Until recently, a diagnosis of gout, also known as gouty arthritis, meant a regimen of mainstay treatments that didn't always work well: a prescription for allopurinol, considered a first-line therapy for gout, for instance, coupled with nonsteroidal anti-inflammatory drugs (NSAIDs) and a gout diet that excludes alcohol and foods, such as meat and seafood, that can aggravate the painful condition. But as of this month, with the entrance of Uloric (febuxostat) to the U.S. market, gout sufferers now have another option. Uloric is the first drug in 40 years to be approved by the Food and Drug Administration to treat gout, which according to a recent estimate affects about 3 million Americans.
Gout develops when too much uric acid accumulates in the blood, soft tissues, or joints. Uloric, made by Takeda Pharmaceutical, works by lowering these levels. Compounds called purines, which can increase levels of uric acid in the body, are abundant in beer, red meat, and seafood, including shellfish. That's why those foods should be avoided. Gout is a "severe [form of] arthritis that . . . usually involves just a single joint," says N. Lawrence Edwards, a professor of medicine at the University of Florida and CEO of the Chicago-based nonprofit group called the Gout and Uric Acid Education Society who has served as a consultant for Takeda and other drug companies. About 60 percent of those who have a gout attack will have another within a year, according to one published estimate.
A painful, swollen, warm-to-the-touch big-toe joint was the first sign of gout for Victor Konshin, 38, of Williamsville, N.Y., who was diagnosed with gouty arthritis in 2002. Konshin has written a book, called Beating Gout: A Sufferer's Guide to Living Pain Free, stemming from his experience and subsequent research into the illness. "I was having severe pain in my foot," says Konshin, who was initially misdiagnosed with osteomyelitis, a bone infection.
Some in the gout community say they hope the approval of a new drug treatment is a sign that the condition is being taken more seriously. Gout has long been known as a problem that primarily affected overweight men—a "disease of kings," as one Arthritis Today article puts it, referring to men who could afford to indulge in pricey food and alcohol. It's true that men are more prone to gout, typically experiencing their first gout attack in their 30s or 40s. But women can also develop the painful condition; they tend to get it later in life, after menopause.
Researchers find gout difficult to study because of its sporadic nature. "The problem with studying gout is that it's an episodic condition," says Jonathan Kay, a rheumatologist and associate clinical professor of medicine at Harvard Medical School. "You get an attack all of the sudden, and then it goes away with treatment." That makes it hard for researchers to gather study data from gout sufferers when attacks are actually happening.
Gout's onset is often sudden, but not always. "My first attack was fairly mild and came on fairly slowly over the course of a couple of days," Konshin says. "I initially thought that I had an infection because redness, swelling, inflammation, and warmth are all symptoms of infection. . . . It did grow to the point where it was very painful to walk." A doctor initially prescribed allopurinol, but Konshin stopped taking it after he developed a liver complication that caused yellowing of his eyes and skin. He now takes another medication, probenecid, to keep his uric acid levels in check. A second edition of his book is slated for release in April.
Diagnosing gout usually involves testing the level of uric acid in a person's blood and the joint that's experiencing pain. Besides Uloric and allopurinol, other drugs approved to treat gout include several NSAIDs and corticosteroids, Benemid (probenecid), Colbenemid (a combination of probenecid and another drug called colchicines), Kenalog (triamcinolone acetonide), and Aristospan (triamcinolone hexacetonide).
Preventing attacks. The key to preventing frequent gout attacks is to lower uric acid levels, experts say. That can be achieved by losing weight and avoiding purine-rich foods, says Edwards. Those steps and taking the medications your doctor recommends, he says, can reduce the risk of gout attacks.
The good news is that "gout is one of the few curable forms of arthritis," Kay says. "Patients with gout should seek the attention of a rheumatologist so that they can be placed on appropriate treatment to prevent recurrent attacks and treat existing manifestations of gout."
While high uric acid levels have long been accepted as a cause of gout as well as kidney stones, some researchers think uric acid may also have other health implications. For this reason, if you've been told you have high uric acid levels but have not been diagnosed with gout, it is still a good idea to try to lower those levels by making changes to your diet and lifestyle. This problem, called asymptomatic hyperuricemia, may play a role in the development of such vascular conditions as stroke and heart and kidney disease, according to an article written by Edwards to be published in March in Current Opinion in Rheumatology. Still, for now, asymptomatic people should forgo drug treatment because it's not clear if it offers a benefit, and some medications can cause serious side effects.
If you're at risk for gout or already have the arthritic condition, consider following the diet advice below from the American Academy of Family Physicians.
Avoid these foods: Liver, kidney, anchovies, sardines, herring, mussels, bacon, codfish, scallops, trout, haddock, veal, venison, turkey, alcohol. These foods are known to be rich in purine.
Eat these foods only occasionally: Asparagus, beef, bouillon, chicken, crab, duck, ham, kidney beans, lentils, lima beans, mushrooms, lobster, oysters, pork, shrimp, and spinach
Eat these with no worries: Carbonated drinks, coffee, fruits, breads, grains, macaroni, cheese, eggs, dairy products, sugar, tomatoes, and most green vegetables (including lettuce but excluding the vegetables listed above)
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