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Gout Dugout.Issue #058.Cherries reduce risk of gout attacks | Krystexxa’s EU approval.
October 30, 2012
Hello and Welcome to the October 2012 issue of the Gout Dugout newsletter. It's the ten minutes' read that gives you ideas that may help you with your gout. If you have difficulty reading it from the screen, by all means copy and print.
Cherries are on the menu again this month, but there's a good reason for another bite. Whenever there's a scientific study of a natural remedy for gout, they are so rare it's worth hearing about. Just as I was about to send out last month's newsletter, with its cherries study story, another study about cherries for gout was published in the Journal Arthritis & Rheumatism.(1).
This one was a different sort of study to those I wrote about last month. It looked at cherry consumption and the risk of gout attacks i.e. are cherries good at preventing gout?
This kind of cherry study hasn't been done before as far as I know. The cherry intake and the gout attack record, gathered online, of a large number, (633 U.S. resident gout sufferers amounting to 1247 attacks over one year), was analysed (analyzed) to find out if their consumption of cherries had any effect on the frequency of their gout attacks.
Cherries are a well known natural remedy for gout but what surprised me was that only about 40% of the 633 took a form of cherries or cherries extract. And on the whole, they were a well educated group. Clearly a majority need to read, hear or do more about gout.
Cherries and uric acid Unfortunately their uric acid levels were not measured so in this study we don't know if cherries consumption lowered it, one of the burning questions about cherries for gout. A couple of studies have said they do, and a couple have said they don't, or not by a significant amount. Plus one more study where tart (sour) cherry juice lowered uric acid in high uric acid rats.
Cherries and gout attack risk In this study cherries, or cherry extract, or both, were examined. Not cherry juice concentrate, canned or dried cherries. In last month's study cherry juice concentrate was used. This study found that fresh cherries had a positive effect, but not a super-strong effect, on preventing gout. If participants ate just 10-12 (half a cup) cherries a day for two days (20-24 over two days), they were 35% less likely to suffer a gout attack than if they didn't eat cherries. Those who consumed cherry extract had a lower risk for gout too,(45%), but this result was from only 15 participants.
But the extract's success is not really surprising since we have heard or read testimonials from gouty folk who have taken cherry extract or dried cherries. And so far the type of cherry doesn't matter – Bing, Montmorency, and all the other different types that must have been eaten by the large number of people who have written testimonials about cherries; also those who took part in this study.
Another score, if they ate cherries plus cherry extract, there was a 37% lowered risk.
If cherries were consumed with allopurinol, attack risk was 75% lower than in periods during the year when cherries and allopurinol were NOT taken. So there you are. If you didn't know that, that's worth knowing.
What happened if the cherry intake was stepped up? An extra single serving over two days (making three in all), tended to lead to a decreased risk of gout attacks. That's not bad and clearly worth doing. But after that, no further increase in consumption led to a lower risk of attacks. So stuffing yourself with more and more cherries in the hope of better results does not seem to work.
Irrespective of factors like weight, purine intake, alcohol use and diuretics use, the effect of cherries was consistent at the quoted percentages.
This was the 8th trial about cherries for gout I can think of. Every study has had some good news. What they all amount to is that cherries in various forms are worth trying.
In view of contradictory findings in studies, what really needs to be resolved is whether cherries act to lower uric acid; their effect on inflammation is more certain, but they are not powerful enough to help everyone, and they are probably more reliable in the early, milder, stages of gout, although that has not yet been proved.
The researchers advised what you'd expect from these results. Eat cherries, but don't give up meds for them. I would add, not until you are dead certain you have control of your gout, and so is your doctor. But why ever give them up? As long as you are aware of their carbs and fructose when you need to be, they are a healthy fruit, albeit expensive in many countries. In Thailand and the Philippines fresh cherries cost about US$30 a kilo.
If you live in a country where cherries are expensive, last month's issue explained that the cost effective way of consuming cherries is to take cherry juice concentrate because good manufacturers put so many cherries into it. There's a link to the back issues page below.
The lead researcher Dr.Yuqing Zhang of the Boston University School of Medicine called for randomised clinical trials of cherries. I expect we shall get them, sooner or later. This
cherries for gout study is not free. It costs US$35 for 24 hours access, during which it can be downloaded.
If you want to read it, you can pay and download it here. Click on Get PDF to start the purchase.
(1) Yuqing Zhang, Tuhina Neogi, Clara Chen, Christine Chaisson, David Hunter, Hyon K. Choi Cherry consumption and the risk of recurrent gout attacks. Arthritis & Rheumatism DOI 10.1002/art.34677
Click on the Flamasil ad to go to the Flamasil website
KRYSTEXXA ALMOST APPROVED IN THE EU
Krystexxa (generic name: pegloticase) is the powerful gout drug that works by cleverly converting uric acid to allantoin, which is more easily excreted by the kidneys than uric acid. In trials it got blood uric acid down to very low levels (such as from 10 mg/dL to under 2.0. mg/dL) in some cases in its trials.
Krystexxa's EU approval, called marketing authorisation (authorization), is almost cut and dried. We have been waiting a few months for news of Krystexxa's approval, and it now just about come. I say "just about" because the EMA (European Medicines Agency) has recommended approval to the European Commission, who finally decide, within about a couple of months. That is by the end of this year. At an 8mg/ml infusion strength, every 2 weeks, same as in the U.S.
It's for people with very serious gout, for whom all else has failed. These are often people with advanced tophi and when bone joints are beginning to erode. It's hard to see the Commission going against the EMA experts - the European Medicines Agency's Committee for Medicinal Products for Human Use (CHMP). It will also be examined by National authorities (for example Britain's NICE in May 2013), so don't expect it yet at your friendly neighbourhood (neighborhood) doctor or rheumatologist. The President of Krystexxa's developers, Savient Pharmaceuticals, is called Louis Ferrari. But gout drug's approvals move more like a tortoise.
And it needs to be administered in specially appointed places. But by all means explain this significant news to your doctor, and that Krystexxa is likely to be on the way.
As usual with the capricious nature of gout, treatment even with this drug can't claim a 100% success rate. But it specialises in difficult gout cases, and it has been successful in some of these. And successful in cases where it would be beyond the ability of a natural remedy for gout to help. So far in America, it has not taken the world of gout by storm, but it has got established. Its use, when all else fails, is one of the American Collage of Rheumatology's gout guidelines.
It is very costly. In America figures of about US$60,000 have been quoted for a months' long course of twice a month infusions, by medical staff who have been trained to administer them. So only governments, and medical/health insurance companies can afford it. Time will tell what effect this high cost will have on Krystexxa getting approval outside the US, Europe and other prosperous places. There won't be any similar competition to Krystexxa to help bring down prices for many, many years.
The UASure is a DIY home uric acid test kit. It measures the level of uric acid in the blood. Click on the link below to visit a company who can ship it world-wide, including to the United States and Canada, from Britain.
My request for photos has brought some excellent gout pictures which will be used. But I'd still like more.....Do you have any photos of your gout? Any part of the body - elbows, arms, hands, ankles, feet, wrists, fingers, toes and big toes, knees, ears, wherever. I know many like to keep their gout confidential so if you don't wish to be identified, don't send me faces – not likely anyway since gout of the ear isn't common. Or, on request, I could always crop out, or blur them.
Please email me at: email@example.com
Thanks for reading, and all the best of health.
799, Infantry Street,
P.S. You may distribute this newsletter freely and free-of-charge, providing any links in it remain unchanged and it remains intact. Partial copying is not allowed.
NB. The contents of this newsletter contain medical information, not medical advice. Please always discuss gout remedies with a doctor, or other health care professional, before implementing any treatment.
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