Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Eat, Drink, and Suffer

Hope for the disease of the old and rich.

Somehow, I do not think that the announcement of a new drug for the treatment of gout, the first drug for gout approved by the United States Food and Drug Administration (FDA) in many decades, will appeal much to the readers of Psychology Today.

They are too young and healthy to have a concern for such things as arthritis. The last thing our readers want to do, as they flip through the blogs in between their studies at the local Borders, is to be reminded of a nasty illness that could affect them in their later years.

But for those who do suffer the pain of gout, this first new drug for gout since 1964 is a welcome addition to the medicine cabinet. It was last February that the FDA approved febuxostat for the long-term management of chronic hyperuricemia in patients with gout. The goal is to lower uric acid, the culprit crystal causing the inflammation in gout. This can lead to acute and/or chronic joint pain.

Gout is a disease associated with elevated levels of uric acid in the bloodstream. Uric acid crystals are deposited on the joint cartilage, tendons and surrounding tissues. Acute and painful attacks of arthritis can occur, initiated by the crystallization of uric acid within and about the joints; this can eventually lead to a chronic gouty arthritis, and also the deposition of masses of uric acid in joint and other sites, creating tophi-all of which can lead to chronic pain.

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Febuxostat is a xanthine oxidase inhibitor, helping to reduce the formation of uric acid, and thus reducing the symptoms of chronic gout. This is an important drug, as many patients are intolerant of that other long-lived xanthine oxidase inhibitor, allopurinol.

Of note is the fact that febuxostat approval was delayed for several years because there was a concern that this new drug may have been associated with cardiovascular thromboembolic events during the initial studies. However, the last of three large studies of febuxostat showed that the rate of cardiovascular events over a six month study period were similar to gout patients taking allopurinol.

Still, the package insert for febuxostat does refer to the increased rate of cardiovascular events seen in the first two studies of febuxostat, but it is also quick to add that "a causal relationship" has not been established. So, it is left for doctors and patients to monitor for any hint of myocardial infarction or stroke. That being said, many gout patients have many other risk factors for cardiovascular disease, including obesity, hypertension, and abnormal lipid panels.

Gout can cause quite a bit of misery in a given patient, not only contributing to a painful and often chronic arthritic condition, but also can cause kidney stones, and the formation of tophaceous deposits, which if situated near the skin, can break through the skin and cause oozing sores which may in turn become infected (many gout patients with tophi die of systemic staph infections, the staph bacteria entering the body through the open sores created by the tophi).

Of course, gout patients can also help themselves by avoiding food which can increase the blood uric acid levels (meats and especially organ meats), and alcohol (especially red wine which is particularly good at slowing the elimination of uric acid through the kidneys). At one time a regular diet of meat and wine was thought to be an exclusive part of the lifestyle of the comfortably rich. However, thanks to the rise of the middle class, not to mention the rise of agribusiness, we commoners are now just as susceptible.

But it is nice to know there is a little pill which might do the job when will power just doesn't cut it.

 

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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