Archive for category Gout Treatments
New Study: Women with Gout at Much Higher Risk of Heart Attack
Posted by Victor Konshin in Gout Treatments, New Research on February 9th, 2010
A new study released this month shows that women with gout have a much higher risk of having a heart attack (acute myocardial infarction) then previously thought. It’s been long known that women with gout are at higher risk of heart attack then men, however, this new study that looked at the history of over 50,000 people shows that the risk is significantly higher than previously thought. Women with gout are 39% more likely to have a heart attack then women without gout. However, men only showed an 11% increase in this study.
The authors of this study speculate that this is due to men having higher levels of uric acid in their bodies throughout life than women. Women’s uric acid levels tend to stay low only to rise suddenly at menopause. As a result, it is believed that men develop more of a tolerance to the effects of high uric acid. However, the difference may also be due to the fact that women tend to receive a gout diagnosis much later then men and are often treated with different medications and at different doses. This is do to the incorrect belief, held by many primary care physicians, that gout is a “men’s disease”.
Regardless of the reason, women with gout, or even women that have passed menopause and have a family history of gout should take note. Controlling uric acid levels with medication is the best way to reduce the risk.
See also: Gout in Women
FDA Rejects New Gout Drug and Approve an Old One
Posted by Victor Konshin in Gout Treatments, New Research on August 4th, 2009
It was starting to look like 2009 was the year going banner year for new gout drugs. That all came to a holt on Sunday as the FDA rejected the application for Savient Pharmaceuticals, Inc.’s drug, Krystexxa® (also called puricase or pegloticase). This new drug used an enzyme not found in humans that breaks down uric acid in the body. To prevent the body rejecting the foreign enzyme it is “locked up” in a molecular “cage”. This cage allowed uric acid to flow in but blocks the immune system from attacking the enzyme (see, New Gout Drugs – Coming to a Pharmacy Near You).
Interestingly, the FDA did not have any complaints about the drug itself and found that the drug was safe and effective. In fact, the FDA’s advisory board voted 14 to 1 to approve the drug. However, the FDA raised concerns that the drug that was studied was created using a different manufacturing process than the drug that would be released to the public. Due to concerns that this different manufacturing process could change the safety or effectiveness of the drug, the FDA rejected the drug until the manufacturer proves that the different manufacturing method resulted in a drug that was also safe and effective.
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Is Febuxostat (Uloric®) Really Better Than Allopurinol?
Posted by Victor Konshin in Gout Treatments on July 3rd, 2009
UK’s National Institute of Health and Clinical Excellence doesn’t think so. In December it issued guidance that the benefits febuxostat (sold in the US under the brand name Uloric®) have not been clearly demonstrated.
The argument is that the pharmaceutical companies tested febuxostat against a fixed dose of 300mg of allopurinol per day. Even though this is the way most doctors prescribe allopurinol, it is not the best way to use it according the expert “best practices” guidelines. The appropriate way is to adjust the dose of allopurinol until uric acid levels are lowered to below 6mg/dL (333µm/L). Allopurinol can safely be prescribed up to 900mg/day.
Because the pharmaceutical companies did not show that febuxostat was more effective than allopurinol when allopurinol is used this way, and because of the cost and other risks, they concluded that for most people it best to just stick with allopurinol.
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The Most Misused Gout Drug, Colchicine
Posted by Victor Konshin in Gout Treatments on May 19th, 2009
Gout is a disease that medical science obsessed over for, well, since medical science came into being. Only in the last fifty years has gout become a “forgotten” disease. Through this long and amazing history, gout has had a more or less faithful companion: the autumn crocus flower. It’s from the bulb of this flower that colchicine comes.
Some reports say that colchicine has been in use for over 6000 years while other reports say its a much newer drug that has only been in use for 2000 years. Regardless, it is still considered to be a first line drug by many doctors. Unfortunately, those doctors are grossly out-of-date. Not only in using colchicine first, but also in how they use it…
Uric Acid Levels and Gout
Posted by Victor Konshin in Diet, General, Gout Treatments on May 8th, 2009
If you have gout, it is important to get your uric acid levels tested regularly. This is important for a couple of reasons. First, if you are taking medication, or even natural remedies to lower uric acid levels, you want to make sure that they are actually working. You also want to make sure that you are maintaining a healthy uric acid level – too much uric acid and gout can occur (bad) – too little uric acid and neurological issues can occur (rare, but worse).
Second, uric acid levels can fluctuate wildly, from day to day, even hour to hour. A blood test gives you a snapshot of what your uric acid level is at that moment. You could be having a good day and your uric acid level is low. This might make you feel as though you do not need to take so much medication and scale back. Unfortunately, this will likely result in a gout attack.
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Swine Flu and Gout
Posted by Victor Konshin in General, Gout Treatments on April 28th, 2009
I have been sitting in my office this morning with the television on, watching the coverage of the swine flu outbreak. I am always impress at how much panic an infections disease can generate. Personally, if the swine flu does become pandemic, I hope I am one of the first to come down with the disease. Why? With a disease as virulent as the flu, the odds are very good that I will develop the disease eventually and if that happens, I want to get it before the medical system is overloaded and drugs like Tamiflu run out. Beside, I am a healthy 38 year old and the risk of serious complications, let alone death, are small. This way, I would get the best care, medications, will get it over with quickly, and be healthy (and immune to the disease) when the disease hits it’s peak so I can help care for others. So you won’t find me walking around with a mask on – which really doesn’t provide much protection anyway.
What does swine flu have to do with gout?
Not much really, however some medications used to treat gout can suppress the immune system which can make you more susceptible to disease including the flu and can make the flu worse if you should get it. If you are unlucky enough to develop the flu just as you are being treated with corticosteroids or colchicine for a gout attack, it could make it much worse - particularly if you are elderly. Note that NSAIDs and medications to lower uric acid levels do not suppress the immune system.
Of course, if you manage gout properly by lowering uric acid levels, there is no need to ever treat a gout attack because you will not get them.
Update: NYC Assistant Principal in Critical Condition
In New York City an Assistant Principal has come down with the N1H1 flu and is now in critical condition. It has been reported in the media that the only preexisting health condition he had was gout. As a result I have seen a lot of interest in any possible connection between gout and swine flu. It has been reported in the media that this Assistant Principal is suffering from kidney failure. As I have written previously (see,Is Gout Dangerous) that gout is strongly associated with kidney failure. If fact, nearly all people suffering from gout have significant kidney damage at the time of death.
So, did gout combine with swine flu contribute to this man’s kidney failure? That remains to be seen, but I would not be surprised if this turns out to be the case. The flu could have found a comfortable home in the already damaged kidneys. As the disease spreads, we will see if more people suffering from gout develop serious kidney complications.
Update 2: NYC Assistant Principal Passes Away
Unfortunately, NYC Assistant Principal Matthew Wiener passed away Sunday, May 17th. Our sympathies go out to his family.
As for the connection between gout and swine flu… Its unlikely that gout played a role, but it is possible. I hope that the CDC takes a close look to see if there was a connection. If they can find a connection, then I hope that they will at least advise the public of the risk and advise the medical community to treat those that have gout and develop swine flu more aggressively.
The Impact of Gout on Your Quality-of-Life, Finances and Family
Posted by Victor Konshin in General, Gout Treatments on April 27th, 2009
If you have gout, you understand that gout has a definite impact on your quality-of-life during an attack — life sucks. The pain can be unbearable. Researchers have looked at this question more quantitatively though and come up with some interesting findings.
As we know, gout is caused by uric acid crystalizing in our joints, which causes an immune response (if you don’t know this, see, Gout Basics). Even when you are not in the middle of a gout attack, if you have high uric acid levels, crystals are always forming and dissolving and not just in your joints, but all over your body. These crystals are seen as invaders by your immune system which causes it to respond. This causes your immune system to alway be in a heightened state of alert and it causes inflammation in your body which can cause many deadly diseases (see, Is Gout Dangerous). But the problems do not stop there…
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The Truth About Homeopathy
Posted by Victor Konshin in Alternative Medicine, Gout Treatments on April 15th, 2009
I am going to start by saying something that is going to upset a lot of people: homeopathy is a fraud. Homeopathy started about five hundred years ago under the idea that “what makes a man ill also cures him.” This idea struggled until it reached it reached a peak in popularity in the 1800s. However, it was criticized heavily by mainstream scientists and was eventually discredited to the point where there where few followers by the 1920s. However, in the 1970s, sensing a commercial opportunity, homeopathy underwent an worldwide revival. Unfortunately, homeopathy does not work. This is not an opinion by the way, but a statement that is backed up by two things, 1) the scientific research and 2) common sense.
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Gout and the Sleep Apnea Connection
Posted by Burton Abrams in General, Gout Treatments on April 14th, 2009
There is a frequently overlooked factor that can cause an acute increase in the concentration of uric acid in the blood as well as increased likelihood of its precipitation as MSU (monosodium urate or uric acid crystals. See, Gout Basics for background). That factor is the reduction of the concentration of oxygen in the blood, which occurs in an individual suffering from sleep apnea.
Sleep apnea is the repeated cessation of breathing for many seconds at a time during sleep, when the muscles lining the airway relax enough to allow it to close, until the brain jolts them to reopen. The resulting reduction of oxygen in the blood causes the cells in the body to undergo a process of disintegration, which leads to their generation of excess uric acid. Once the uric acid is formed, the process is irreversible, even when breathing restarts. With each apneic period, more and more uric acid is fed into the blood, faster than the kidneys can dispose of it. Furthermore, the increased ratio of carbon dioxide to oxygen in the blood makes the blood more acidic, so that its ability to hold uric acid in solution is reduced and MSU is more likely to precipitate. These processes were described in medical journal literature about twenty years ago, and subsequent literature has confirmed that sleep apnea leads to excess uric acid in the blood and in the urine.
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Secondary Gout
Posted by Victor Konshin in Diet, General, Gout Treatments on April 10th, 2009
For the overwhelming majority of people with gout (90%), gout is a genetic disease. These cases are called primary gout. In this article will talk about the other 10% – what is called secondary gout. There is a very long list of causes of secondary gout. Here I will talk about the most common and the most serious.
Lifestyle
The single most common cause of secondary gout are lifestyle issues. Lifestyle covers a lot of different areas. Unfortunately, one of the most common is obesity. About 60% of Americans are now considered obese and the number is still growing and is the leading reason why the incidence of gout continues to rise. Being overweight causes the body to create more uric acid but also reduces the bodies ability to eliminate uric acid. If you have gout and are overweight, the single best thing you can do for your gout, and for your overall health, is to eat a healthy, well balanced, reduced calorie diet, lose weight and exercise regularly (See “The ‘Skinny’ on Gout Diets”). Of course everyone that is overweight wants to do this but few people are actually successful, myself included.
How to Stop a Gout Attack
Posted by Victor Konshin in Gout Treatments on April 9th, 2009
One of the myths that I wrote about in my Top 10 Gout Myths post is: “Once a gout attacks starts, there is nothing you can do but ride it out”. In this post I will talk about what to do when you feel a gout attack coming on.
Act Fast!
Gout is caused by an immune response to uric acid crystals forming in the joint (see Gout Basics). This immune response starts a spiral that quickly causes massive inflammation and pain. The key to stopping a gout attack is to break the spiral!
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New Gout Drugs – Coming Soon to a Pharmacy Near You
Posted by Victor Konshin in Gout Treatments, New Research on April 7th, 2009
On valentine’s day this year, the FDA gave all of us gout sufferer’s a special valentine’s day gift. They approved the first new gout drug in more than forty years. But the good news doesn’t end there. There are several other new gout drugs that are in development.
Febuxostat
Febuxostat is the generic name for the drug released on Valentine’s day. It will be sold on the market under the brand name Ulroic® and is the first new xanthine oxidase inhibitor to be approved since allopurinol. Xanthine oxidase inhibitors are medications that block the xanthine oxidase enzyme from creating uric acid in the body and thus, lowers uric acid levels. This medication is chemically very different from allopurinol so it is hoped that people that have had allergic reactions to allopurinol will be able to take Uloric without any problems. Though there are many documented cases of people that where allergic to allopurinol that have taken febuxostat without any problems, I would still recommend caution if you have had severe reactions to allopurinol — better safe than sorry. Its best to start this medication at a very low dose and watch for any adverse reactions.
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The ‘Skinny’ on Gout Diets
Posted by Victor Konshin in Diet, Gout Treatments on April 2nd, 2009
Diet is the most common method dragged out as a means of controlling gout but as I have written in previous posts, diet alone can almost never eliminate gout. Research has shown that diet, even tightly controlled diets can reduce uric acid levels by at most 1-2mg/dL (55-110µmols/L). This can ‘cure’ gout only if your uric acid levels are just over the level where gout becomes possible. For example, gout is only possible in people with uric acid levels above 6.8mg/dL (380µmols/L). If your uric acid level is normally 8mg/dL(440µmols/L), then with a very tightly restricted diet, you might be about to pull it off, but if you slip up — you’re in trouble. If your uric acid level is normally 9mg/dL(500µmols/L) then the best you can manage is 7mg/dL(390µmols/L) which would definitely reduce the number of attacks, but can never eliminate them entirely.
What’s more interesting is that the most commonly referred to diet for people with gout is a “low purine diet” but few people, even medical professionals, really understand what this means. Yes, they may pull out some old chart that tells you to stay away from shellfish, beer and asparagus — among others, but you need to know these lists are only just guesses.
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Top 10 Gout Myths
Posted by Victor Konshin in Alternative Medicine, Diet, General, Gout Treatments on April 2nd, 2009
I am always taken aback at the number and persistence of gout myths. Just read a few Internet web pages on gout and gout treatments and it won’t take you long to find contradicting information – even from supposedly reputable sites. These myths are one of the key reasons why the quality of gout care for gout has fallen so much over the past few decades. Bad information keeps getting passed on – over and over. This article will help you understand some of these myths and learn the truth.
Myth #1: Gout is curable. There are tons of websites out there that promise “gout cures” if only you send them some amount of money. The truth is, that for 90% of cases, gout is a genetic condition. This is why gout often runs in families. Genetic conditions cannot be cured, only managed. The other 10 % of cases are called secondary gout. These are usually caused by some underlying medical condition. Some of these conditions can be very serious such as lymphoma or kidney disease. Only a small number of cases are truly ‘curable’. These cases are usually caused by high blood pressure medications called diuretics or extreme obesity. If you have gout, your doctor should check for a secondary cause of gout, if none is found, then you have a genetic condition that can only be managed.
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