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Gout Dugout. Issue #024.New gout drugs progress;my dad's first gout attack;free pH foods chart;
December 01, 2009
Welcome to the December 2009 issue of The Gout Dugout Newsletter. If you get two new ideas from it you can use or find encouraging, reading it will be 10 minutes well spent.
THREE NEW GOUT DRUGS MAKE PROGRESS
First here's some news about three new gout drugs. All news is from presentations at the recent ACR/ARHP annual meeting. (American College of Rheumatology/Association of Rheumatology Health Professionals). These drugs are still in clinical trials.
I last wrote about Rilonacept (trade name: Arcalyst)last year in the October issue. It's being developed to deal with the pain of a gout attack (i.e. the job usually done by NSAIDs and Colchicine) and to prevent an attack whilst a uric acid lowering medication is being taken. As you know falling levels of uric acid can initiate gout attacks. This confuses some sufferers who forget that gout often gets worse before it gets better when it's being treated in this way.
Rilonacept (Arcalyst) came though a 16 week trial among 83 gout patients who simultaneously took Allopurinol at 300 mg for lowering UA levels. It outperformed, as you'd really expect, those on a placebo (dummy drug)plus allopurinol. More interestingly those on Rilonacept after 16 weeks had significantly fewer gout attacks (flares).
Rilonacept has been approved by the U.S. FDA and the European Medicines Agency (EMEA) for other conditions. So far it looks good as a gout med, but any possibility of approval is still a few years away.
This is a new gout drug under development that I haven't written about before. Its results in an eight week phase 2 trial amongst 191 gout sufferers, compared with triamcinalone acetonide at 40 mg, were presented at the ACR conference. After 72 hours (3 days) those patients suffering an attack and who received a 150 mg dose of Canakinumab got better pain relief than those who received triamcinalone. And it achieved a 50% reduction in pain after a day. Those on triamcinalone took twice as long to get a 50% reduction.
This isn't bad but many gout sufferers can get complete gout pain relief with NSAIDs or Colchicine much faster, although it is being trialed and developed because many can’t tolerate either NSAIDs or Colchicine. And it might be better, side effects wise, than Corticosteroids like Prednisone.
What may turn out to be a better use of this drug, when or if it's approved, is to prevent gout attacks whilst uric acid lowering drugs are taken, because only one patient on Canakinumab at 150 mg suffered a gout attack in eight weeks.
RDEA 594 has also recently been subject of positive news. This medication encourages the excretion of uric acid. In a phase 2a trial this year it helped a significant per cent of trial patients to reduce serum uric acid through improved excretion. In just 2 weeks. And, among patients with mild or moderate kidney disease, over 80% of them achieved useful uric acid reductions. It may turn out to be excellent for gout sufferers with moderately impaired kidneys.
A REMINDER TO WRAP UP WARMLY IN WINTER
I hate to sound like a killjoy, but anyone who has ever had a gout attack needs to wrap up warmly in winter. Don't forget! Fail to do so, and a gout attack could be triggered.
CHRISTMAS GOUT FOODS TO AVOID
Popular Christmas foods include some foods that cause gout i.e. they are high purine, probably high purine (if we have to guess the purine content) or can raise uric acid levels. I'm not going to repeat what I wrote in last December's edition about cranberry sauce, mincemeat and gravies. Remember too, game is usually high purine.
If you want to read about these, click here to go to the December 2008 issue
My father, who has reached the grand age of 87, had his first ever attack of gout in November. Predictably it was in the big toe joint of his right foot. Two days of pain. Because of his age it isn't likely to be an inheritance case, and his parents didn't suffer gout. But is the cause purines, or insulin resistance or something else? You know the insulin resistance (and high blood pressure) argument I guess but if you don't you can read about it here.
And he's had type 2 diabetes for over 3 years, so this is definitely another possible cause.
His kidneys are OK he says, it's not that and he hasn't taken chemotherapy drugs. But it could be the purines cause too, and most likely in his case not because of dietary excesses but simply that slow and steady "Bolero-style" build up of uric acid over the years. At his age there have been a lot of years for his uric acid level to rise. And he needs a wheelchair and is unable to exercise by walking. He is a long way from the young man who, as a soldier in World War 2, once walked 40 miles (64 kilometres) across northern France to the port of Dunkirk, to escape pursuing German tanks and infantry.
Like most people who know little about gout until it happens, his uric acid level has never been tested. If you have a relative or friend with a similar profile to my father.... you could suggest a uric acid test.
There weren't any of the obvious gout triggers - cold weather, dehydration, over exercise, binges - but he could be thinner and he has been taking blood pressure lowering meds for a few years. As you probably know, being overweight, and these medicines, can cause gout too. We await a doctor's verdict.
Paying attention to body alkalinity for treating gout is a big, under researched subject. I ought to say more about it in The Gout Dugout, and plan to do so next year. If any reader thinks that raising his/her pH did help reduce uric acid levels, I'd love to hear from you. You have much to say that's of interest to others.
On the other hand, if you know little about pH and gout you can begin on the pH pages on www.best-gout-remedies.com (Type pH into the home page website search box - not the world wide web one)to get all the pH pages on screen. You may feel that raising pH through eating more alkaline foods and less acidic foods, is the best and cheapest route for you to work on your uric acid level.
If you take the pH foods route, you have to know which foods have an alkaline effect and which have an acidic effect. The free pH foods chart and alkalizing recipes at www.phionbalance.com is worth using.Click on the following link and when the home page arrives, the download link for the chart is on the right. pHionbalance products
This site sells pH boosting products such as alkalizing water and minerals, antioxidant fruit supplements and pH test strips. Become a member,its free, and there's much better prices.
Thanks for reading. A very Merry Christmas and a gout free 2010 to all readers.
John Mepham BA (Hons)
165,Union Street, Maidstone, Kent, United Kingdom ME14 1EY
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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