Homoeopathic Treatment in Acute Gout A research report submitted to the faculty of Health Sciences, Technikon Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Technology: Homoeopathy by Raakhi Cara (Student number: 9614149) Prof. M. Tikly Supervisor Dr. E. M. Solomon Co-Supervisor Johannesburg, 2003 DECLARATION I declare that this research report is my own, unaided work. It is being submitted for the Degree of Masters of Technology at the Technikon Witwatersrand, Johannesburg. It has not been submitted before any degree or examination in any other Technikon, or University. su, (Signature of candidate) (cid:9)13fhn day of l'''Ec'"9' E2 a c '° 3 ii Dedicated to my loving, husband Nilesh, and my parents, Pravin and Luxmi, for enabling me to pursue my dreams Ill ACKNOWLEDGEMENTS I would like to express my sincere gratitude to the following individuals for their assistance in the completion of this dissertation. Supervisor: Prof. M. Tikly (FRCP, PhD) Co-Supervisor: Dr. E.M. Solomon (HD. ND.DO . (Lind), BA (Unisa) Statistician: Lasath Pundyadeera Technikon Witwatersrand for financial assistance All the volunteers that participated in this trial Dr. Bradshaw, Dr. Eden, Dr. Hardy and Dr Pellow from Weleda Pharmacy for their guidance iv ABSTRACT This research was conducted to determine the effect of homoeopathic treatment on acute gout patients. Putterman (1994) conducted a research study on the effect of the homoeopathic remedy Colchicum autumnale in gout, and found partial improvement in the clinical picture of gout. No research has been conducted in South Africa on the efficacy of homoeopathic medicines in acute gout patients. This study focused on the homoeopathic Law of Similars, where a single most similar homoeopathic remedy was chosen according to the unique characteristic symptoms displayed by each participant suffering with acute gout. This was a qualitative study that used ten subjects who presented within five days of acute gout and participated in the fifteen-day study period. Participants that complied with the American College of Rheumatology (formerly American Rheumatism Association, ACR) criteria for gout were selected. Serum uric acid tests were taken on day 0 and day 6 to assess hyperuricemia. On day 0 a thorough case history and examination was taken followed by administration of the indicated remedy. Treatment efficacy was evaluated on day 1, 3 and 6, based on daily subjective impression of participant involvement, objective analysis and comparative analysis of serum uric acid. Re-examination for relapses or rebound attacks followed on day 15. In a study using allopathic remedies in acute gout, resolution of all acute gout symptoms occurred at an average of 8 days using indomethacin and 7 days using triamcinolone (Alloway et. al., 1993). In this study using homoeopathic similimum treatment, resolution of all acute gout symptoms occurred at an average of 6 days. One episode of a rebound gout attack occurred and serum uric acid decreased in 80% of patients. Homoeopathic similimum prescribing is an effective alternative treatment for acute gout. Although more research is required, the preliminary findings of this study suggest that the correct homoeopathic similimum treatment is an effective treatment for the symptoms of acute gout. TABLE OF CONTENTS(cid:9) Page no. TITLE PAGE (cid:9) i DECLARATION (cid:9) ii DEDICATION (cid:9) iii ACKNOWLEDGEMENTS (cid:9) iv I (cid:9) ABSTRACT(cid:9) v TABLE OF CONTENTS (cid:9) vi APPENDICES(cid:9) xii LIST OF TABLES (cid:9) xiii LIST OF GRAPHS (cid:9) xv LIST OF ABBREVIATIONS (cid:9) xvi CHAPTER ONE: INTRODUCTION(cid:9) 1 1.1 General Introduction (cid:9) 1 I (cid:9) 1.2 Aim of study (cid:9) 1 CHAPTER TWO: LITERATURE REVIEW (cid:9) 2 2.1 Gout (cid:9) 2 2.2 Four stages of gout (cid:9) 2 2.2.1 Asymptomatic hyperuricemia (cid:9) 2 2.2.2 Acute gout (cid:9) 3 2.2.3 Recurrent attacks (cid:9) 4 I (cid:9) 2.2.4 Intercritical stage (cid:9) 4 2.2.5 Chronic stage (cid:9) 5 2.3 Hyperuricemia (cid:9) 6 2.3.1 Underexcretion of urate (cid:9) 7 2.3.2 Overproduction of urate (cid:9) 8 2.4 Pathogenesis (cid:9) 9 vi page no. 2.5 Prognosis (cid:9) 10 2.6 Diagnosis (cid:9) 10 2.7 Risk factors (cid:9) 11 2.8 Epidemiology (cid:9) 12 2.9 Randomized studies on acute gout (cid:9) 12 2.10 Management of gout (cid:9) 13 2.10.1 Termination of the acute painful attack (cid:9) 13 2.10.2 Prevention of recurrences (cid:9) 13 2.10.3 Preventing urate deposition (cid:9) 13 2.10.4 Diet (cid:9) 13 2.10.5 Complications of allopathic treatment (cid:9) 14 2.10.6 Alternative approach (cid:9) 15 2.11 Homoeopathy (cid:9) 15 2.11.1 Preparation of homoeopathic remedies and potentization (cid:9) 16 2.11.2 Proving (cid:9) 17 2.11.3 Materia medica (cid:9) 17 2.11.4 Single remedy (cid:9) 18 2.11.5 Determination of homoeopathic remedies in acute cases (cid:9) 18 2.11.6 Repertorization (cid:9) 19 2.11.7 Responses that indicate cure (cid:9) 20 2.11.8 Aggravation (cid:9) 21 CHAPTER THREE: METHODOLOGY (cid:9) 22 3.1 Sample selection (cid:9) 22 3.2 Trial period (cid:9) 22 3.3 Homoeopathic repertorization and treatment (cid:9) 23 3.4 Medication (cid:9) 23 3.5 Subjective and objective assessment (cid:9) 23 vii page no. 3.6 Questionnaires (cid:9) 24 3.7 Analysis of urate (cid:9) 25 3.8 Data interpretation and statistical analysis (cid:9) 25 CHAPTER FOUR: CASE STUDIES (cid:9) 27 4.1 Patient A (cid:9) 27 4.1.1 Homoeopathic treatment (cid:9) 28 4.1.2 Follow up cases (cid:9) 29 4.1.3 Discussion (cid:9) 30 4.1.4 Subjective improvement as a percentage (cid:9) 31 4.1.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 31 4.1.6 Change in SUA on day 0 and day 6 (cid:9) 31 4.2 Patient B (cid:9) 32 4.2.1 Homoeopathic treatment (cid:9) 33 4.2.2 Follow up cases (cid:9) 34 4.2.3 Discussion (cid:9) 35 4.2.4 Subjective improvement as a percentage (cid:9) 36 4.2.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 36 4.2.6 Change in SUA on day 0 and day 6 (cid:9) 36 4.3 Patient C (cid:9) 37 4.3.1 Homoeopathic treatment (cid:9) 38 4.3.2 Follow up cases (cid:9) 39 4.3.3 Discussion (cid:9) 40 4.3.4 Subjective improvement as a percentage (cid:9) 41 4.3.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 41 4.3.6 Change in SUA on day 0 and day 6 (cid:9) 41 4.4 Patient D (cid:9) 42 4.4.1 Homoeopathic treatment (cid:9) 42 4.4.2 Follow up cases (cid:9) 43 4.4.3 Discussion (cid:9) 44 viii page no. 4.4.4 Subjective improvement as a percentage (cid:9) 45 4.4.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 45 4.4.6 Change in SUA on day 0 and day 6 (cid:9) 45 4.5 Patient E (cid:9) 46 4.5.1 Homoeopathic treatment (cid:9) 47 4.5.2 Follow up cases (cid:9) 48 4.5.3 Discussion (cid:9) 49 4.5.4 Subjective improvement as a percentage (cid:9) 50 4.5.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 50 4.5.6 Change in SUA on day 0 and day 6 (cid:9) 50 4.6 Patient F (cid:9) 51 4.6.1 Homoeopathic treatment (cid:9) 52 4.6.2 Follow up cases (cid:9) 52 4.6.3 Discussion (cid:9) 53 4.6.4 Subjective improvement as a percentage (cid:9) 54 4.6.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 54 4.6.6 Change in SUA on day 0 and day 6 (cid:9) 54 4.7 Patient G (cid:9) 55 4.7.1 Homoeopathic treatment (cid:9) 56 4.7.2 Follow up cases (cid:9) 57 4.7.3 Discussion (cid:9) 58 4.7.4 Subjective improvement as a percentage (cid:9) 58 4.7.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 58 4.7.6 Change in SUA on day 0 and day 6 (cid:9) 58 4.8 Patient H (cid:9) 59 4.8.1 Homoeopathic treatment (cid:9) 60 4.8.2 Follow up cases (cid:9) 61 4.8.3 Discussion (cid:9) 61 4.8.4 Subjective improvement as a percentage (cid:9) 62 4.8.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 62 4.8.6 Change in SUA on day 0 and day 6 (cid:9) 62 ix page no. 4.9 Patient I (cid:9) 63 4.9.1 Homoeopathic treatment (cid:9) 64 4.9.2 Follow up cases (cid:9) 64 4.9.3 Discussion (cid:9) 65 4.9.4 Subjective improvement as a percentage (cid:9) 66 4.9.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 66 4.9.6 Change in SUA on day 0 and day 6 (cid:9) 66 4.10 Patient J (cid:9) 67 4.10.1 Homoeopathic treatment (cid:9) 68 4.10.2 Follow up cases (cid:9) 68 4.10.3 Discussion (cid:9) 69 4.10.4 Subjective improvement as a percentage (cid:9) 70 4.10.5 Objective improvement on day 0, 1, 3, 6 and 15 (cid:9) 70 4.10.6 Change in SUA on day 0 and day 6 (cid:9) 70 CHAPTER FIVE: QUANTITATIVE ANALYSIS(cid:9) 71 5.1 Demographics (cid:9) 71 5.2 Clinical baseline data (cid:9) 72 5.3 Response to therapy (cid:9) 73 5.4 Compliance of patients (cid:9) 74 CHAPTER SIX: QUALITATIVE ANALYSIS(cid:9) 90 6.1 The correlation with other studies of acute gout (cid:9) 90 6.1.1 Diagnosis (cid:9) 90 6.1.2 Gender (cid:9) 90 6.1.3 Family history (cid:9) 91 6.1.4 Age related symptoms (cid:9) 91 6.1.5 Obesity (cid:9) 91 6.1.6 Alcohol abuse (cid:9) 91