Reports From National Arthritis Meeting
Dr. Shiel
Gives Perspectives Of Interest On Gout From
2003 Annual Scientific Meeting Of The American College Of Rheumatology
Introduction
GOUT
Gout is a
medical condition that is characterized by abnormally elevated levels of uric
acid in the blood, recurring attacks of joint inflammation (arthritis), deposits
of hard lumps of uric acid in and around the joints, decreased kidney function
and kidney stones.
Gout has the
unique distinction of being one of the most frequently recorded medical
illnesses throughout history. It is often related to an inherited abnormality in
the body's ability to process uric acid. Uric acid is a breakdown product of
purines, which are part of many foods we eat. An abnormality in handling uric
acid can cause attacks of painful arthritis (gout attack), kidney stones, and
blockage of the kidney tubules with uric acid crystals, leading to kidney
failure. On the other hand, some patients may only develop elevated blood
uric acid levels (hyperuricemia) without having arthritis or kidney problems.
The term "gout" is commonly used to refer to the painful arthritis
attacks.
Gouty arthritis
is usually an extremely painful attack with a rapid onset of joint inflammation.
The joint inflammation is precipitated (brought on) by deposits of uric acid
crystals in the joint fluid (synovial fluid) and joint lining (synovial lining).
Intense joint inflammation occurs as white blood cells engulf the uric acid
crystals and release chemicals of inflammation , thereby causing pain, heat, and
redness of the joint tissues.
Diet
Research
From Massachusetts General Hospital in Boston, researchers
reported important dietary information for patients with gout. Here are
important highlights: Meat or seafood consumption increases the risk of gout
attacks, while dairy consumption seemed to reduce the risk! Protein intake or
purine-rich vegetable consumption was not associated with an increased risk of
gout. Total alcohol intake was strongly associated with an increased risk of
gout (beer and liquor were particularly
strong factors).
Dr.
Shiel's Perspective: Well, alcohol is old business here. It causes gout by impeding
(slowing down) the excretion of uric acid from the kidneys as well as by causing
dehydration,
which precipitates the crystals in the joints. Animal protein might be something
to minimize for gout patients. Perhaps it's time for more milk?
Low
Dose Prednisone
Low dose prednisone (10 mg per day) was effective and safe
in treating acute gouty arthritis.
Dr.
Shiel's Perspective: This is important news. Traditionally, doctors tend to use
prednisone only in patients who are unable to tolerate non-steroid
antiinflammatory drugs or colchicine. In that setting, when we do use
prednisone, we typically use high doses of at least 30 mg daily. This report is
directly useful as it seems lower doses, which may be less toxic, can work as
well.
New
Medications
Several research centers reported on new drugs for treating
the elevated levels of uric acid that lead to gout.
Dr.
Shiel's Perspective: This is exciting news for the gout field. There was especially
promising news of an experimental drug called Y700 that can be used even in
patients with kidney disease (where often other drugs cannot) because the drug
is metabolized by the liver and not the kidneys like the traditional gout drug
allopurinol.
For more information, please visit the Gout Center.
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Last Editorial Review: 10/24/2003
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