Severe gout pain: a case of Asterias rubens

The symptoms started very suddenly in the afternoon with intense pain in the left big toe joint. Overnight, the entire foot became swollen and the pain became excruciating, driving the patient out of bed. By the next afternoon, the swelling and pain was so severe, he was unable to drive his manual car or put weight on his foot.

The symptoms described included heat and redness, throbbing like a pounding headache in the big toe. He could not bear having his foot covered because of the pain and the heat but when he put out of bed, it got cold. Everything was worse in the afternoon and at night, with twitching in his leg, like a shock. The patient had a history of high uric acid levels and had passed kidney stones on three previous occasions. He described himself as an impatient person, as one who does not tolerate contradiction.

Several remedies were tried: Colchicum, Lycopodium, Ledum and Apis, with no relief.
Two rubrics were used:
-Extremities, Pain, Toes, joints, gouty
-Generalities, Pulsation (due to the intense throbbing pain). 

Asterias rubens, the common starfish, featured amongst the many remedies listed in both these rubrics.

Gout is often brought on by indulging in purine concentrated foods that break down into uric acid, such as shellfish, mackerel, sardines, organ meats or alcohol, although in this case none of these had been consumed recently. Knowing the starfish fed on purine rich shellfish gave a clue that this might be an effective remedy.

Further research from Clarke and Hering revealed further similarities this remedy had to the case.

Clarke: “Asterias rubens has gouty pain in the joint formed by the left big toe, (this appears to be a left sided remedy) redness and heat of the skin at this place, nerve remedy with electric shocks; intense throbbing pain in head (which is how the person referred to the pain in toe), aggravation towards 6pm, night aggravation; impatience, cannot bear contradiction.” This remedy is described by Clarke as “a very important remedy, too seldom used.”

Hering: “Violent pain in left toe; pain in left foot concentrated in ball of great toe, heat of bed renews pain, cannot endure covers.”

Prescription: one dose of Asterias rubens was given in the evening.

Follow-ups: the patient fell asleep and did not wake all night. Next morning, the swelling had reduced to less than half and the redness, heat, and pain were almost gone. Swelling and pain continued to reduce over the next day and no more doses were needed.  

This was the first and only case of gout for the patient. He had not experienced it before nor has he experienced symptoms of gout since. This is over a year ago now.

Photo: Wikimedia Commons
Gout in foot; wagawi; CC-BY 2.0