Reports From National Arthritis Meeting

Dr. Shiel Gives Perspectives Of Interest On Gout From
2004 Annual Scientific Meeting Of The American College Of Rheumatology

Introduction

GOUT

Gout is condition that results from crystals of uric acid depositing in tissues of the body. Gout is characterized by an overload of uric acid in the body and recurring attacks of joint inflammation (arthritis ). Chronic gout can lead to 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). The researchers confirmed studies presented at last year's meeting. They also found elevated blood uric acid levels associated with meat and seafood consumption, but lowered uric acid levels with dairy consumption.

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. It looks like it is time for more milk.

Researchers from Boston found that fruits or vegetables did not have an affect on gout risk.

Dr. Shiel's Perspective: An apple a day and bring on the beans!

New Medications

Several research centers reported on a new drug for treating the elevated levels of uric acid that lead to gout. This drug, febuxostat, produced by TAP pharmaceuticals, can be used in persons who are allergic to allopurinol.

Dr. Shiel's Perspective: This is exciting news for the gout field. Rash allergic reactions to allopurinol do occur and this drug will provide a viable option in this setting. This is also important news for patients with kidney disease who have elevated blood levels of uric acid or gout because the drug is metabolized by the liver and not the kidneys like the traditional gout drug allopurinol. Febuxostat is not yet on the market in the U.S., but will likely be approved for use soon.

Etoricoxib (Arcoxia) is a new Cox-2 antiinflammation medication that can be effective in treating the acute attacks of gout.

Dr. Shiel's Perspective: We need more options in the treatment of arthritis attacks in gout patients. This drug is somewhat related to Vioxx, another Cox-2 inhibitor that was withdrawn from the market by Merck because of heart attack and stroke side effects. As a result, Arcoxia will likely be required to undergo significant further study before being released in the U.S. (It is already being used outside of the U.S.)

For more information, please visit the Gout Index.

Return To Reports From National Meeting Disease Index 2004


Last Editorial Review: 11/1/2004



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