Featured Case

TITLE OF CASE

Successful Ayurvedic management of hyperuricemia- a case report

Dr Partap Chauhan

ABSTRACT

A 56 year old female patient, presented with stiffness and pain in the joints of the elbow, wrist and bilateral knees since 1 and half months associated with continuous low grade fever. There was no prior consultation or treatment. She opted for Ayurvedic treatment and approached Dr Partap Chauhan. Based on the clinical evaluation and the blood reports, the condition was diagnosed as Hyperuricemia and the Ayurvedic diagnosis as Vatarakta. The line of treatment followed was Tridosa shamana, specifically vata shamana. Sroto and rakta shodhana, vedana shamana and dipana- pacana were also included in the cikitsa. After 5 months of treatment, the patient had significant relief in the stiffness and pain in multiple joints and recovered from the constant low-grade fever. Serum uric acid level documented as 9.65 at baseline reduced to 4.72 at endpoint. With Ayurvedic treatments over a year, the patient was completely relieved from all the symptoms. This case report demonstrates the successful standalone ayurvedic management of Hyperuricemia in a patient who opted for Ayurvedic management as the first line of consultation. 

KEYWORDS

Hyperuricemia, vatarakta, uric acid, joint pain, ayurveda, case report

INTRODUCTION

Hyperuricemia occurs when there’s too much uric acid in your blood. Only about a third of people experience symptoms. If uric acid levels remain high, over time they can lead to several diseases, such as gout or kidney stones. High uric acid levels can lead to several diseases, including a painful type of arthritis called gout. Elevated uric acid levels are also associated with health conditions such as heart disease, diabetes, and kidney disease.

Causes: Uric acid is formed when purines break down in your body. Purines are chemicals found in certain foods. This typically includes:

• red meat
• organ meat
• seafood
• beans

Normally, your body rids itself of uric acid when you urinate. Hyperuricemia occurs when your body either makes too much uric acid or is unable to excrete enough of it. It usually happens because your kidneys aren’t eliminating it quickly enough.

Excess uric acid levels in your blood can lead to the formation of crystals. Although these can form anywhere in the body, they tend to form in and around your joints and in your kidneys. Your body’s defensive white blood cells may attack the crystals, causing inflammation and pain.

Only about one-third of people with hyperuricemia experience symptoms. This is known as asymptomatic hyperuricemia.

Although hyperuricemia isn’t a disease, if uric acid levels remain high, over time they can lead to several diseases like gout, Tophaceous gout, Kidney stones. 

Diagnosis: Medical history and clinical evaluation are the primary diagnostic tools. Blood test and urine test are the laboratory investigations that is used in confirming the diagnosis. Uric acid is normally found in your urine as your body excretes it. A 24-hour urine collection if elevated levels of uric acid are found in your blood. This urine test is then repeated after a purine-restricted diet, which helps in determining whether: 

you’re eating too much high-purine foods: 

your body is making too much uric acid;

your body isn’t excreting enough uric acid.

Treatment & prognosis: The treatment for hyperuricemia will depend on its cause. If hyperuricemia is asymptomatic, treatment isn’t recommended. If hyperuricemia is caused by an underlying cause, then the cause is addressed. This as such, is not life threatening, but this leads to other conditions, over time that can cause serious health issues. These definitely require medical intervention and can become life threatening. 

PATIENT INFORMATION

In this case report, In this case report, a 56 year old female patient, presented with stiffness and pain in the joints of the elbow, wrist and bilateral knees since 1 and half months associated with continuous low grade fever. There was no prior consultation or treatment. She opted for Ayurvedic treatment and approached Dr Partap Chauhan. Based on the clinical evaluation and the blood reports, the condition was diagnosed as Hyperuricemia and the Ayurvedic diagnosis as Vatarakta.

No relevant Family/genetic history.

Surgical History- Hysterectomy done. 

Psychosocial History- Patient is stressed and the sleep is disturbed.

Addictions- Nil

CLINICAL FINDINGS

General examination.

Vitals- Normal
BP- 150/110 mmHg 

TIMELINE

Image 1. Timeline of events added below

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter; The biomedical diagnosis was confirmed based on the clinical evaluation and the lab investigation done at baseline.

Image 2. Lab report at baseline dated 13.12.2022

Ayurvedic Assessment was done based on the presenting complaints and clinical evaluation. The treating physician confirmed the Ayurvedic diagnosis as Vatarakta. 

Differential Diagnosis- 

Alcoholic ketoacidosis, 

Diabetic ketoacidosis, 

Gout and pseudogout, 

Hemolytic anemia.
Based on the blood investigation, and the clinical evaluation, the biomedical diagnosis was diagnosed as Hyperuricemia.

Prognosis: Increased levels of uric acid predispose for gout and, if very high, can cause kidney failure. Prognosis is good with regular consumption of allopurinol or febuxostat. In this case report, with 1-month of Ayurvedic treatment, the patient could get relief from all the symptoms. The repeated blood investigation reveals uric acid level within normal limits.

THERAPEUTIC INTERVENTION

Refer the tab ‘Treatment’ in the Portal. 

FOLLOW-UP AND OUTCOMES

The patient had 3 follow ups in total, over a period of 1 year. The subjective and objective parameters were the primary assessment modality. 

Clinician-based assessment; 

After 5 months of treatment, the patient had significant relief in the multiple joint stiffness and pain and recovered from the persistent low-grade fever. Serum uric acid level has reduced to 6.38. With ongoing treatments for 1 year, the patient was completely relieved from all the symptoms and the uric acid level reached within the normal limits. 

Table 1. The symptoms observed and tabulated throughout the treatment

 

Chief complaints	Nov 22	Jan 23	Feb 23	Mar 23	May 23	Nov 23
Stiffness	Severe	Mild relief	Moderate relief	Significant relief	Significant relief	Absent
Pain in elbows and wrists	Severe	Mild relief	Moderate relief	Significant relief	Absent	Absent
Knee pain	Severe	Mild relief	Moderate relief	Significant relief	Significant relief	Absent
Fever	Moderate	Moderate relief	Nil	Nil	Absent	Absent

Patient-assessed; Not relevant

Objective parameters: Uric acid was constantly monitored during and after treatment to assess the outcome of the treatment. 

Image 1. Uric acid value during treatment dated 12.5.2023

Image 2. Uric acid value after treatment dated 15.11.2023

The uric acid value at baseline was 9.65. During treatment, it became 6.38 and after treatment, it was recorded 4.72.

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

Method of assessment- Lab investigations, images, questionnaire and symptom evaluation were the primary assessment criteria. 

Adverse and unanticipated events; None reported

DISCUSSION: 

Increased levels predispose for gout and, if very high, kidney failure. Prognosis is good with regular consumption of allopurinol or febuxostat. In this case, with 1-month of Ayurvedic treatment, the patient could get relief from all the symptoms. The repeated blood investigation reveals uric acid level within normal limits. In this case report, the patient’s first choice of treatment was Ayurveda. The line of treatment followed was Tridosa shamana specifically vata. Sroto and rakta shodhana, vedana shamana, dipana and pacana were also included in the chikitsa sutra. 

PATIENT’S PERSPECTIVE

Not available. 

LEARNING POINTS/TAKE HOME MESSAGES 

This case underscores the significant clinical efficacy of Ayurveda as a supportive therapy in  hyperuricemia, with a very simple formulation for a short span of time. Ayurveda can be considered as an alternative in patients who are not getting satisfactory outcomes inspite of taking allopathic medicines.

INFORMED CONSENT

Written consent obtained from patient for publishing of the case report in the Portal 

ACKNOWLEDGEMENTS

None

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE 

1. https://www.healthline.com/health/hyperuricemia
2. AH. Ni.16 and AH.Ci.22