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Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000






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My husband has suffered with gout for years. I've been trying to find any information possible about a different or better way to treat this disease. His doctor says there hasn't been anything new drug-wise since the 1960s but there's some indication that this might change soon. What can you tell us?

Gout is a form of arthritis with joint inflammation. It's caused by too much urate (uric acid) in the body because of a missing enzyme (uricase). Excess uric acid causes needle-shaped crystals to form in the synovial (joint) fluid. One of the most distressing symptoms of gout is painful, inflamed, hot, and tender joints. The big toe is affected most often but other joints can become symptomatic, too. For the last 40 years, treatment has focused on diet to reduce urate levels. Painful inflammation is managed with nonsteroidal antiinflammatory drugs (NSAIDs) and corticosteroids. In 2009, the Food and Drug Administration (FDA) approved a group of new drugs for the treatment of gout. These new medications are the subject of today's review and include colchicine, anti-interleukin (IL)-1 beta therapy, urate transporter (URAT1) inhibitors, febuxostat, and uricase replacement. The first drug mentioned (colchicine) isn't really new. It's been used for gout for 200 years. But the FDA has never formally approved it. As a result of reviewing the effectiveness and safety of this drug, a new nongeneric drug (Colcrys) has been developed, approved, and is now available. Colcrys has the advantage of stopping the gouty attack quickly but it only worked for half the people who tried it. Anti-interleukin therapy is a biologic approach designed to prevent the inflammation associated with gout. These medications can also be used to treat inflammation once it begins. Three of these anti-interleukins (Anakinra, Rilonacept, and Canakinumab) are being tested and studied in humans. So far, Anakinra has been effective in reducing 50 per cent of the painful symptoms associated with gout and it does so within 48 hours. Rilonacept provided 75 per cent pain relief for half of the patients who took it and prevented symptoms in three-fourths of the patients who took it prophylactically (to prevent joint inflammation). Canakinumab is faster in delivering relief from pain (within 24 hours) and seemed to be able to prevent recurrent attacks later. Besides treating the symptoms of a gouty attack, modern treatment now has new agents to reduce urate levels. This can be done by helping the body get rid of the excess urate or by keeping the body from making so much urate in the first place. Febuxostat is a new drug that does both at the same time. Compared with the drug that's been in use since 1963 (Allopurinol), Febuxostat is almost twice as effective. And Febuxostat can be used by patients who have kidney problems if they don't already have severe kidney failure. Studies with most of these drugs are in the early phases (human trials) right now. Results look promising, but time will tell. If your husband is not getting the relief he needs from painful symptoms, he should make an appointment with his primary care physician or rheumatologist if he has one. The key to successful management of gout is to prevent symptoms and/or catch them when they first appear. There may be a more effective way to do this than he is currently using.

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