Posts Tagged liver disease
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.
Gout: The Forgotten Disease
Posted by Victor Konshin in General on June 2nd, 2009
I think what’s most amazing about medical science is how small it’s focus has become. I’m not talking about the scale of medical science, or the focus on making people healthy, but on the scale at which it is studying the complex mechanisms of the human body.
Over the past few hundred years medical science has gone from looking at the structure of the body, to its organs, down to the cells that make up those organs and now down to the most tiny and intricate molecular machines that make everything actually work. Molecules so small and sophisticated that ever the most advanced microscopes in the world can only view them dimly and we are only just beginning to grasp how they actually function.
However, this all seems to be changing. This focus on the very small has obscured a larger reality – that the human body is a large, unimaginably complex and integrated machine – a single machine. If something is broken in one part of that machine, the function of the whole suffers.
I think that more and more researchers are starting to get their heads out of their microscopes and starting to look at what happens to the whole machine when those microscopic machines misbehave. And I think this will be the next great step forward for medical science.
Why is Gout so Often Mismanaged
Posted by Victor Konshin in General on April 13th, 2009
I often quote the statistic that 78% of doctors do not properly manage gout. This statistic is true (based on the research study that reported it) but the big question is, why? This article with take a look at this question.
First off, let me start by saying that I am not someone that bashes doctors and the medical community or says things like, “all doctors are arrogant, lazy, over-paid idiots.” Though, as with any profession, there will always be some that fit this description, most doctors are caring, compassionate, highly competent people that do a fantastic job. The problem however, is that the medical profession is the victim of technology, its own success and its failures…
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Is Gout Dangerous?
Posted by Victor Konshin in General on April 6th, 2009
The overwhelming belief by most doctors is that gout is a relatively benign disease – that is, it may cause a lot of pain but really doesn’t cause too many problems otherwise. Unfortunately this belief is wrong. Gout is dangerous in a couple different ways. First is the damage that gout attacks directly cause. Second is the underlying cause of gout, a condition called hyperuricemia is associated with many very serious and life-threatening diseases.
The Damage of Gout Attacks
As described in one of my previous post, Gout Basics, gout is cause by an immune response to uric acid crystals that form in the joints. This immune response causes much inflammation, which is the actual source of the pain of a gout attack. This inflammation also damages the joint slightly. If gout is not properly managed, over the course of years and many gout attacks, this damage can accumulate and cause constant pain in the joint, limiting of the mobility of the joint (the joint will become stiff and painful to move), it will cause boney changes in the joints called punch-out lesions (where the bone grows in abnormal ways) and ultimately, it will cause the gout to become completely immobilized.
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