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Gout and Pseudogout: A Rising Challenge
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Posted on: 02/11/2010
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As the incidence of obesity, hypertension, and metabolic syndrome
grow, so too do gout and pseudogout. This rise in prevalence is not
only a byproduct of people living longer lives, but also the result of
a change in diet. The consumption of alcohol, fructose-sweetened soft
drinks, and high-protein foods have all been found to increase uric
acid levels and cause gout. As such, new developments are needed to
combat this growing trend. This article examines recent advances made in the diagnosis and treatment of gout and psuedogout.
Gout, sometimes referred to as “the unwalkable disease,” is caused by
an excess of uric acid in the body. This excess causes needle-shaped
crystals to form in the synovial fluid responsible for lubricating
one's joints. As the immune system tries to rid the body of these
crystals, inflammation develops, causing joint pain and swelling.
One of the difficulties surrounding diagnosis lies in differentiating
between the unique crystal deposits associated with an onset of Gout
from those associated with Pseudogout. However, the prospect of a new
form of imaging, musculoskeletal ultrasonography (MSUS), offers
doctors the ability to efficiently distinguish between both kind of
crystal deposits according to each disease's distinctive formation.
Although further research is needed, MSUS may potentially preclude the
need for synovial fluid analysis and enhance both the efficiency and
accuracy of Gout and Psuedogout diagnosis.
The treatment of acute attacks of Gout and Psuedogout relies on many
of the same medications to promote relief. Non-steroidal
anti-inflammatory drugs are typically used as the first line of
defense in such cases. However, those individuals who suffer from
impaired liver or kidney function, gastric or peptic ulcer disease, or
decompensated congestive heart failure, or those taking
anticoagulation medication will require an alternative solution.
Colchicine is one such alternative for patients to NSAIDs. Side
effects include nausea, vomiting abdominal pain, and particularly
diahrrhea. Corticosteroids have proven particularly useful in patients
suffering from liver and kidney dysfunction. The medication has been
noted to cause hyperglycemia, gastritis, and isomnia. If a patient's
acute gout attack fails to respond to these medications, anakinra may
be used.
While chronic Gout cannot be cured, it can be successfully treated.
Lifestyle changes can be effective in long-term management. It might
be suggested that one lose weight, quit drinking alcohol, avoid
fructose-rich soft drinks as wells as high-purine meats and shellfish.
Further, serum uric acid-lowering (SUA) medications have been shown to
reduce the risk of occurrence. One of these medications, Febuxostat,
recently approved by the FDA, has proven useful for patients with mild
to moderate kidney disease.
The treatment of Pseudogout has also experienced new developments.
Early testing has suggested the potential of Hydroxychloroquine or
Methotrexate to significantly decrease pain severity and the frequency
of attack and inflammation. No significant adverse effects have been
reported.
With the increasing numbers of those affected by gout and pseudogout,
innovations in diagnosis and treatment are required. Developments such
as these are rising to meet this growing need.
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References:
Gregory R. Emkey, MD, Anthony M. Reginato, MD, PhD. All About Gout and
Pseudogout: Meeting a Growing Challenge. In The Journal of
Musculoskeletal Medicine. October 2009. Vol. 26. No. 10. Pp. S17-S23
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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