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Gout Dugout. Issue #025. A gaze into the 2010 gout crystal ball; pain, pain go away; history of gout
January 01, 2010

A warm welcome to the January 2010 edition of The Gout Dugout newsletter. Ten minutes to read and you may get a couple of very usable ideas, or ideas you find encouraging.


Here's some events to be on alert for in 2010.

2008 and 2009 were both landmark years in the history of gout, to go alongside such years as 1679, 1776, 1798 and 1848. In 2008 Febuxostat first gained approval from medical authorities and in 2009 the discovery of a malfunctioing gene that causes gout was announced. Will 2010 also be a landmark year?

It will if Krystexxa (Pegloticase) is approved by the U.S. FDA. This gout news is likely to come by mid year, perhaps earlier. Krystexxa's approval, if it happens, will be highly significant. If you are someone who hasn't been able to get control of gout, and especially if you have tophi, Krystexxa is a gout med that's had significant success in its trials against tophi as well as uric acid levels. But not 100%.

It's a "when all else fails" gout med. There are thousands of gout sufferers who have suffered gout for years, and tried many things. So the promise is great. But I have a feeling that Krystexxa will not be cheap. It's delivered by a series of intravenus infusions by specially trained staff. So we shall see. Keep reading the Gout Dugout for Krystexxa developments this year.

Other new gout drugs 2010 should also see more trials progress for four new gout drugs - RDEA594, Arcalyst, Xoma052 and Ilaris.

And the folks at the Johns Hopkins University School of Medicine in the U.S. may well have more gout news for us this year. Last year they announced they had discovered a malfunctioning gene - the ABCG2 gene - that causes gout. How? When this gene doesn't behave normally it reduces the amount of uric acid excreted by the kidneys.


A lengthy new page with some colour pictures went live on the website in mid December about the history of gout, at least from B.C. years until the end of the 19th Century.

IMHO the most important people in the history of gout have been the ones who made the scientific breakthroughs that led to a correct understanding of the causes of gout. Not the writers, many doctors, and the unusual remedy merchants.

Although many of the gouty observations of early medical writers such as Hippocrates and Galen were correct, the true causes of gout could not be remotely understood until the breakthrough of 1679, when Van Leeuwenhoek in Holland discovered that tophi actually consisted of crystals, although it looked chalky to the naked eye. Crystals of what he didn't know, but once this had been learnt the major true cause could eventually be understood.

The other four major pioneers, IMHO, were Scheele, Wollaston, Garrod and Fischer because they each came up with a key breakthrough, following on from Van Leeuwenhoek's observations. That is, they found out what was needed to be known before the next thing could be learnt. These breakthroughs led to the understanding that purines and(excess) uric acid from them, led to gout attacks and eventually perhaps to tophi.

I managed to find a drawing of Van Leeuvenhoek's revolutionary microscope which enabled him to see the gouty crystals. And another of Garrod's thread experiment. This told him that when a linen thread was placed in blood, uric acid crystals were attracted to it providing that serum levels of uric acid were high enough. So you can view these drawings too.

If you want to know what these four learnt and why their breakthroughs were important, and perhaps broaden your knowledge of gout (always a good thing if you have it) be a good "gout internaut." Visit

At present my history ends at the end of the 19th century. I'll do the 20th at some later date. It doesn't say much about gout remedies in the past because I concentrated on the breakthroughs, but I'll write about these later too.


A couple of month's ago I went into hospital for an emergency hernia repair operation. This isn't gout but the pain I suffered for a few hours, and I mean I suffered, was definitely in the gout pain league. I thought you'd be interested to know what got rid of the pain. I did first try one of the NSAIDs that's used for pain relief for gout, sodium diclofenac. It had no effect. Neither did the liquid morphine (possibly similar to laudanum but without the alcohol) which I sucked in the hospital's accident and emergency unit.

Morphine for gout attacks? Only when a medic eventually injected me on the inside of my right arm with a morphine preparation did the pain mercifully subside. I don't recall the exact amount injected, but it would have been a standard amount. There's no chance you'll be able to take intravenous morphine at home for pain relief for gout, but if you find yourself having to go to a hospital to end an attack of gout, take note that intravenous morphine got rid of my pain in about 10 minutes. Some NSAIDS for gout such as Indomethacin can be delivered intravenously too.

However, I suggest you take great care if it's ever suggested you have a colchicine injection. Make sure the injectable colchicine preparation has been approved by a government medical authority. In 2008 the U.S. FDA reported many serious adverse events, even deaths, from colchicine injections. The colchicine preparations used were not approved. (The FDA's warning did not apply to colchicine tablets). Read this, courtesy of the U.S. FDA


Paying attention to body alkalinity for treating gout is a big, under researched subject, although it has been a known gout treatment since at least the middle of the 19th century. I will write more about it this year.

If you take the pH foods route to help lower uric acid levels, 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 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. All can play a role in lowering uric acid levels or improving body function. Become a member - it's free - and there are much better prices.

If you are not a subscriber to the Gout Dugout, this free monthly gout newsletter, you can sign up at this page.

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Thanks for reading. A very happy New Year 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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