Back to Back Issues Page
Gout Dugout.Issue #074 Eular's gout guidelines; a simple gout solution
August 15, 2016

Hello and Welcome to the Summer 2016, edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read from that gives you useful ideas that may help with your gout. Copy and print if you prefer to read a version on paper. If you are extra busy now you could bookmark it for later.


Congratulations for taking such an interest in gout that you read this newsletter. Those who are willing to spend time to find more information about gout will gain the benefit. Who says this ? The recent 2016 update of the EULAR (European League against Rheumatism) gout guidelines says it, after much study of why gout is not treated better. EULAR has identified that a lack of gout knowledge means lack of adherence to treatment.

Ten years have passed since EULAR’s first gout guidelines. This update of the 2006 guidelines reflects changes in gout treatment since 2006. These guidelines are intended for Europe not any other part of the world, although EULAR will have considerable influence in other regions.

So what has changed ?

The first change is that quite a number of medications have been added to the treatment armoury for gout since 2006.

They are:

Firstly three majors – Febuxostat and Krystexxa have been approved. Also Lesinurad. It improves uric acid excretion by blocking a kidney transporter (URAT1) from returning it to the blood, and is used in combination therapy - see below.

Secondly the Interleukin-1 blockers (IL-1B) have arrived on the gout scene. They are all for reducing pain and ending flares. These are – Canakinumab (brand name Ilaris) 150 mg for one dose (available in Europe but not in the U.S for gout; Triamcinalone 40 mg one dose; Rilonacept 320 mg one dose; Anakinra 100 mg one dose. Canakinumab is for patients who can't take Colchicine, NSAIDs like Indomethacin, Ibuprofen and Naproxen, and the corticosteroids.

Next there are new trends in prescribing medications for gout. Corticosteriods including prednisone and prednisolone have become more popular in doing the colchicine job. i.e.dealing with flares.

Sheep's heart is offal (organ meat) and high purine. See below - A simple gout solution

Another medication trend has been, and remains, when patients take their gout meds they combine xanthine oxidase inhibitor drugs (e.g. Allopurinol and Febuxostat) that lower uric acid production with drugs that increase its excretion (e.g. Probenecid, Benzbromarone, Lesinurad). Thus delivering a double whammy against uric acid to help get it down.

Another new combination therapy - remember this is for Europe - is for patients with acute gout and flares in more than one joint. They treat with Colchicine and corticosteroids or Colchicine and NSAIDs (Indomethacin, Naproxen. Ibuprofen etc.).

Being careful of consuming fructose has crept into the guidelines too.

For patients with severe gout there is now a lower serum uric acid target, down to 5.0 mg/dL (297 µmol/L).

However, there is no EULAR advice to cut down on carbohydrates to improve insulin resistance which may well be the cause of the phenomenal growth of gout worldwide. People everywhere eating more carbs. But there is the usual decades-old advice about watching your purines.

EULAR's Overarching information about gout principles.

These are worth reading to ensure you know them. They are aimed at doctors too. A large proportion of gout patient’s treatment could be better. For example under half do not get something as simple and obvious as uric acid lowering treatment. One main reason is a lack of gout treatment knowledge, referred to above. One study found when this is improved 92% of patients become effectively treated.

Second is the need to give patients lifestyle advice – that includes the important dietary advice.

And the third of these three principles is the importance of screening all gout patients for the co-morbidities, (other nasties you could get with gout e.g kidney impairment, cardiovascular risk factors), to which they are prone because co-morbidities are so prevalent in gout.

Those are the main changes I’d say. In all there are 11 recommendations for the 2016 guidelines plus the three “overarching principles" I have discussed. You can read all in more detail free of charge here courtesy of the Annals of the Rheumatic Diseases Journal. They may be in use for the next 10 years.


Some people are lucky enough to cure/control their gout quite easily. I suspect these cases are of people who deal with their gout immediately; then it is correctly diagnosed, and quickly, and they are lucky enough to have uric acid levels just slightly above the trouble causing level. Hence they don’t have to bring it down much to get a gout solution.

Here is one easy example I read recently. The lady gout sufferer gave up fish and offal (organ meat) – internal organs and entrails e.g. liver, kidneys, hearts, tripe. There is never any contradiction or doubt about offal (organ meat) being high in purines. It is high. It should not be eaten if you are trying to get uric acid down. Eating offal would make it much harder to succeed, or be a main cause of failure.

As well as giving up fish and offal she only ate meat at weekends. She also watched her consumption of lamb. Don’t know why because lamb is not, for a meat, exceptionally high in purines.

Specifically the fish she discontinued were – haddock, herring, anchovies, salmon, sardines and fish sauce (if made with anchovies fish sauce is high purine). And she took 500 mg of Vitamin C daily.

She said “It was the diet, or the Vitamin C or both, but it worked for me. I have been gout free for four years.” I’d say probably both the diet and Vitamin C helped her.

There you are. If only all gout cases could be solved like this!

And which of these fish holds the most purines? Sardines then anchovies. But giving up fish completely is not necessary. Dealing with fish is explained on this page of Better to cut it down to twice a week, and make sure you take fish oil supplements – take high quality ones.

The fish with the most EPA/DHA compared to their purines amount are explained on our best fish for gout page.

Lamb's kidneys are offal (organ meat) and thus high purine. Nice on toast, or with steak in a pie, but not if your have gout.


What is Vitamin B5? Pause, pause and pause again. The least known B vitamin is probably Pantothenic acid. And with a name like that, which does not stick, it’s pretty clear why it’s not well known.

You can find it in foods such as Sunflower seeds, salmon, avocados, sun-dried tomatoes, corn, broccoli, and mushrooms.

Those who have noted it gets uric acid down include the famous diet Doctor, Robert Atkins. I have had a few emails over the years about it and they are published on the Pantothenic acid for gout page. They are from people who believe it did their gout good.

On the other hand, I once took it in an experiment to get my uric acid down. But it didn't work for me. That may be because I put on weight at the same time. What the studies call a confounding factor.

I recently received another website contact form message about pantothenic acid and gout. It has yet to be published but my correspondent recommended pantothenic acid too. He says he has been using it for years and his uric acid levels are very low. More about that later.

Click here to read more about the foods that contain Pantothenic Acid (Vitamin B5)


Selecta Biosciences, the company developing Pegsiticase has raised US$70 million to develop it via issuing shares. So it is now a public company quoted on the Nasdaq exchange with the stock code SELB, if you want to check its price. As I have said before I am enthusiastic about this drug turning out to be the best of all gout drugs.
About one in five gout sufferers has kidney stones. Get rid of them naturally if you can. Click on the banner ad

Kidney Stone Natural Treatment

If you are not a subscriber to the Gout Dugout, this free gout newsletter, you can sign up at this page - click on the link below.

Back Issues for The Gout Dugout Newsletter

Go to the home page by clicking on this link.


Use's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Rasburicase for gout ? Type – Rasburicase - in the site search box.

There are currently around 250 pages, including all the back issues of this newsletter. It works. Use it!

Thanks for reading. Best of gout free health !

John Mepham BA (Econ)
Makati City,

Back to Back Issues Page