2005 ACR/ARHP Annual Scientific Meeting: Reports From National Arthritis Meeting
William Shiel, M.D., FACP, FACR, Editor of MedicineNet's Arthritis Overview, Offers Perspectives Of Interest On Topics From 2005 Annual Scientific Meeting of The American College of Rheumatology (held November 12-17, 2005)
Arthritis Conference - Installment #1 (transcript) on Gout
- Gout and Gouty Arthritis - New Treatment and Diagnosis
- More News in the Field of Gout Treatment
- Gout Diagnosis
Monday, November 14 - This is Dr. William Shiel reporting from San Diego for the 2005 annual scientific meeting of the American College of Rheumatology -- the national arthritis meeting. Today I'd like to discuss several very interesting papers related to gout that I believe are very important for our viewers. They represent new information both in diagnosis and treatment of gout.Researchers from the University of Oklahoma, University of Pennsylvania, and University of Chicago report two very interesting papers on a new product of treatment called febuxostat as a generic name that is useful for the long-term management of gout. Febuxostat was shown to reduce the incidence of gouty attacks and gouty arthritis more effectively than the long-term gold standard treatment for gouty arthritis called allopurinol. Febuxostat was also shown by the same research groups to reduce the size of the clumps of uric acid called tophus or tophi (plural) which are annoying lumps that occur in the skin of patients with chronic gout. The tophus size in these patients was reduced overtime very effectively with the treatment of a febuxostat.
It was shown by researchers that treating the uric acid level very aggressively -- even below previous standards (serum uric acid levels well below 6.0) much more effectively control gouty arthritis then simply lowering the uric acid level to lower ranges of normal. I think what we are going to see doctors doing in the future is aggressively treating the serum uric acid as an integral part of the treatment of gout.There is also a new medication that's being proposed as a treatment for gouty tophi -- the uric acid lumps of accumulation that can occur in the skin in patients with gout. In this particular treatment it is given intravenously and would be for patients who have resisted treatment responses to other drugs. This treatment is called uricase. Uricase is an enzyme that in mammals, other than the great apes and in humans, that exists naturally. This enzyme degrades uric acid for these mammals since humans do not have it. The treatment with uricase was proposed as a possible treatment for gout. In fact when given intravenously, it was shown by these researchers to significantly reduce the size of the tophi. So I think we are going to see this product -- uricase undergo further scrutiny of medical research to determine whether or not it might be an applicable treatment for gouty tophi.
In the area of diagnosis of gout, a new imaging technique was studied by researchers at Cooper University Hospital in New Jersey. It demonstrates that using ultrasonography or ultrasound method (much like what a mother uses when she's happily having a look at her baby in her womb), that this technique can be used to look at the feet in patients who have inflamed joints and actually detect the accumulation of uric acid over the inflamed joints of the classic gouty foot. It remains to be seen whether this will be a practical method of determining whether a patient has gout in the future, but this is an exciting potential new avenue of diagnosis.
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