Medieval ‘bloodletting’ could ease gout pain
COULD the medieval cure of bloodletting be a treatment for gout? A review of studies involving nearly 1,000 people suggests the ancient therapy, largely abandoned in modern medical practice, could in fact be nearly 40 per cent more effective at treating the condition than the painkillers and antiinflammatory drugs currently used.
Gout is estimated to affect more than 2 million people in the UK — with cases rising, due to diet and lifestyle changes. But some researchers now believe bloodletting may ease symptoms, by lowering inflammation and levels of uric acid, a known cause of gout.
Uric acid is produced by the body when it breaks down purines, compounds that occur naturally in the body but are also found in red meat, some seafood and shellfish. High blood levels of uric acid lead urate crystals to form in the joints, causing intense pain and swelling.
Gout, a form of arthritis, typically affects the big toe because it is furthest from the heart — uric acid is more likely to turn into crystals at the extremities where body temperature is coolest.
Gout attacks are usually treated with nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen, or with colchicine.
Bloodletting was used for many ailments at the cutting edge of medicine for thousands of years, both literally and metaphorically.
A vein would be cut and blood drained into a cup, with site and quantity left up to the practitioner. Leeches were used for a less severe form of bloodletting.
It was based on the ‘humoral’ theory, in which the human body consisted of four key humours, or liquids — blood, black bile, yellow bile, and phlegm. Imbalances in these, which could be corrected by bloodletting, were believed to be responsible for many illnesses.
By the late 1800s new technologies had sidelined bloodletting in Western medicine.
BUT now new research by scientists from Sichuan Integrative Medicine Hospital, China, found bloodletting was 37 per cent more effective in treating gout than medicines such as colchicine and NSAIDs — and patients’ pain was also reduced by 13 per cent.
The controversial review, published in the current edition of Complementary Therapies in Clinical Practice examined data from 12 separate studies involving a total of 894 patients.
Blood was taken from the patients using syringes and different types of acupuncture needles — with the amount taken varying.
In some trials less than 10ml of blood was taken, in others more. Bloodletting in these trials was also reported to cause 36 per cent fewer side-effects.
Researchers found it lowered uric acid levels by the same amount as standard medicine, but was more effective at cutting blood levels of an inflammatory compound, C-reactive protein (CRP) — found by previous research to stick to uric acid crystals, triggering the inflammation seen in gout.
‘Bloodletting is both effective and safe in treating gout and can especially ease acute severe pain and reduce CRP inflammatory levels in patients, with a lower risk of evoking adverse reactions,’ the researchers say.
‘Bloodletting was better than Western medicine in ameliorating symptoms of gout.’
However, Professor Philip Conaghan, director of the Leeds University Institute of Rheumatic and Musculoskeletal Medicine, said: ‘This new review summarised previous studies, and many had design flaws.’
Controlling uric acid levels effectively is key, he says, adding that current therapies for treating acute gout are ‘highly effective’ in most patients ‘if used appropriately’.