulting from persistently elevated uric acid levels in the body. It presents as an intermittent episode of severely painful arthritis (gout flares); it may be acute or chronic. Complications include recurrent attacks, tophi, joint deformity, renal calculi. Treatment of Gout can be difficult due to increased severity of pain.

Allopathic system of medicine, uses multiple drugs to manage gout temporarily, like Allupurinol and febuxostat, both are known to have side effects. In such a case, homeopathy can be considered as safe alternative system of medicine that follows holistic approach of treatment with minimal side effects.

In this case report, a 35 years old, male patient suffering from gout was treated with individualised homeopathic medicine and serum uric acid levels were monitored with regular follow ups at Out Patient Department (OPD) of Government Homoeopathic Medical College and Hospital, Bangalore. Patient showed marked symptomatic improvement within first month after the remedy with gradual reduction in serum uric acid levels, which reached normal levels after 7 months of treatment.

Key words: Case report, Homoeopathy, Gout, Serum uric acid levels, Lachesis.

Introduction: Gout is an inflammatory arthritis characterized by intermittent episodes of joint swelling and pain (gout flares), usually affecting the first metatarsophalangeal joint. It occurs due to an increased uric acid levels in the body, which crystallizes as monosodium urate (MSU) in the synovial fluid, bones, cartilage, tendons, bursae stimulating an acute inflammatory attack.¹

This is usually caused by inheritance, increased consumption of sugary drinks, beer, alcohol, purine-rich foods such as red meat, seafood.

Gout usually occurs in middle age. Men are six times more prone to develop gout than women. Women at menopausal age are at more risk to develop gout.

Initially, gout attacks are usually monoarthritic. But polyarthritic attacks can also occur, affecting the feet, heels, ankles, knees, wrists and elbows. The patient has severe pain, redness, heat, swelling and tenderness of the affected joint. Attacks usually occur at night.

It is clinically diagnosed when serum levels of uric acid are greater than 7 mg/dL in men and 6 mg/dL in women with symptoms of arthritis. If the diagnosis is uncertain, an analysis of the synovial fluid of the affected joint can be performed to detect uric acid crystals. The goals of therapy are to stop an acute attack, prevent recurrent attacks, and prevent complications.²

The key strategy for effective treatment of gout is long-term urate-lowering therapy to correct hyperuricemia and analgesics to relieve pain in allopathic treatment. Currently used allopathic drugs such as alupurinol, febuxostat, NSAIDs and corticosteroids are known to have significant side effects such as nausea, vomiting, diarrhea, drug sensitivity, hepatotoxicity, gastrointestinal bleeding.³ Therefore, there is a need for alternative drugs with minimal side effects.

Whereas homoeopathic medicines not only reduce the levels of uric acid and symptoms of gouty arthritis, but also reduce the tendency to excessive formation of uric acid, significantly reducing exacerbations, aids in treating diseases without side effects, and can therefore be an effective and good alternative to other hypouricemic and analgesic drugs.

Case Report

A 35 years old, male patient presented with severe, episodic pain and swelling of right ankle joint since 1 year, with sudden onset and increasing progression, which would occur 1 – 2 times/week. Pain would aggravate while walking and ameliorate from pressure. Patient has taken allopathic medicines with temporary amelioration. OPD no: 5123/23. Date of consultation is 10 June 2024.

Past Medical History: none

Family History: Mother – DM, Father: Apparently healthy, Elder Sister: apparently healthy

Personal History: Diet: mixed, Appetite: good, Thirst: Thirst less+, Desire: alcoholic drinks+++, Aversion: n.s, Bladder/Bowel: n.a.d. Sleep: side- right, good. Dreams: unremembered. Thermals: warm agg++

Mentals: Nature: reserved, talks with smile on face for every question. Behaves well with others, but expresses anger on wife, hits her and children, if angry. Patient is irritable at home. In general, has good relation with family. Insecured about others success. Patient’s relative built a home about 1 year ago. He is disturbed since then, always keeps complaining to wife about other’s achievements. He wants to have what others own, feels jealous. Very competitive. Remembers if someone hurts him, hates that person, plans and takes revenge(verbal). Aim: wants to work hard and earn well to achieve his dreams. Fears: n.s

Locomotor system Examination:

Inspection: right ankle swollen, red

Palpation: right ankle tenderness seen

Other abnormality seen.

Investigations: S. uric acid levels: 10.1mg/dL as on 11 May 2023

Diagnosis: Gout

Case Analysis: His complaints started since 1 year. When asked, he revealed that his relative built a new home about 1 year ago, since then he is disturbed, feels jealous and wants to own it. Considering this as a probable cause for his present complaint including his mental symptoms like dual nature, jealousy, insecurity, competitiveness and revengeful attitude with physical symptoms like ankle pain better with pressure and thermally being hot patient with a desire for alcoholic beverages, the following remedy was considered. ⁴

Repertory Selected: Synthesis Repertory

Repertorisation (Rubrics selected):

1. Mind – duality sense of
2. Mind – HATRED – revengeful and hatred
3. Mind – Jealousy
4. Stomach – Thirst less
5. Extremities – Pain – Ankles – gouty
6. Extremities – Pain -Ankles – walking agg
7. Extremities – Pain – Ankles – walking agg – stitching pain
8. Dreams – unremembered
9. Generals – Food and Drinks – alcoholic drinks – desire
10. Generals – warm agg ⁵

Repertorial Result: listed below in Table 1

Table 1: reportorial result

Remedies	Total Symptoms covered	Total marks obtained
Lachesis	9	18
Nat mur	8	13
Lycopodium	8	12
Sulphur	7	12
Agaricus	7	10

Prescription:

Lachesis 10M, one dose was given on 10 June 2023

The follow up of case is listed in Table 2.

Table 2: Follow up of the case.

Date	Symptoms	Analysis	Prescription
15 July 2023 Follow up 1	Right ankle pain had increased for 2 days initially, soon after the remedy. Right ankle pain and swelling is completely better since 15 days. C/O Bilateral Knee pain on ascending stairs since 3 days. Complaints of sternal region pain since 3 days (H/O physical exertion – lifting heavy weights). Mind: Irritability better Appetite – good Sleep – good, refreshing	As there was initial aggravation followed by amelioration of the presenting symptom along with general betterment, this indicates that the given remedy was a similimum. Though patient has few new symptoms since 3 days, which is after physical exertion, as intensity is mild, can wait for self-resolution of symptoms.	Placebo /6-0-6/ 1 month
31 Aug 23 Follow up 2	S. Uric acid: 8.4mg/dl (3.4 – 7mg/dl) on 23/07/24 C/O mild right ankle pain only on exertion/ lifting weights, can drive tempo without any discomfort. No swelling. C/O left knee pain 4 – 5 episodes in 1.5 months. C/O right ear pinna pain since 2 weeks, after exposure to cold air (decreasing in intensity, 90% better now) Sternum pain completely better. Generally doing well.	Chief complaint is improving. New complaints which occurred in last visit got resolved by itself. Pt. has developed new acute complaint, which is self-resolving, indicates immune system is healthy and any external stimulation (remedy) is not required.	Pl/ 6-0-6 /1 month
03 Nov 23 Follow up 3	S. Uric acid: 9.92mg/dl (3.4 – 7mg/dl) on 27/10/24 Ankle pain completely better, can walk freely, can drive tempo, can lift weights. Left knee pain completely better, no episodes since last visit. Right ear pinna pain completely better. C/O indigestion since few days. C/O coryza, nose block, eye lachrymation on and off, on exposure to cold air since 1 month. C/O Left shoulder pain on and off, 4 episodes, since 1 month, of 1- 2day duration, mild – moderate intensity, gets better by itself. (old complaint – H/O Left shoulder sprain in 2015). Mind: Irritability much better, striking better, comparing himself with others better, complaining wife about other’s success better. Generally doing well.	Though uric acid levels have slightly increased compared to last time, patient is better symptomatically, chief complaint is continuing to improve with no exacerbation of attacks even on exertion. Recurrence of old complaint during homoeopathic treatment is a good indication according to Kent’s 11th observation.6 Hence we can still wait with placebo	Pl/ 6-0-6 /1 month
22 Jan 24 Follow up 4	S. Uric acid: 5.9 mg/dl (3.4 – 7mg/dl) on 22/01/24 No episodes of right ankle pain and swelling since 1 month. (Had one episode of right ankle pain from over exertion, 5 weeks ago, intensity much better than before, duration: few hours. Resolved by itself). Sneezing, coryza, lachrymation completely better. Left Shoulder pain completely better. Indigestion completely better. Generally doing well.	S. Uric acid levels are normal with symptomatic improvement and generalized amelioration.	Pl / 6-0-6 /1 month
26 Feb 2024 Follow up 5	No episodes of right ankle pain and swelling. No episodes of any other joint affections. No new complaints. Appetite: good Sleep: good, refreshing Stool: regular, satisfactory	All complaints are better, no occurrence of new complaints with generally wellbeing of patient, implies the remedy was a similimum.	nil

Table 3: S. Uric acid levels before and after treatment

Date	S. Uric acid levels
Before treatment 11 May 2023	10.1 mg/dL  (4.2 – 7.3)
After treatment 23 July 2023	8.4 mg/dL  (3.4 – 7.0)
27 Oct 2023	9.92 mg/dL  (3.7 – 7.2)
22 Jan 2023	5.9 mg/dL  (3.4 – 7.0)

Discussion: Gout usually occurs in attacks that require immediate medical attention due to severe, excruciating pain. Gout patients receive long-term urate-lowering therapy, which has its own side effects. Painkillers are also prescribed, which only temporarily reduce pain. Due to the increase in the incidence and prevalence of gout in recent decades, a better treatment method with as few side effects as possible is needed. Although gout has its own pathological symptoms, each person has a unique way. Therefore, it is important to create an individualized treatment plan that takes into account the patient’s unique symptoms, including medical history and general health. In the homeopathic system of medicine, one medicine is prescribed for each patient. Homeopathy has several gout remedies with excellent results without serious side effects.

In this case, a single, simple remedy was prescribed in single dose (Law of Minimum Dose), and case was followed for 7 months using Master Kent’s wait and watch method. Patient’s uric acid levels gradually improved over 7 months. Patient was not on any other medicine (homeopathy/allopathy) during the course of treatment.

Hence patients should be made aware of homoeopathic method of treatment as it is, cost effective, painless and natural mode of treatment following the law of similia similibus curantur.

The Modified Naranjo Criteria for Homeopathy (MONARCH) causality assessment provided a score of 9/13, suggesting a significant causal relationship between the treatment and the observed outcome (Table 4).⁷

This case report suggests that individualized homeopathy can be a safe and effective treatment option for individuals with Gout.

Table 4: Modified Naranjo Criteria for Homeopathy (MONARCH) – for causality assessment

Criteria	Y	N	Not sure/NA	Score in case
1. Was there an improvement in the main symptom or condition for which the homeopathic medicine was prescribed?	2	-1	0	2
2. Did the clinical improvement occur within a plausible time frame relative to the drug intake?	1	-2	0	1
3. Was there an initial aggravation of symptoms?	1	0	0	1
4. Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed?	1	0	0	1
5. Did overall well-being improve?	1	0	0	1
6 (A) Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease?	1	0	0	0
6 (B) Direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms:- from organs of more importance to those of less importance, from deeper to more superficial aspects of the individual, from the top downwards	1	0	0	1
7. Did “old symptoms” (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement?	1	0	0	1
8. Are there alternate causes (other than the medicine) that with a high probability could have caused the improvement? (consider known course of disease, other forms of treatment, and other clinically relevant interventions)	-3	1	0	1
9. Was the health improvement confirmed by any objective evidence? (photos before and after treatment)	2	0	0	0
10. Did repeat dosing, if conducted, create similar clinical improvement?	1	0	0	0
Total				9

Conclusion:
In this case, individualised homeopathy has demonstrated encouraging outcomes in addressing gout. In addition to managing the symptoms of the condition, it also improved the overall wellbeing of the patient. However, further research is needed to fully understand the mechanisms of the treatment and to determine its effectiveness in larger populations. It is important to continue exploring alternative therapies like individualised homeopathy as they may provide valuable options for those suffering from gout and other joint disorders.

References:

1. Shekelle PG, FitzGerald J, Newberry SJ, et al. Management of Gout. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Mar. (Comparative Effectiveness Reviews, No. 176.) Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK356136/

2. JOEL R. PITTMAN, PHARM. D., AND MICHAEL H. BROSS, M.D. info Am Fam Physician. 1999;59(7):1799-1806 https://www.aafp.org/pubs/afp/issues/1999/0401/p1799.html
3. Engel B, Just J, Bleckwenn M, Weckbecker K. Treatment Options for Gout. Dtsch Arztebl Int: 2017 Mar 31; 114(13), 215-222. DOI: 10.3238/arztebl.2017.0215. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624445/ [Accessed on 26 June 2024]

4. Kent JT. Lectures on Homoeopathic Materia Medica. B. Jain Publishers (P) ltd, Uttar Pradesh, 2017. 682 – 694
5. Schroyens F. Synthesis Repertorium Homeopathicum Syntheticum. 7th ed. B. Jain Publishers (P) Ltd, New Delhi, 1997.
6. Kent JT. Lectures on homoeopathic philosophy. B. Jain Publishers (P) ltd, India, 2008. Lecture 35.
7. Lamba CD, Gupta VK, Van Haselen R, et al. Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports. Homeopathy. 2020;109(4):191-197. doi:10.1055/s-0040-1701251 https://pubmed.ncbi.nlm.nih.gov/32215892/

Dr. Anjum Fathima Warsi
PG Scholar, Department of Homoeopathic Materia Medica
Government Homoeopathic Medical college and hospital, Bengaluru – 560079
anjumfathimawarsi@gmail.com

Under the Guidance of Dr. Ashok Kumar Dantkale
Professor and PG Guide GHMC Bengaluru

Download the full case with images