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Clinical Review

Diagnosis and management of gout

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7553.1315 (Published 01 June 2006) Cite this as: BMJ 2006;332:1315

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Management of Gout.

Many cases of "arthritis" could well be re-classified as Gout.

The condition is caused by the deposition of Urate crystals on joint
surfaces, in tendon and ligamentous insertions, paricularly when they have
been recently stressed or strained.

Hence Achilles tendonitis, Calcaneal Spur, Golfer's forearm (L),
tennis elbow, olecranon bursitis, carpal tunnel ("mouse") syndrome and
sacro-iliac strain.

To just prescribe for the pain the latest NSAID (Non-Steroidal Anti-
Inflammatory Drug) is too easy. It does not get at the cause, is only
palliative and may have side effects.

The cause lies in the source of that Uric Acid. Though it can and
has come from the breakdown of one's own specialised tissues when
debilitated, as amongst the inmates of Changi Gaol and Camp in the last
War, the origin is more likely in one's own diet.

Such a diet that is rich in DNA (Deoxyribo-Nucleic Acid) which will
of course be found in the highly nucleated tissues of rich meats, and
offal, liver, brain, kidney, tongue, sausage and close-fibred fish and all
shell-fish. Also in the young growing-tips of vegetables as found in
Asparagus and bean-sprouts, and bamboo shoots. All show a similar
histological pattern of closely packed nuclei with little cytoplasm in
proportion.

Hence from this nucleo-protein the enzymes break down that DNA
through Adenine and Guanine to Hypoxanthine to Uric Acid.

It seems wrong therefore to see repeated from time to time the
advertisement that "diet plays little or no part in the causation of
Gout". Which is just a promotion of Allopurinol to be taken for the rest
of one's life.

When Uric Acid cannot be blamed then Oxalic Acid will replace it, and
a watch must be kept on some vegetables, spinach for instance, and fruit
such as Raspberies, Strawberries, Gooseberries, Rhubarb, Apricots,
Persimmons and Peaches. Mango has no Oxalate but in susceptible and
particular people will cause Gout.

The list is long.

Alcohol in any form plays its part by blocking the kidney's ability
to excrete the Uric and Oxalic Acids. All such drinks must be stopped
during any treatment.

An important part of the treatment will be an adequate intake of
water (not iced), enough to produce urination at least six times a day, as
clear as a mountain stream.

Urate excretion can be accelerated, even ridding the kidney of
offending recent stones and crystals, by taking three times a day a soup
of the large white radish (Raphanus Sativus), called "Moolie" in
supermarkets and "Daikon" in Japanese restaurants. Stones will either
dissolve away or be passed in two or three days. It may be mentioned that
this was noted by Nicholas Culpeper in his 17th Century "Herbal". It has
been part of Indonesian family lore for far longer.

Chocolate and coffee are both strong in Oxalates and strongly-brewed
English tea more in Urates, from those growing tips of the tea-bush.

Treatment of Gout then is with the well-tried Colchicine (500 mcg,)
taken as two tablets (1,000 mcg.) to begin and repeat one after an hour.
Four tablets in one day will probably produce bowel looseness and patients
shouod be so warned.

And in combination with Benzbromarone ("Narcaricin"), found more on
the European continent. Two tablets to be taken at night-time followed by
two Colchicine tablets each morning.

In very severe attacks of Gout then recourse must be to intramuscular
injections of Steroids, and then tail them off with tablets on a reducing
daily dosage.

Competing interests:
None declared

Competing interests: No competing interests

09 June 2006
GEORGE Y. CALDWELL.
General Practitioner
SINGAPORE 259858
31 BALMORAL PARK, #18-33,