At a recent conference in Colorado, discussion of the optimal treatment for gout was a major area of discussion among rheumatologists.
It appears that the disease, while growing in incidence and prevalence is not being treated appropriately. Factors that seem to contribute to this phenomenon are: metabolic syndrome (the association of diabetes, obesity, high blood pressure, elevated blood lipids), obesity, excessive alcohol ingestion, and the increased intake of high fructose containing beverages.
Roughly eight million Americans have the disease; yet, only three million are being treated. Another issue is noncompliance. Studies have shown that about half of patients with gout don't take their medicines.
Some important issues have been raised.
First, not all patients with an elevated serum uric acid (SUA) have gout and not everyone with an elevated SUA should be treated with uric acid lowering therapies because of potential side effects.
That being said, very elevated SUA levels should not be ignored because they are linked to high blood pressure, diabetes, chronic kidney disease, and cardiovascular problems. Any level of 6.8 mgs/dl or higher is abnormal. Nowadays, laboratory "normal values" are higher than they were in the past because of the changing health status of Americans. More are obese and more have elevated SUA. They are the ones on whom the new "normal values" have been based. Does that make the "new normal" acceptable?
Absolutely not!
The Framingham study showed that people who had SUA levels higher than 9.8 mg/dl had a 22 per cent chance of getting gout within 5 years.
Clearly, instituting early treatment for a gout attack is wise. Among the drugs that work well include non-steroidal anti-inflammatory drugs, colchicine, and glucocorticoids. Sometimes, combinations of these drugs need to be used in order to break an attack.
SUA lowering treatments should not be started until the acute attack has been resolved.
One big mistake is that some physicians unfamiliar with gout will start uric acid lowering treatment at much too high a dose. This only increases the likelihood of drug toxicity without increasing the chances of successfully controlling the gout. The two most effective drugs available for lowering SUA currently are allopurinol and febuxostat (Uloric).
In patients where these drugs are ineffective, peguricase (Krystexxxa) is a viable option.
The way to treat gout is to start low and go slow with frequent monitoring of SUA level shooting for a target of less than 6.0 mgs/dl.
No comments:
Post a Comment