Gout Treatment Blog Section

Dalbeth and Stamp, in Allopurinol dosing in renal impairment: walking the tightrope between adequate urate lowering and adverse events, recognize that:

Allopurinol is the mainstay of urate-lowering therapy for patients with gout and impaired renal function.

They note that deadly Allopurinol Hypersensitivity Syndrome (AHS) is a rare, but real, risk. A risk that increases with kidney impairment.

They are concerned that current dosage guidelines do not accurately reflect real life risks for developing AHS. Sometimes allopurinol doses below the guideline levels can induce AHS, and sometimes higher doses can be tolerated with few adverse effects.

Like many aspects of gout, particularly when complicated by other diseases, they recommend that each case is managed individually. Taking into account recent research data, they advocate:

gradual introduction of allopurinol according to current treatment guidelines, with close monitoring of serum uric acid concentrations. In patients with severe disease and persistent hyperuricemia, allopurinol dose escalation above those recommended by the guidelines should be considered, with careful evaluation of the benefits and risks of therapy.

Most importantly, they conclude that more work is needed to clarify the safety and effectiveness of increasing allopurinol dosage, especially with patients who have impaired kidney function.

Please note that this is a reformatted page from the old style website. See my allopurinol pages for more information about other effects of allopurinol.

Allopurinol Misspellings

Like many medicines, allopurinol is often misspelled. Though spelling is often overrated, it pays to take extra care with medicines, as a misunderstanding might cause treatment problems in the unlikely event of a similar sounding drug being taken mistakenly.

Allopurino

Missing final l.

Alluporinol

lupo changed to lopu.

Allupurinol

lop changed to lup.

Alopurinol

allo changed to alo.

Alopurenol

allo changed to alo, and purin changed to puren.

Alipurinol

allo changed to ali.

Alipurinal

allo changed to ali, and nol changed to nal.

Allipurinal

allo changed to alli, and nol changed to nal.

Alopurinal

allo changed to alo, and nol changed to nal.

Allopurinol

This is the correct spelling of allopurinol - the most common gout treatment for lowering uric acid.

Allopurinal

nal ending changed to nol. This is the most frequent mis-spelling of allopurinol

Alupurionol

Allo changed to Alu, and extra o added before nol.

If you are aware of other alternative spellings, please share them on the gout forum.

Some reprieve for gout patients who cannot tolerate allopurinol arrived in recent years in the form of febuxostat. Sold as Uloric, or Adenuric, this was hailed as the first new gout treatment in 40 years.

Now, those patients who, try as they might, cannot get uric acid low enough, have a further option, but it is far from an easy one.

FDA approves new drug for gout

In a press release yesterday, the U.S. Food and Drug Administration announced the approval of Krystexxa (pegloticase) for gout in adults who do not respond to, or who cannot tolerate, conventional therapy.

They explain how gouty arthritis occurs

due to an excess of the bodily waste uric acid, which is eventually deposited as needle-like crystals in the joints or in soft tissue. These crystals can cause intermittent swelling, redness, heat, pain and stiffness in the joints.

Gout is strongly associated with obesity, high blood pressure, high cholesterol and diabetes, and occurs more often in men, in women after menopause, and in people with kidney disease.

“About 3 percent of the three million adults who suffer from gout are not helped by conventional therapy. This new drug offers an important new option for them,” said Badrul Chowdhury, M.D., director of the Division of Pulmonary, Allergy, and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research.

They then explain how, Krystexxa differs from allopurinol and febuxostat, which blocks the enzyme (xanthine oxidase) that produces uric acid. The new gout treatment is an enzyme that lowers uric acid levels by metabolizing it into a harmless chemical that is excreted in the urine. The drug is administered to patients every two weeks as an intravenous infusion.

I will summarize the research that supports the license application when I update the gout treatments reference section with this newly approved treatment. For now, you need to be aware of the cautionary conclusion to the FDA Krystexxa press release:

Since one out of every four patients in the clinical trials experienced a severe allergic reaction when receiving an infusion of Krystexxa, health care providers should dispense a corticosteroid and an antihistamine to their patients beforehand to minimize the risk of such a reaction. Other reactions during the clinical trials included gout flare, nausea, injection site bruising, irritation of the nasal passages, constipation, chest pain and vomiting.

Physicians are also being warned to be cautious about administering Krystexxa to patients with congestive heart failure because the drug was not studied in this patient population.

Krystexxa is being approved with a Risk Evaluation and Mitigation Strategy that includes a medication guide for patients and materials for healthcare providers to communicate the risk of severe infusion and allergic reactions.

Sounds serious doesn’t it?

Let that be a reminder just how serious excess uric acid really is. If yours is high, you must do all you can to lower uric acid in your blood. If you do not know your uric acid number, please get it sorted. Today.

Uric acid crystals must be dissolved to permanently get rid of gout pain, but how long does it take to get rid of them?

Like all gouty issues, the answer is never simple. However, we can see some factors that affect the time it takes for crystals to dissolve, and see that the time to start dissolving is now.

In an earlier article, I explained how tophi shrink quicker with lower uric acid concentrations. But this does not mean that once you lower uric acid to a safe level you will immediately stop all gout attacks. In fact, partially dissolved uric acid crystals can start a gout attack, as I explained in Allopurinol Medication: Why It Hurts To Get Rid Of Gout. Though that article looks specifically at allopurinol, the effects of dissolving uric acid crystals might occur with any urate lowering treatment, including diet, until all urate deposits dissolve. But how long does this cleansing period take?
Read the rest of this Uric Acid Crystals article…

Acupuncture is commonly viewed as sticking needles into various parts of the body. Though needles are often involved, the aim is to stimulate energy flow in the body, and so other related techniques are often grouped under the acupuncture umbrella.

A detailed study of acupuncture is beyond the scope of this gout website, however I would like to draw your attention to 3 studies reported last year. (more…)

Do not start with the herbal mixture, and explain how you are sort-of-cured, but not quite.

Do not start with the allopurinol itch, and explain how your gout would be fixed if only you took the meds every day.

Do not hide behind food obsessions, and explain how gout never troubles you if you can only avoid purines.

Get a plan, and focus on fixing your gout. Let me help you focus on G.O.U.T.

The ⒼⓄⓊⓉ Plan To Fix Gout

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As far as I can see, there have been no studies of Devil Claw & gout. However, a number of studies have looked at the anti-inflammatory properties. I have summarized 3 studies below.

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Your gout symptoms clear faster with lower uric acid, but how low should you go?

It is very difficult to measure how fast old uric acid crystals are dissolving, but for chronic tophaceous gout sufferers, we can measure how fast their tophi shrink.

Allopurinol for gout has been around for 40 years, and febuxostat is the latest weapon in a growing list of medicines that will lower uric acid. But still people are unsure how low they need to go.
(more…)