Role of individualized homoeopathic medicine in the treatment of gout - An observational study

Abstract

Objectives
The objectives of the study were to evaluate the effects of homoeopathic treatment on patient distress, sociodemographic factors and outcomes in patients with gout.

Materials and Methods
This was an observational study conducted using secondary data from hospital records, pathological reports, patient prescription sheet and the sociodemographic data from computerised records in Mahesh Bhattacharyya Homoeopathic Medical College and Hospital.

Results
A total of 150 patients (94 men and 56 women) were included in the study. Gout was diagnosed based on clinical symptoms and laboratory reports. All patients were prescribed homoeopathic medicines along with dietary management. The patients were prescribed Lycopodium ( n =22, 14.67%), Colchicum ( n =17, 11.38%), Natrum sulph ( n =18, 12%) and nitric acid ( n =14, 9.38%) on the basis of totality and symptoms and individualisation. Improvement was assessed in four different categories: Marked, moderate, mild and no improvement. The patients improved clinically as well as pathologically. Uric acid (UA) reduction was marked in 26 (17.33%) patients, moderate in 67 (44.67%) patients and mild in 25 (16.67%) patients. Almost 125 (83.33%) among the 150 reported reduction in physical discomfort and have been doing well after treatment.

Conclusion
This study showed that homoeopathic treatment is very effective in reducing clinical symptoms and serum UA levels in subjects having gout.

Full text

Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | PB Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 75
Original Article
Role of individualized homoeopathic medicine in the
treatment of gout - An observational study
Bikash Biswas1, Sanjukta Mandal2
Departments of 1Case Taking and Repertory, 2Homoeopathic Materia Medica, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah,
West Bengal, India.
INTRODUCTION
Gout is a metabolic disease that primarily aects middle aged to elderly men and postmenopausal
women.[1] Gout is among the most prevalent aetiologies of chronic inammatory arthritis in the
United States. e general prevalence of gout is 1–4% of the general population and can rise to
10% in men and 6% in women in those aged above 80years. Globally, the occurrence is 2–6times
higher in men than in women.[2] Hyperuricaemia is the biologic hallmark of gout. In this
condition, the plasma and extracellular uids become supersaturated with uric acid (UA); under
certain conditions, the UA crystallises and may result in a spectrum of clinical manifestations
occurring singly or in combination.[1] Gout is characterised by deposition of monosodium urate
(MSU) monohydrate crystals in the tissues.[3,4]
It is well known that reduced physical activity, higher intake of purine-rich food and alcoholic
beverages as well as smoking cause hyperuricaemia.[5] Hyperuricaemia is the leading cause of
ABSTRACT
Objectives: e objectives of the study were to evaluate the eects of homoeopathic treatment on patient distress,
sociodemographic factors and outcomes in patients with gout.
Materials and Methods: is was an observational study conducted using secondary data from hospital records,
pathological reports, patient prescription sheet and the sociodemographic data from computerised records in
Mahesh Bhattacharyya Homoeopathic Medical College and Hospital.
Results: Atotal of 150 patients (94 men and 56 women) were included in the study. Gout was diagnosed
based on clinical symptoms and laboratory reports. All patients were prescribed homoeopathic medicines
along with dietary management. e patients were prescribed Lycopodium (n=22, 14.67%), Colchicum (n=17,
11.38%), Natrum sulph (n=18, 12%) and nitric acid (n=14, 9.38%) on the basis of totality and symptoms and
individualisation. Improvement was assessed in four dierent categories: Marked, moderate, mild and no
improvement. e patients improved clinically as well as pathologically. Uric acid (UA) reduction was marked in
26(17.33%) patients, moderate in 67(44.67%) patients and mild in 25(16.67%) patients. Almost 125(83.33%)
among the 150 reported reduction in physical discomfort and have been doing well aer treatment.
Conclusion: is study showed that homoeopathic treatment is very eective in reducing clinical symptoms and
serum UA levels in subjects having gout.
Keywords: Gout, Homoeopathy, Hyperuricaemia, Observational study
is is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others
to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
©2021 Published by Scientic Scholar on behalf of Journal of Integrated Standardized Homoeopathy
www.jish-mldtrust.com
Journal of Integrated Standardized
Homoeopathy
*Corresponding author:
Dr. Bikash Biswas,
Department of Case Taking
and Repertory, Mahesh
Bhattacharyya Homoeopathic
Medical College and Hospital,
Howrah, West Bengal, India.
bikash21592@gmail.com
Received : 20May2021
Accepted : 25August 2021
Published : 21 October 2021
DOI
10.25259/JISH_14_2021
Quick Response Code:

Biswas and Mandal: Role of individualized homoeopathic medicine in the treatment of gout - An observational study
Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 76 Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 77
gout.[1,6] Increased serum UA (SUA) level above a specic
threshold (< 6mg/dL in women and <7mg/dL in men) is
a requirement for the formation of UA crystals. Although
hyperuricaemia is the main pathogenic process in gout,
many people with hyperuricaemia do not develop gout or
form UA crystals. In fact, only 5% of people with UA levels
above 9mg/dL develop gout. us, the diagnostic utility of
measuring UA levels is limited.[7] Genetic predisposition also
aects the incidence of gout.[8,9]
While MSU crystals can be deposited in all tissues, deposition
mainly occurs in and around the joints, forming tophi. Early
presentation of gout is oen acute joint inammation that
is quickly relieved by nonsteroidal anti-inammatory drugs
(NSAIDs) or colchicine. Renal stones and tophi are late
presentations. Lowering SUA levels below the deposition
threshold through dietary modication and/or using SUA-
lowering drugs are the main goal in the management of
gout. is results in dissolution of MSU crystals, preventing
further attacks.[10,11]
e most common presentation of gout is recurrent attacks
of acute inammatory arthritis (a red, tender, hot, swollen
joint).[12] e metatarsophalangeal joint at the base of the big
toe is aected most oen, accounting for half of cases.[7] Other
joints, such as the heels, knees, wrists and ngers, may also be
aected.[3] Joint pain usually begins during the night and peaks
within 24h of onset.[3] is joint pain increases due to lower
body temperature.[4] Other symptoms may rarely occur along
with the joint pain, including fatigue and a high fever.[7,13]
Other blood tests commonly performed are white blood cell
(WBC) count, electrolytes, kidney function and erythrocyte
sedimentation rate (ESR). However, both the WBCs and ESR
may be elevated due to gout in the absence of infection.[14,15]
WBC counts as high as 40.0 × 109/l (40,000/mm3) have been
documented.[13]
UA levels can be reduced by lowering the intake of alcohol,
fructose, purine-rich foods, red meat, sea food, coee and
stimulants. Patients are advised to consume low-fat products
such as yoghurt, fresh fruits and vegetables along with
Vitamin C supplementation.[16]
Role of homoeopathy in cases of gout
e number of evidence-based studies on homoeopathic
treatment of gout is very limited. An open-label observational
trial to assess the eect of individualised homoeopathic medicine
in patients with gout was found to have a positive result.[17]
A prospective, randomised, single-blind placebo-controlled
study was conducted with an objective to evaluate improvement
in the SUA level and visual analogue scale score of pain. e
mean score reduction in the medicinal group was higher than in
the placebo group; the dierence was statistically signicant.[18]
It is being claimed that homoeopathic medicines are ecacious
in treating gout but enough evidences are lacking.
is study was undertaken for that very purpose. We
collected secondary data from hospital records and
pathological reports to nd out the degrees of improvement
in cases of gout aer administration of individualised
homoeopathic medicines; and also the frequently indicated
remedies [Tab le1]. is has helped to state the eectiveness
of homoeopathy in cases of gout.
MATERIALS AND METHODS
Process of study
An observational study on homoeopathic treatment of gout
was conducted. Individualisation of each case was done by
evaluating the totality of symptoms with the help of a proper
case taking proforma. Data collection was through the
secondary method; data were obtained from laboratory records,
case taking proforma and records – both paper and computer.
Study design
is was an observational cohort study.
Declaration of patient consent
Not applicable.
Inclusion criteria
1. Patients suering from chronic and acute gout with high
UA levels (≥7mg/dL)
2. e gout had to be clinically apparent, with symptoms
such as joint pains
3. Patients aged 18–70years, both sexes, all religions and
socioeconomic status
Tab le1: Most frequently prescribed medicines.
Frequently prescribed medicine No. of patients Percentage
Lycopodium n= 22 14.67
Nitric acid n=14 9.38
Natrum sulph n=18 12
Colchicum autumnale n=17 11.38
Medorrhinum n=7 4.67
Calcarea uor n=13 8.67
Calcarea carb n=10 6.67
Sulphur n=8 5.33
Benzoic acid n=11 7.33
Pulsatilla n=9 6
Coea cruda n=9 6
Rhus toxicodendron n=6 4
uja occ n=6 4

Biswas and Mandal: Role of individualized homoeopathic medicine in the treatment of gout - An observational study
Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 76 Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 77
4. Patients undergoing treatment but without any
improvement.
Exclusion criteria
e following criteria were excluded from the study:
1. Patients already undergoing treatment with other system
of medicine
2. Patients with other systemic diseases such as high blood
pressure and diabetes mellitus.
Study design
is study was conducted in the outpatient department
of the Mahesh Bhattacharyya Homoeopathic Medical
College and Hospital, Dumurjola, Howrah. A majority of
the patients are from the lower socioeconomic strata. e
study sample was retrospectively selected from patients with
hyperuricaemia who underwent estimation of UA during
a 9-month period from November 2018 to February 2021.
Due to the COVID-19 lockdown, data from March 2020 to
September 2020 were not included. All pathology data were
provided by the pathology department.
A total of 150 patients had undergone UA estimation for
the treatment of gout in the above-mentioned study period.
Sociodemographic data were available only regarding patient
sex, age, name and religion [Table 2]. e body mass index
(BMI) was calculated using the height and weight that were
measured for the pathology records. e patients were
classied into dierent groups according to the BMI as per
the WHO criteria for South Asia.[19]
Homoeopathic intervention
e homoeopathic medicine was selected on the basis of
individualisation for each case with a proper totality of symptoms
created using homoeopathic philosophy. Medicines [Tabl e 3]
were prescribed in the centesimal potency and dispensed by
the hospital dispensary. e doses comprised six globules (size
10) to be taken on an empty stomach early in the morning.
Repetition of doses and patient follow-up were conducted
according to Kent’s second prescription.[3] e potencies
varied according to the patients’ condition, susceptibilities and
nature of disease. e follow-up interval was 2weeks, 1week
in case of acute pain. UA levels were rechecked 4weeks aer
symptoms ameliorated and compared with the pre-treatment
values [Tables 4 and 5].
Tab le2: Patient characteristics patients with gout=150.
Sociodemographic
features
Numbers with percentage
Sex
Male 94 (62.67)
Female 56 (37.33)
Age (years)
18–30 18 (12)
31–45 99 (66)
46–70 33 (22)
BMI (kg/m2)
Underweight < 18 7 (4.67)
Normal 18–24.99 80 (53.33)
Overweight 25–29.99 47 (31.33)
Obese >30 16 (10.67)
Occupation
Labour 79 (52.66)
Housewife 64 (42.66)
Teacher 2 (1.33)
Sedentary jobs 5 (3.33)
BMI: Body mass index
Tab le3: Indications of the prescribed medicines.[20]
Medicine Indication
Lycopodium Chronic gout, with deposits in joints. Toes
and ngers contracted. Worse in right
side. Better by motion
Nitric acid Pain as from splinters. Sticking pain in
toe. Pain appears and disappears quickly
Natrum sulph Gout. Worse in damp cold weather.
Frequently changing position, worse le
side
Colchicum Inammation of great toe, gout in heel.
Cannot bear to have it touched or moved.
Worse motion, sundown to rise
Medorrhinum Gouty concentration. Heel and balls of
feet tender. Finger joints enlarged. Worse
from daylight to sunset, better at seashore,
damp weather
Calcarea uor Gouty enlargements of the joints of the
ngers. Worse during rest, change of
weather. Better by warm application
Calcarea carb Gouty nodosities. Swelling of joints.
Worse cold weather, washing, better by
dry climate, pressure
Sulphur Rheumatic gout with itching, with
stiness in joints. Worse standing, rest.
Better by warm weather
Benzoic acid Rheumatic gout, nodes very painful,
gouty deposits, swelling of wrist. Worse
uncovering. Better by warmth
Pulsatilla Boring pain in heels, tensive pain. Better
in open air, warm room. Worse from heat
Coea cruda Over use of coee causing rheumatic
gout. Better warmth
Rhus toxicodendron Hot painful swelling of joints. Better by
motion. Worse at night
uja occ Gout. Pain in heels. Tips of ngers
swollen red. Cracking of joints. Worse at
night, from heat. Better by while drawing
up the limb

Biswas and Mandal: Role of individualized homoeopathic medicine in the treatment of gout - An observational study
Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 78 Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 79
frequently indicated homoeopathic remedies prescribed in
case of gout were found out and this will help in treatment of
more such cases. However, there were also a few limitations
of this study – the study was based on secondary data and no
patient interaction was done.
CONCLUSION
Homoeopathic treatment has a signicant role to reduce UA
levels and provide symptomatic relief in the treatment of
patients with gout. Further studies, including randomised
controlled trials and observational studies, are required
to obtain a deeper knowledge of clinicopathological and
Materia Medica correlations.
Acknowledgments
We thank the Principal, Administrator, Resident medical
ocers and the Pathology department sta of the Mahesh
Bhattacharyya Homoeopathic Medical College and Hospital,
Dumurjola, Howrah.
Declaration of patient consent
Patient’s consent not required as patients identity is not
disclosed or compromised.
Financial support and sponsorship
Nil.
Conicts of interest
ere are no conicts of interest.
REFERENCES
1. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL,
Loscalzo J. Harrison’s Manual of Medicine. 18th ed., Ch. 175.
NewYork: McGraw Hill Publication; 1978. p.1091.
2. Kuo CF, Grainge MJ, Zhang W, Doherty M. Global
epidemiology of gout: Prevalence, incidence and risk factors.
Nat Rev Rheumatol 2015;11:649-62.
3. Neogi T. Gout. Ann Intern Med 2016;165:ITC1-16.
4. Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet (London,
England) 2016;388:2039-52.
5. Richette P, Bardin T. Gout. Lancet (London, England)
2010;375:318-28.
6. Abhishek A, Roddy E, Doherty M. Gout a guide for the general
and acute physicians. Clin Med (London, England) 2017;17:54-59.
7. Schlesinger N. Diagnosing and treating gout: Areview to aid
primary care physicians. Postgrad Med 2010;122:157-61.
8. Dalbeth N, Merriman TR, Stamp LK. Gout. Lancet
2016;388:2039-52.
9. Emmerson BT. e management of gout. N Engl J Med
1996;334:445-51.
RESULTS
Treatment outcome was assessed on the basis of pathological
report and symptomatic improvement of pain in joints and
general well-being. Four categories of improvement were
determined: Marked, moderate, mild and none. Complete
reduction of joint pain with no functional disturbances
and lower UA levels was considered marked improvement.
Moderate improvement was dened as occasional lower
intensity of joint pain with border line UA level. Mild
improvement was dened as UA levels between 6.5mg/dL
and 7mg/dL with sudden pain at night. No amelioration in
symptoms and the UA level remaining the same as before
treatment was dened as no improvement.
DISCUSSION
e various studies have shown that homoeopathic treatment
was very successful in the treatment of gout. is study was
done to conrm the same.
is is an observational study and results were obtained very
quickly and the cost to carry out the study was minimal.
ere was also no risk of loss to follow up of patients. e
Tab le5: Degree of improvement aer homoeopathic treatment.
Degree of
improvement
Clinical pictures Number of
patients (%)
Marked
improvement
Pain in joints is completely gone.
No episodes of pain. Patient
doing very well aer treatment.
UA level normal
26 (17.33)
Moderate
improvement
Patient feels occasional low-
intensity pain. UA level slightly
raised. Otherwise, patient doing
well
67 (44.67)
Mild
improvement
Pain occurs suddenly at night
and but lower than before. UA
level is 6.5–7 mg/dL
32 (21.33)
No
improvement
Same as before 25 (16.67)
UA: Uric acid
Tab le4: UA level estimation.
Reduction
value
UA level (mg/dL) Number
of patients
Percentage
Marked
reduction
Below 6 mg/dL n=26 17.33
Moderate
reduction
Borderline: 6 mg/dL n=67 44.67
Mild reduction 6.5 mg/dL n=32 21.33
No change Above 7 mg/dL n=25 16.67
UA: Uric acid

Biswas and Mandal: Role of individualized homoeopathic medicine in the treatment of gout - An observational study
Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 78 Journal of Integrated Standardized Homoeopathy • Volume 4 • Issue 3 • July-September 2021 | 79
10. Pascual E, Sivera F. Time required for disappearance of urate
crystals from synovial uid aer successful hypouricemic
treatment relates to the duration of gout. Ann Rheum Dis
2007;66:1056-8.
11. Singh JA. Challenges faced by patients in gout treatment:
Aqualitative study. JClin Rheumatol 2014;20:172-4.
12. Sachs L, Batra KL, Zimmermann B. Medical implications of
hyperuricemia. Med Health R I 2009;92:353-5.
13. National Institute of Arthritis and Musculoskeletal and Skin
Diseases; 2015.
14. Gout: Dierential Diagnoses and Workup eMedicine
Rheumatology. Medscape; 2019.
15. Gout and Pseudogout: Dierential Diagnoses and Workup
eMedicine Emergency Medicine. Medscape; 2019.
16. Amnik J, Rehman S, Mejia SB, de Souza RJ, Khan TA, LeiterLA,
et al. Fructose intake and risk of gout and hyperuricemia:
A systematic review and meta-analysis of prospective cohort
studies. BMJ Open 2016;6:e013191.
17. Saha S, Sarkar P, Chattopadhyay R, Saha S. An open label
prospective observational trial for assessing the eects of
Homoeopathic medicines in patient’s suerings from gout.
Indian J Res Homoeopathy 2019;13:236-43.
18. Deep A, Kumar A. Homoeopathic management of
hyperuricemia in primary gout: A randomized single blind
placebo-controlled study. Int J Health Sci;4:73-7.
19. World Health Organization. WHO Global Database on Body
Mass Index, BMI Classication, Criteria for South-Asian
Region. Geneva: World Health Organization.
20. Boericke W. In: Boericke OE, editor. Pocket Manual of
Homoeopathic Materia Medica Comprising the Characteristic
and Guiding Symptoms of all Remedies. 9thed. India: Modern
Homoeopathic Publication; 2003.
How to cite this article: Biswas B, Mandal S. Role of individualized
homoeopathic medicine in the treatment of gout - An observational study.
JIntgr Stand Homoeopathy 2021;4:75-9.