Posts Tagged gout medications
Questions Being Raised About the Importance of Diet on Gout
Posted by Victor Konshin in Diet on August 27th, 2009
An article that will appear in the September Issue of the Journal of the American Dietetic Association calls into question the long held belief that those with gout need to maintain a “purine-restricted” diet. This article points out that some foods, such as some vegetables are very high in purines, yet research has consistently shown that consumption of these vegetables is strongly correlated with a reduction in uric acid levels and in gout attacks. Research has also shown that beer is strongly correlated with higher instances of gout even though modern beers often have very low levels of purines.
Although diet has long been assumed to be associated with hyperuricemia, this association remains to be verified. Studies that have reviewed the relationship of diet and hyperuricemia have found it to be a difficult and complex issue.
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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New Research: Allopurinol Can Help You Live Longer
Posted by Victor Konshin in New Research on June 29th, 2009
New research published in the medical journal, Rheumatology, has shown that lowering uric acid levels using the medication allopurinol can result in a significant decrease in the risk of death.
Recent research has shown that high levels of uric acid have been strongly associated with diseases such as heart disease, high blood pressure, kidney disease, liver disease, diabetes, stroke and obesity. However, little is known about the effects of lowering uric acid levels on the risk of these diseases and even less is known about whether or not lowering uric acid levels can actually extend life. This is one of the first research studies that has shown a strong correlation between lowering uric acid levels and living a longer life.
This study, that followed almost 10,000 people, showed an average reduction in uric acid levels of 1.86mg/dL (111µmol/L). This resulted in an overall reduction in the risk of death by about 22%.
Unfortunately, we do not yet understand the mechanisms by which uric acid causes disease. The current theory is that uric acid, when it reaches high levels, is constantly forming crystals in all parts of the body, not just the joints as in gout. These crystals are spotted by the immune system and spark an immune response that increases inflammation. This inflammation has been identified as a leading cause of some of the most deadly diseases mentioned above.
Hopefully, researchers will soon find proof as to exactly how uric acid causes disease. This information will is the next step in finding the best means of dealing with high uric acid levels.
In the meantime, this new research shows us that fighting gout by lowering uric acid levels is not only the best way of stopping gout attacks, but may also be helping us live a longer and healthier life.
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.
Kidney Stones, a Gout Early Warning?
Posted by Victor Konshin in General, New Research on April 22nd, 2009
The “German Professional Association of Internists” released a statement on Monday saying that kidney stones may be an early warning sign for gout. The statement claimed that as many as 40% developed kidney stones as a first indication of gout.
This makes sense. It had been known for a long time that high levels of uric acid in the body can cause increased levels of uric acid excreted by the kidneys. This excess uric acid can form uric acid kidney stones. Not only that, but uric acid crystals can serve as a catalyst for the formation of kidney stones based on other substances such as calcium.
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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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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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