Published online: 30.06.

2019

Case Report 105

Case Report on Hyperuricemia Presenting as

One-Sided Disease
Renu Bala1 Amit Srivastava2

1 Regional Research Institute for Homoeopathy, Ground Floor, Old
Building, NEIARI, Ayurvedic Campus, Barsojai, Bhetapara, Guwahati,
Assam, India
2 Regional Research Institute for Homoeopathy, New Checkon,
Opposite Tribal Colony, Imphal, Manipur, India
Address for correspondence Dr. Renu Bala, MD (Hom), Research
Officer (H)/Scientist 1, Regional Research Institute for Homoeopathy,
Ground Floor, Old Building, NEIARI, Ayurvedic Campus, Barsojai,
Bhetapara, Guwahati 781028, Assam, India
(e-mail: drrenu3011@gmail.com).

Homœopathic Links 2019;32(2):105–111.

Abstract Hyperuricemia is very common, and a prevalence of up to 15 to 20% has been reported
in population-based studies. Although hyperuricemia is not a disease, if uric acid levels
remain high, over time they can lead to several diseases. Hyperuricemia is the central
risk factor for gout and is a key component of the metabolic syndrome. The case

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illustrated here is of hyperuricemia with only symptom of pain in the joints, large as well
as small, mainly the shoulder joints, knee joints, ankle joints and interphalangeal joints
for 2 years without any associated complaint. The case is a one-sided disease, that is,
Keywords disease in which symptoms are very few, which got cleared up with antisycotic drugs.
► hyperuricemia Thuja and Medorrhinum prescribed in the beginning of the case on the guidelines for
► joint pain one-sided diseases mentioned in Organon of Medicine and later responded very well to
► one-sided disease Bryonia alba in higher potencies to lower the level of serum uric acid significantly along
► homoeopathy with long-lasting improvement in signs and symptoms of the patient.

Introduction
Hyperuricemia is recognised as one of the main risk factors
for gout, and studies have shown that the higher the serum
uric acid (sUA), the greater the risk of gout.1,2 Gout is caused
by elevated levels of uric acid in the blood (hyperuricemia),
with persistence of hyperuricemia at levels higher than a
serum saturation of 6.8 mg/dL leading to deposit of urates on
articular cartilage. However, only a minority of individuals
with elevated sUA levels ever develop gout, emphasising the
importance of other factors in determining crystal forma-
tion.3 Serum urate level should be lowered sufficiently to
achieve long-lasting improvement in signs and symptoms of
gout, with the target < 6 mg/dL at a minimum and often
< 5 mg/dL.4
urine. Both conditions are often associated with chronic
diseases such as hypertension, diabetes mellitus, metabolic
syndrome and renal and cardiovascular diseases.5
Diagnosis
Hyperuricemia is defined as  7 mg/dL for men and
 6.0 mg/dL for women and is found mainly in postmeno-
pausal women, African American and in patients with renal
disease and alcohol intake.6
In the light of the new scientific knowledge on the patho-
physiologic role of uric acid in human disease, a threshold
value < 6.0 mg/dL (< 360 µmol/L) seems to better identify
true ‘healthy patients’ and should reasonably be considered for
all patients.7

Pathophysiology Treatment in Modern Medicine

Hyperuricemia and gout are pathologic conditions charac- The long-term management of hyperuricemia is divided in
terised by overproduction or underexcretion of uric acid, a two main classes: uricostatic drugs (e.g., allopurinol), which
product of purine catabolism physiologically excreted in the reduce uric acid production, and uricosuric drugs (e.g.,

© 2019 Thieme Medical and Scientific DOI https://doi.org/

Publishers Private Ltd. 10.1055/s-0039-1693014.
ISSN 1019-2050.
106 Hyperuricemia Presenting as One-Sided Disease Bala, Srivastava
sulfinpyrazone, probenecid and benzbromarone), which
increase urinary uric acid excretion.8
Therapeutic strategies used to treat hyperuricemia are
often focused on limiting acute episodes which are counter-
acted using nonsteroidal anti-inflammatory drugs (NSAIDs),
colchicine or glucocorticoids which act through different
mechanisms.9
Homoeopathy in Hyperuricemia
Relevant publications concerning treatment of hyperurice-
mia by homoeopathy was searched in the electronic data-
bases such as PubMed,10 Core-Hom database11 and AYUSH
Research Portal.12 The keywords used for the search were
‘Homoeopathy’, ‘Treatment’ and ‘Hyperuricemia’. No rigid
inclusion criteria were adopted, but unfortunately no such
publications were found in the electronic databases.
Case History
Patient Information
A 50-year-old female patient attended the outpatient depart-
ment (OPD) on 16.11.2016 with complaint of pain in the
joints for 2 years.
Clinical Features
The patient presented with complaint of joint pain for 2 years
which got aggravated at night and during rainy weather.
There was symmetrical involvement of both large and small
joints, mainly the shoulder joints, knee joints, ankle joints
and interphalangeal joints. There was no associated com-
plaint. The patient did not present with any significant
mental and physical generals symptoms.
History of Present Complaint
Previously the patient was on allopathic medication for
1 year with no significant improvement and has discontin-
ued it for last 3 months. She was on allopathic treatment for
prolonged period, so the correct picture of the case was
difficult to ascertain. There was only one symptom present
related to joint pain. Earlier there were blood investigations
done for haemoglobin percent (Hb%), total leucocyte count
(TLC), differential leucocyte count (DLC) and erythrocyte
sedimentation rate (ESR) which revealed normal results
except ESR which was raised (32%).
Past History
Past history was uneventful.
Family History
The patient could not recollect any disease that prevailed in
her family sphere.
Personal History
The patient is illiterate, belongs to lower socioeconomic class
and is Hindu by faith. She does household works at many
houses for her living. On enquiry into her living condition, it
came to the notice that much of her daily routine involves
working in water for long hours.
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Clinical Findings
Physical examination: Pulse rate (PR) 76 beats/min, respiratory
rate (RR) 14 breaths/min, blood pressure (BP) 126/80 mm Hg.
Built: The patient is of short stature and medium built.
Musculoskeletal examination: Examination of the
involved joints revealed following findings:
Inspection: No pigmentation, discoloration, deformity
or scar seen over the affected joints.
Palpation: Moderate swelling was present on lateral
aspect of both the ankle joints. No tenderness, cyst
or crystal deposition was palpable over the joints
involved.
Limitation of movement: Stiffness was of marked degree
in the interphalangeal joints of both the hands. Flexion
and abduction was restricted and painful in both the
shoulder joints. Flexion was painful and restricted in
right knee joint.
Timeline
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The timeline of event is described in ►Fig. 1.
Diagnostic Assessment
The patient was advised for complete blood count, sUA,
rheumatoid (RA) factor and X-ray of both the shoulder and
knee joints (AP and lateral view).
The patient expressed her financial constraint to undergo
the recommended investigations which might prove to be a
diagnostic challenge.
This case is probably of hyperuricemia as per the case
history and clinical findings. Despite being the most impor-
tant risk factor for gout, sUA levels do not confirm or exclude
gout as many patients with hyperuricemia do not develop
gout and in many patients sUA may be normal during acute
attacks.13 Early stages of gout or hyperuricemia usually affect
only one joint. However, this disease also should be con-
sidered in patients with acute polyarticular arthritis, parti-
cularly older women.14
The previous allopathic treatment was also on the line of
increased uric acid as detailed by the patient. Therefore,
pathologic investigation of sUA and RA factor was strongly
recommended to the patient.
Analysis of the Case
With scarcity of symptoms pertaining to generals, only one
particular symptom related to the joints was present which
was pain aggravated at night and during rainy weather. ‘One-
sided disease’ in homoeopathy as per Aphorism 173 of
Organon of Medicine15 by Hahnemann refers to the diseases
that seem to have few symptoms and are less amenable to
cure because they display only one or two principal symp-
toms which obscure almost all the others.
This case was referred to as ‘one-sided disease’ as it
presented with only pain in the joints, though multiple joints
were involved and other symptoms (mental or physical
generals) were obscured. One-sided diseases are of chronic
in nature, and mostly psoric miasm is considered to be in the
background,16 but in this case sycotic miasm seems to be
predominant.
 Hyperuricemia Presenting as One-Sided Disease
Fig. 1 Timeline of events.
Therapeutic Intervention
The patient was advised to avoid overexertion of involved
joints. Hot fomentation and physiotherapy was advised
routinely.
First Prescription (16.11.2016)
Keeping in view the occupation and daily routine of the
patient which pointed out affinity towards water molecule
and consequently aggravating her joint pain, Thuja occiden-
talis 200C/2 doses were prescribed to be taken on empty
stomach early in the morning for 2 days, followed by placebo
for 15 days.
Follow-ups
Follow-up 1 (30.11.2016)
The patient presented with advised pathologic reports of
blood revealing increased uric acid (7.2 mg/dL) and RA factor
to be negative, so a diagnosis of hyperuricemia was con-
firmed. There was no change in complaint of joint pain. The
patient did not report any new symptoms either. She also
seemed to be uncooperative and did not want to describe
anything. Physical examination of the joints showed no
change (►Fig. 2).
As a complementary to Thuja, Medorrhinum 200C/2 doses
were prescribed, to be taken in morning on empty stomach
for 2 days, followed by placebo for 15 days.
Follow-up 2 (02.01.2017)
There was slight improvement in joint pain but movement of
affected joints restricted as before. No new symptom was
observed. Swelling in ankle joints was mildly reduced.
Bala, Srivastava 107
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Medorrhinum 200C/1dose was prescribed, to be taken in
morning on empty stomach followed by placebo for 15 days.
Follow-up 3 (25.01.2017)
There was improvement in joint pain. The patient seemed to
be more cooperative and descriptive and presented with
prominent physical and mental generals. She gave history of
grief due to accidental death of her 23-year-old son which
she has not revealed in earlier appointments. She described
desire for cold water, thirst for large amount of cold water.
She has aggravation of all complaints when she becomes
heated either due to heat of sun or after exertion. She feels
better on exposure to cold things or cold weather. She does
not feel well after eating flatulent food. There was difficulty
in evacuation as the stool was hard and large. Main complaint
of pain in the joints gets aggravated while walking or with
movement.
Repertorisation
As the case gets clearer and manifested by few symptoms
pertaining to generals, repertorisation was done with Kent
Repertory using Hompath Classic17 software (version 8.0)
(►Fig. 3).
Thermal reaction: Hot.
Selection of remedy: Bryonia alba 200C/4 doses, to be
taken on empty stomach once daily for 4 days, followed by
placebo for next 7 days.
Follow-up 4 (08.02.2017)
There was marked improvement in pain in joints with an
intermittent period of complete relief for 2 to 3 days. Stiffness
in the interphalangeal joints of both the hands was little
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108 Hyperuricemia Presenting as One-Sided Disease Bala, Srivastava
Fig. 2 First laboratory investigation on 30.11.2016.
better. Swelling in both the ankle joints slightly reduced.
Movement of the knee and shoulder joint restricted as
before.
Modalities of the case remained the same—aggravation by
motion, exertion and amelioration by rest. Stool still
remained to be hard. sUA was 5.63 mg/dL (►Fig. 4).
Bryonia alba 1M/3 doses were prescribed, to be taken once
daily morning on empty stomach for 3 days followed, by
placebo for 7 days.
Follow-up 5 (17.02.2017)
Pain in the joints continued to getting improved. Stool was
also better than before. In general, the patient was feeling
much better than before.
Swelling in the ankle joints was reduced. Stiffness in the
interphalangeal joints was same as before. Movement of the
knee and shoulder joint was restricted as before.
Bryonia alba 1M/4 doses were prescribed, to be taken at an
interval of 1 week, in the morning on empty stomach.
Placebo was to be taken for 1 month in the intervening
days during which no medicine was advised.
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Follow-up 6 (22.03.2017)
The patient reported marked improvement in pain in the
joints. Pain decreased both in intensity and in recurrence.
Stool was now passed regularly and was soft and clear. Swelling
in ankle joints reduced significantly. Stiffness in the interpha-
langeal joints also improved markedly. Movement of the knee
and shoulder joint was less restricted than earlier.
Bryonia alba 10M/3 doses were prescribed, to be taken at
an interval of 10 days in the morning on empty stomach.
Placebo was to be taken for 1 month in the intervening days
during which no medicine was advised.
Follow-up 7 (19.04.2017)
The patient again complained of pain in the joints which got
aggravated by warmth or heat and relieved by cold application.
Along with this symptom, she experienced a burning sensation
in the soles. Stool was clear and soft. Swelling of the ankle joints
resolved completely but recurred on standing for long intervals.
Sulphur 200C/2 doses were prescribed as an intercurrent
remedy, to be taken on empty stomach in the morning for 2 days
followed by placebo for 7 days. sUA was 4.57 mg/dL (►Fig. 5).
 Hyperuricemia Presenting as One-Sided Disease Bala, Srivastava 109

Fig. 3 Repertorisation sheet.

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Fig. 4 Follow-up laboratory investigation report on 08.02.2017.

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110 Hyperuricemia Presenting as One-Sided Disease Bala, Srivastava
Fig. 5 Follow-up laboratory investigation report on 19.04.2017.
Follow-up 8 (26.04.2017)
Pain in the joints again persisted with impairment of daily
activities. There was aggravation by warmth or heat and
better by cold application. Swelling in ankles returned again.
Ledum palustre 200C/2 doses were prescribed, to be taken
on empty stomach in the morning for 2 days, followed by
placebo for 15 days.
Follow-up 9 (17.05.2017)
Pain in the joints improved now. Stiffness in the interphalan-
geal joints reduced moderately. Swelling in the ankle joints was
not present. Flexion in the right knee joint was less restricted.
Flexion and abduction in both the shoulder joints improved.
Ledum palustre 200C/4 doses were prescribed, to be taken
at an interval of 1 week, in the morning on empty stomach,
followed by placebo for 30 days.
Follow-up 10 (15.06.2017)
Pain was better than before but more in the left knee joint.
There was aggravation on motion and amelioration by rest.
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Evacuations were not regular, passed at 1 to 2 days interval,
and stool was again hard. The patient reported herself to be
much better in general than the previous year. Stiffness in the
interphalangeal joints reduced significantly. Swelling in the
ankle joints was completely resolved. Range of movement in
the knee and shoulder joints has improved since her last visit.
Bryonia alba 10M/4 doses were prescribed, one dose after
every 10 days, in the morning on empty stomach. Placebo
was to be taken for 1 month in the intervening days during
which no medicine was advised.
The patient was advised for repeat pathologic laboratory
investigation for sUA.
Follow-up 11 (20.07.2017)
There was marked improvement in general condition of the
patient along with her main complaint. Joint pain has
reduced to a great extent. Stiffness in the interphalangeal
joints completely resolved, and now the patient can perform
her daily activities without any discomfort. There was sig-
nificant improvement in range of movement in the knee and
 Hyperuricemia Presenting as One-Sided Disease
shoulder joints. The only joint affected now was the ankle
joint of both the legs with very mild discomfort intermit-
tently when weather became too hot. Stool was again clear
and passed regularly.
The patient was not willing to undergo repeat investiga-
tion for sUA as she was devoid of all her complaints. Placebo
for 30 days was prescribed.
Discussion
Homeopathy never works when prescribed by the name of
the disease. Homeopathic prescription comprises the indi-
vidualised symptom totality of the patient presenting with
certain disease condition.
Homoeopathy treats the person as a whole. Homeopathy
in the treatment of chronic disease is best appreciated by
the understanding of its approach. Chronic diseases need
constitutional treatment, but it is not easy as the patient’s
mental makeup and physical makeup are to be considered.
Hereditary tendencies and personal history of the patient are
also kept in mind for constitutional prescribing. But in this case,
the patient presented with very few symptoms on her first visit
which posted a challenge to the attending physician. Mental
and physical general symptoms were not found on first visit.
The symptom of joint pain and circumstances of the
patient working for long hours in water aggravating the
complaint pointed out towards hydrogenoid constitution.
Also, hydrogenoid constitution corresponds closely with
Hahnemann’s sycosis, and Burnett regarded gout as belong-
ing to sycotic diseases. As Thuja is one of Gravougl’s principal
remedies for the hydrogenoid cases and is an antisycotic
remedy, the patient was prescribed Thuja. The patient did not
report any change with the first prescription. To complement
the action of Thuja, Medorrhinum was prescribed. The reme-
dies were, without doubt, only partially suitable due to lack
of considerable number of symptoms present initially. But in
subsequent appointments, it was seen that partially suitable
remedies produced certain array of symptoms (mental and
physical generals). Now the new symptoms which were
induced to appear by the remedies given were taken into
consideration and the case was repertorised with Kent
repertory using Hompath Classic software which led to a
more suitable homeopathic remedy for the case, that is,
Bryonia alba. After every prescription ceased to have a
beneficial effect, a new homeopathic remedy was selected
in accordance with the prevailing state of the patient.
Bryonia was prescribed in ascending potencies with inter-
mittent doses of Sulphur and Ledum pal on the basis of
symptom totality. It was also observed that the higher the
potency of the remedy, the more relieved was the patient.
This case has shown the efficacy of high potencies in improv-
ing the pain as well as in reducing the limitation of move-
ment and stiffness of the involved joints. Homeopathic
Bala, Srivastava 111
intervention in this case has lowered the sUA remarkably,
thereby improving the quality of life of the patient.
The outcome of primary interest was significant reduc-
tion in the sUA level achieved by following the path shown by
Master Hahnemann in Organon of Medicine. The three
general goals of homeopathic intervention in the manage-
ment of hyperuricemia in this case were to terminate the
acute painful attack, prevent recurrences and prevent the
complications of urate deposition in the joints, kidneys or
other involved sites.
Conflict of Interest
None.
References
1 Doherty M. New insights into the epidemiology of gout. Rheu-
matology (Oxford) 2009;48(Suppl 2):ii2–ii8
2 Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperurice-
mia. Risks and consequences in the Normative Aging Study. Am J
Downloaded by: University of Connecticut. Copyrighted material.
Med 1987;82(03):421–426
3 Conway N, Schwartz S. Diagnosis and management of acute gout.
Med Health R I 2009;92(11):356–358
4 Khanna D, Fitzgerald JD, Khanna PP, et al; American College of
Rheumatology. 2012 American College of Rheumatology guidelines
for management of gout. Part 1: systematic nonpharmacologic and
pharmacologic therapeutic approaches to hyperuricemia. Arthritis
Care Res (Hoboken) 2012;64(10):1431–1446
5 Gliozzi M, Malara N, Muscoli S, Mollace V. The treatment of
hyperuricemia. Int J Cardiol 2016;213:23–27
6 de Oliveira EP, Burini RC. High plasma uric acid concentration:
causes and consequences. Diabetol Metab Syndr 2012;4:12
7 Desideri G, Castaldo G, Lombardi A, et al. Is it time to revise the
normal range of serum uric acid levels? Eur Rev Med Pharmacol
Sci 2014;18(09):1295–1306
8 Suresh E, Das P. Recent advances in management of gout. QJM
2012;105(05):407–417
9 Cronstein BN, Sunkureddi P. Mechanistic aspects of inflammation
and clinical management of inflammation in acute gouty arthri-
tis. J Clin Rheumatol 2013;19(01):19–29
10 PubMed [Internet]. US: US National Library of Medicine; 1996
[cited January 15, 2019]. https://www.ncbi.nlm.nih.gov/pubmed/
11 CORE-Hom database [Internet]. Germany: CARSTENS-STIFTUNG
Homeopathy Research Institute [cited January 15, 2019]. http://
archiv.carstens-stiftung.de/suche
12 AYUSH RESEARCH PORTAL [Internet]. India: Ministry of AYUSH, Govt.
Of India; 2011 [cited January 15, 2019]. http://ayushportal.nic.in/
13 Hamburger M, Baraf HS, Adamson TC III, et al. 2011 recommenda-
tions for the diagnosis and management of gout and hyperur-
icemia. Phys Sportsmed 2011;39(04):98–123
14 Mies R A, Francis ML. Diagnostic approach to polyarticular joint
pain. Am Fam Physician 2003;68(06):1151–1160
15 Hahnemann S. Organon of Medicine. Reprint ed. Translated from 6th
edition by William Boericke. New Delhi, India: B. Jain Publishers;
1996:227
16 Hahnemann S. Organon of Medicine. Reprint ed. Translated from
6th edition by William Boericke. New Delhi, India: B. Jain Publish-
ers; 1996:248
17 Shah J. Hompath Classic—Homeopathic Software. Version 8.0
Premium. Mumbai, India 2005
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