Synopsis

Source of validity: Traditional
Rating (out of 5): 2

Alkali substances, such as potassium citrate, sodium bicarbonate, or other alkaline agents, have a long tradition of use in the management of gout, particularly before the advent of modern urate-lowering therapies. Historically, physicians believed that alkalinizing the urine could help dissolve uric acid crystals and facilitate their excretion, as uric acid is more soluble in alkaline urine. This approach was especially prevalent in the 19th and early 20th centuries, when the understanding of gout was more limited and effective medications were not yet available.

While there is a rational biochemical basis for urine alkalinization theoretically increasing uric acid solubility, direct scientific evidence supporting the efficacy of alkali therapy as a primary or standalone treatment for gout is limited. Modern clinical guidelines do not recommend alkali therapy as a primary treatment for gout, except in certain cases where uric acid nephrolithiasis (uric acid kidney stones) is present. In such cases, alkalinizing agents may be used adjunctively to prevent stone formation. Overall, the use of alkali for general gout management is largely historical and not supported by strong contemporary scientific evidence.

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