Gout is a form of inflammatory arthritis due to the deposition of monosodium urate crystals. The underlying problem is a metabolic abnormality that leads to an imbalance between uric acid production and uric acid excretion. Uric acid is a byproduct of the metabolism of purines, a constituent of many foods. Ordinarily, uric acid is excreted via the kidneys. In gout, the excretion rate can't keep up with the production rate. Uric acid then deposits out in various tissues including joints and the kidneys.
It is common knowledge that gout is associated with other medical problems including obesity, hypertension, diabetes, and elevated blood lipids. It is also a known cause of increased susceptibility to heart attacks.
It is also a well-supported theory that atherosclerosis ("hardening of the arteries") is an inflammatory process. Lipids within an atherosclerotic plaque attract whiter blood cells. These white blood cells secrete cytokines, protein messengers that recruit other white blood cells and other molecules. Destructive enzymes eventually lead to rupture of the plaque with the formation of a clot, blockage of a coronary artery, and a subsequent heart attack.
A blood test, the C reactive protein, is a marker of inflammation and is often elevated in patients with active atherosclerotic heart disease.
The treatment of an acute attack of gout usually revolves around the use of one of three different types of medications: non-steroidal anti-inflammatory drugs, colchicine, and steroids.
A recent study showed that colchicine, a good anti-inflammatory agent, appeared to protect against heart attack. How this accomplishes the task is still unknown. Whether it is through an anti-inflammatory effect, stabilization of clot formation, or whatever, is still unknown.
What is known is that classic non-steroidal anti-inflammatory drugs should probably be used sparingly in gout because of the increased risk of cardiovascular events such as stroke and heart attack associated with these drugs.
And steroids are also problematic since they tend to drive up levels of blood sugar and blood lipids.
Colchicine can be used in relatively low doses to prevent gout attacks. And in fact, when used as prophylaxis along with a uric acid lowering therapy program, it appears to be well tolerated and reasonably safe.
What is clear is that with the burgeoning incidence of gout in the United States, better strategies at managing this condition will be needed. This will require both better uric acid-lowering therapies as well as more effective treatments for acute attacks. And any new therapy will have to be safe as well as being effective. Colchicine may be a "forgotten drug" but it appears to be ready to begin a new role.
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