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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