Gout

[GordMay]

From The ‘New England Journal of Medicine’: http://content.nejm.org/

Deforming Gout
by
Gonzalo Pacheco, M.D., and Javier A. Cavallasca, M.D.
Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
http://content.nejm.org/cgi/content/full/353/23/e20

be glad this isn't you ...

Febuxostat — Treatment for Hyperuricemia and Gout?
By
Larry W. Moreland, M.D.
http://content.nejm.org/cgi/content/short/353/23/2505

Thanks GORD. It seems that allopurinol is the most common effective solution. Kevin also provided some good links, and all either suggested this medication, or condemned it in favor of holistic cures. While I am not against hollistic medicine, I do believe modern pharmacuticals have their place. It sounds like this is one of them.

[CaptainK]

You're welcome Scott. I help out all of my friends. Anyway that I humanly can.

[GordMay]

I’m not advocating any particular drug, which would be WAY beyond my competence. I only note that the first new treatment for Gout is on the Horizon.

Surprisingly few new pharmacotherapies for gout have been introduced since the introduction of Allopurinol in the 1960’s. As many patients will experience dose limiting toxicities or incomplete responses to currently available therapies, new therapeutic modalities are clearly needed. Here, Becker et al examine the safety and efficacy of Febuxostat, a non-purine selective inhibitor of xanthine oxidase/xanthine dehydrogenase on serum uric acid levels.

Based on results from a phase 3 clinical trial, TAP Pharmaceutical Products Inc., the makers of Febuxostat, have submitted an application seeking FDA approval for febuxostat in the management of hyperuricemia in patients with chronic gout. Results from a Phase 3 clinical trial showed that daily oral Febuxostat (80 or 120 mg) is effective in reducing the level of serum uric acid in subjects with gout and hyperuricemia compared to Allopurinol 300 mg per day. Safety of both doses of febuxostat was comparable to allopurinol, currently the only approved treatment for gout.

In addition to treating acute attacks of arthritis, the management of chronic gout includes control of the serum urate level. In the clinical studies, more patients taking febuxostat than allopurinol achieved the target level of less than 6.0 mg/dL," said Michael A. Becker, M.D., professor of medicine, University of Chicago.

FWIW,
Gord

[Talbot]

There is anothe drug that I know off as an alternative to alopurinall - it is called sulfinpyrazone. Dont know what its like, but was nearly changed over to it recently, but doc changed their minds at last minute.

GORD, I know you were not plying doctor (at least not with me), but I think you greatly under rate your expertise.
Talbot, I am a conservitve guy when it comes to meds. I am all for the tried and true.

[Talbot]

Conservative with meds is a good principle, however, with meds that you will be taking for the rest of your life, it is wise to know that there are alternatives, so that you can find the one that has the least side-effects for you, then it is the time to be conservative.

Agreed!

OK, week three into another bout of this stuff. I went about a year without a flare up. Stress really seems to be a factor. Someone recomended unfiltered apple cider vinager. I tried it this morning. That is about the most foul thing I have ever put in my mouth, but already, it seems to makee a difference. Not sure if it just gave me something more unpleasant than gout to focus on, or if it really works, but I am giving it a chance

[Talbot]

Total Sympathy. Either mine is playing up today, or the wet weather is agravating the arthiritis from the damage to the joint caused by Gout in the past - same problem, same pain, different treatment!

With me, de-hydration was a major cause of onset. with a three week bout, it is time you moved over to the daily pill.

Stress is another factor that will make any problem worse. I have more stress in my life than I can handle at the moment - last couple of weeks (hopefully) before court case to settle finances of my divorce.

[btrayfors]

Kai Nui,

This has been going on for at least 3 years, from the dates of your posts.

Gout is a very treatable problem. You don't have to suffer these attacks!

My mother had it, and I was diagnosed with a bad case of gout (hyper-urecemia) in 1975. I was then posted in Kathmandu, in the Foreign Service.

Happily, we had a young Embassy doc who was interested in science and experimentation. So, over a period of six months, we experimented with a couple of the then-available treatments. I had 2 uric acid blood tests done EACH WEEK for the six months (this would be prohibitive in cost today), while we experimented with drugs and dosages.

There are/were basically three treatments: one which cuts into your metabolism and reduces the formation of uric acid (which is the proximate cause of gout); a second which helps your kidneys get rid of uric acid after it has formed; and a third -- colchicine -- which is the traditional drug used to treat acute attacks (and for which the active mechanism is not known).

I settled on a 150mg dose of Allopurinol, which I have been taking daily for over 30 years. One half of a 300mg tablet. Allopurinol (and several brand names of the same drug) is cheap, and works perfectly.

No relapses in several decades. Only problem I've had is on those rare occasions when I forget to take the drug for a few days (like when I go off sailing and forget my meds), I feel the pre-tingle of gout in my big toe.

A cheap and very effective remedy. You do not have to suffer.

Disclaimer. BTW, I am not a physician and this isn't medical advice. See your doctor (I believe they have physicians on the central California coast these days), and forget your gout for the next 50 years.

Bill

I share your pain Talbot. Have gone through the divorce thing. The stress there can not be described to anyone who has not experienced it.
I am still not ready to resort to daily meds. As long as I can keep it to once a year, I can still deal with it. Just need to arrange to set aside some time to stay off my feet and heal. This time it is in my ankles. Good and bad. Ice actually helped this time, when it has not before. Unfortunately, I still can not stay off ym feet as long as I need to. It will be interesting to see if the vinager makes any difference. I have had about 5 gallons of cherry juice in the past 3 weeks, but that does not seem to be doing the job.

[btrayfors]

Kai Nui,

Our messages crossed.

I would urge you to reconsider your reluctance to take daily drugs to treat gout.

Gout is a form of arthritis and is DEGENERATIVE...that is, you can do permanent and irreversible damage to your joints if you let the uric acid levels get up too far.

Unless you're looking for early arthritic paralysis, I'd really consult a physician (and not take the word of a fellow gout patient who is NOT a physician).

Bill

[Talbot]

The worry I always had was that a joint problem was always treated immediately as another incidence of gout. For me, my main site is ALWAYS the joint of my left big toe, with some secondaries in both knees.

If I started having pains elsewhere to normal I would be pounding the docs ear about what else it might be!

Bill, so far, the doctors have been useless. Guess I just have bad luck in choosing them. Yes, they can put me on daily meds, but so far, I have not needed that for anything else, so I am hoping to maintain my health for a few more years before the daily drug regimens need to start.
You are fortunate if you get some warning. For me, it always starts at night in my sleep. I wake up in pain. I think the vinegar treatment will be the last of the holistic approaches. Keeping hydrated has been very successful to date. If it hits again this bad, I will definitely go back to the doctor, and take the pharmaceutical route.