Herbal Medicines May be Effective Alternative for Treating Gout Flare Pain

External use herbal medicines may be a safe and effective alternative strategy to treat the pain and symptoms associated with acute gouty arthritis, according to a study published in Medicine.¹

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The treatment of severe pain during an acute attack is generally focused on the use of anti-inflammatory drugs and pain relief. In Western medicine, nonsteroidal anti-inflammatory drugs, glucocorticoids, and colchicine are the most common treatments. However, long-term use of these options can cause side effects including organ dysfunction, gastrointestinal issues, and rashes.²

“Although there have been reports of herbal medicines for external use in the treatment of gout, a comparative analysis through a systematic literature review of herbal medicines for external use for gout treatment is yet to be performed,” wrote co-lead investigator Ho-Sueb Song, PhD, Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Gachon University, Seongnam, Republic of Korea, and colleagues. “The Korean medicine literature on gout mentions kneading Sophora flavescens powder with alcohol and applying it to the affected area; however, relevant clinical reports are scarce.”

Investigators performed a database search of China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, and Cochrane to assess the safety and efficacy of herbal medicines placed directly on the area of acute gouty arthritis. Ultimately, 27 randomized controlled trials with a total of 1951 patients were included in the analysis. These interventions could be applied alone or in combination with Western medicine and all types of herbal medicines were included. The primary outcomes assessed were the pain score, uric acid level, the total effective rate, and inflammatory factor levels including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). A quality assessment and meta-analysis were also conducted.

Regarding quality assessment, the bias was categorized as low because all clinical data points were obtained using a random assignment method. However, the risk of bias was deemed uncertain due to the outcome assessors, allocation concealment, and selective reporting.

All assessed outcomes revealed the treatment effects were significantly better in the external herbal medicine group compared to the western medicine control group. The total effective rate in the herbal medicine cohort was 92.7%, which was 12.9% higher than controls. Reductions in blood uric acid levels were also higher in the intervention group compared with the control cohort (standardized mean differences [SMD] = −.58, 95% confidence interval [CI] = −.92 to −.23, P = .0010). Regarding inflammatory markers, results of the meta-analysis of CRP (SMD = −1.04, 95% CI = −1.58 to −.50, P = .0002) and ESR (SMD = −.91, 95% CI = −1.33 to −.48, P <.0001) showed patients receiving herbal medicine had better effects than those in the control group.

A total of 10 studies evaluated side effects, of which 4 reported no side effects and the remaining had a much lower incidence of complications in the herbal medicine cohort than the control group.

Investigators noted the current study could be used as a reference for future clinical research on herbal medicines regarding the type of medicine, its use as either monotherapy or in combination with Western medicine, and the duration of treatment. It could also help to determine the optimal clinical treatment strategies for clinicians, researchers, and patients when establishing a combination therapy approach for gout.

However, heterogeneity, the possibility of regional and linguistic bias, an unspecified dosage of medicine, varying treatment periods, and the lack of a control group limited the study.

“The results indicate that herbal medicines for external useis effective in improving uric acid levels, pain, and inflammation in patients with acute gouty arthritis and are relatively free of side effects,” investigators summarized. “This is consistent with reviews showing that existing CAM treatment is effective and relatively safe for reducing uric acid levels, pain, and symptoms in patients with acute gout.”

References

1. ^{Choi SH, Song HS, Hwang J. Herbal medicine for external use in acute gouty arthritis: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2023;102(37):e34936. doi:10.1097/MD.0000000000034936}
2. ^{Smith HS, Bracken D, Smith JM. Gout: current insights and future perspectives. J Pain. 2011;12:1113–29.}