Introduction

Gout is a type of arthritis that affecting the joints of the arms and legs, and affects less than 0.1% of adults, but its prevalence increases with age, especially in men, with men aged 60+ about 5 times more likely to have it than men in their 40’s [1].

Historically, gout has been associated with a so-called “rich” food, that is, over-consumption of meats and seafood, foods with higher fat content, and overconsumption of alcohol. Today, we know that diet is an important contributor in the development of gout, because of its origins in the build-up of uric acid in the blood that eventually forms solid crystals around the body’s internal fluid areas, such as fluid joints.

When we consume protein, part of it is converted to substances called purines in the liver, which are then made into uric acid. Too much protein, liver problems, or other metabolic issues can mean that there are more purines in the body, so more uric acid than normal is made. Arthritis-like problems happen when uric acid starts to form crystals within joint fluid and connective tissues, causing a sudden “flare”, which is a episode of acute pain, swelling and loss of physical function [2].

To combat these symptoms, drugs call uricosurics are frequently prescribed. These act by slowing down the enzyme that controls formation of uric acid in the liver. Other drugs include pain relievers and anti-inflammatories. However, many conventional drugs are associated with significant side effects or lack of response, so herbal medicines and supplements are frequently seen as an alternative or complementary option. This article highlights the outcomes of a clinical pilot study report of an herbal medicine used to treat symptoms of gout.

Study design  

The nutraceutical used in the study by Vu et al (2020) [3] used a combination of medicinal herbs known for their effects in pain relief. A combination of Prunus cerasus, Harpagophytum procumbens, Apium graveolens, with the micronutrients, potassium citrate, vitamin C and folic acid. In this single arm study, researchers in Vietnam evaluated the efficacy, safety and tolerability this formula in 35 gout sufferers (aged 41-66 yrs). The investigators evaluated the effects of the formula on self-rated pain severity, swelling, redness and warmth in joints affected by gout, and ratings were recorded on day 0 (baseline), 15, 30 and 45 of the intervention. Clinical evaluations also included monitoring for blood indicators of liver or kidney toxicity, inflammation, and changes in their general vital signs, including blood pressure.

Study outcomes

Regarding efficacy, as soon as 15 days after product use, subjects observed almost complete reduction in global joint pain, sustained until the end of the trial. By day 30, subjects also reported a complete reduction in joint swelling, also sustained until completion. The average blood uric acid level had also declined significantly by 5% (p=0.024) by the end of the trial, which represented a pooled decrease of  20.8 μmol/L, P = 0.032) compared to baseline. In relation to safety, there were no significant differences in tests for liver function, blood cell counts or vital signs throughout the treatment and the nutraceutical was well-tolerated.

**P<0.001, ***P<0.0001

**P<0.001

*P<0.05

Implications of the study

Considering that the study participants used the nutraceutical in the absence of any prescription medications with the 45-day period, the outcomes suggest that the ingredients worked together to alleviate the main hallmarks of gout, without causing notable side effects.

Of the herbs, the most widely known for arthritis management is Harpagophytum procumbens, which has been reported to provide pain relief in inflammatory joint conditions, from general arthritis to rheumatic conditions [4]. Additionally, Prunus cerasus usage has been reported to reduce the risk of gout flares by 35% [5] and Apium graveolens has been reported to block the liver’s uric acid converting enzyme [6].

The other nutrients have also independently been reported to control uric acid levels or block the same enzyme [7-11]. It is also possible that the inclusion of these nutrients provided additional benefits, including the antioxidant effects of vitamin C, and the epigenetic stabilizing effects of folate, although these were not measured directly.

Conclusion

In summary, the outcomes of the reviewed pilot study suggest that the herbal/micronutrient formula can result in a measurable improvement in gout symptoms in middle aged adults.

References

1. Robinson, P.C., W.J. Taylor, and N. Dalbeth, An Observational Study of Gout Prevalence and Quality of Care in a National Australian General Practice Population. J Rheumatol., 2015. 42(9): p. 1702-7. doi: 10.3899/jrheum.150310. Epub 2015 Aug 1.
2. Dalbeth, N., T.R. Merriman, and L.K. Stamp, Gout. Lancet., 2016. 388(10055): p. 2039-2052. doi: 10.1016/S0140-6736(16)00346-9. Epub 2016 Apr 21.
3. Vu, N., et al., Safety, efficacy and tolerability of a combination micronutrient and polyherbal preparation (GoutFighter (TM)) for gout: a single-arm open-label pilot study. J Complement Integr Med., 2020. 18(1): p. 113-121. doi: 10.1515/jcim-2019-0074.
4. Warnock, M., et al., Effectiveness and safety of Devil’s Claw tablets in patients with general rheumatic disorders. Phytother Res, 2007. 21(12): p. 1228-33.
5. Zhang, Y., et al., Cherry consumption and decreased risk of recurrent gout attacks. Arthritis Rheum, 2012. 64(12): p. 4004-11.
6. Akram, M., et al., In vitro xanthine oxidase inhibitory and in vivo hypouricemic activity of herbal coded formulation (Gouticin). Pak J Pharm Sci, 2014. 27(3): p. 541-50.
7. Koff, S.G., et al., Comparison between lemonade and potassium citrate and impact on urine pH and 24-hour urine parameters in patients with kidney stone formation. Urology, 2007. 69(6): p. 1013-6.
8. Zhang, G.N., et al., Property changes of urinary nanocrystallites and urine of uric acid stone formers after taking potassium citrate. Mater Sci Eng C Mater Biol Appl, 2013. 33(7): p. 4039-45.
9. Huang, H.Y., et al., The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum, 2005. 52(6): p. 1843-7.
10. Hwang, S.Y., et al., Folic acid supplementation inhibits NADPH oxidase-mediated superoxide anion production in the kidney. Am J Physiol Renal Physiol, 2011. 300(1): p. F189-98.
11. Verhaar, M.C., et al., 5-methyltetrahydrofolate, the active form of folic acid, restores endothelial function in familial hypercholesterolemia. Circulation, 1998. 97(3): p. 237-41.

from an Expert Author

George Thouas

BSc, MRepSc, PhD – Biomedical Scientist

George has worked as a medical researcher for 17 years in the university sector, at both Monash University health institutes, and The University of Melbourne. He spent 12 of those years in reproductive health and fertility research, in roles such as Clinical Research Associate, Clinical Embryologist, Post-graduate Demonstrator, Lecturer, and later as a Senior Research Fellow and Lab Manager. His doctoral thesis investigated the effects of mitochondrial damage in the oocyte. He also worked on improving the nutrient and growth requirements for in vitro fertilization and embryo development.

George has authored and coauthored more than 50 publications, including 1 book, 5 book chapters, 30 peer-reviewed journal reports and reviews, 6 patents, international scientific conference proceedings and health practitioner journal articles.

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