What is Gout?

Gout is a form of arthritis, characterized by an acute onset of extreme pain. Gout attacks most commonly occur in the foot and ankle, in particular at the first metatarsophalangeal joint, the joint that connects the great toe to the foot. Gout also appears in the ankle, and can theoretically occur in any joint of the foot.

During an acute attack, the affected joint will appear red and swollen, and it will be hot to touch. It will also be extremely painful to touch. The simple touch of a bed sheet or even a slight breeze can cause an immense amount of pain. Evaluation by a doctor will be used to rule out other possibilities such as a fracture, infection, or other forms of arthritis. X-rays may be taken to visualize the effected joint as well. There are generally not any changes seen on x-ray with the first gout attack, but distinct changes may be seen with repetitive attacks. These changes include bony erosions seen around the joint, with the appearance of bone that has been chewed away. This is referred to as Martel’s sign.

An excess of uric acid in the body causes a gout attack. Uric acid is a byproduct of many foods; in particular it found in high quantity in red meats, lobster, and beer. Because of its association with overindulgence of rich foods, it has been historically referred to as “the disease of kings”. The high volume of uric acid crystallizes at the level of the joints, causing a tophus to form. The crystallization most commonly happens overnight. Some believe that this is due to a drop in body temperature, particularly in the feet, while sleeping.

A high level of uric acid in the body is a condition known as hyperuricemia. The excessive uric acid may come from several different sources. It may be dietary, as in the overconsumption of red meat, beer, and seafood. Hyperuricemia may also be associated with diabetes mellitus, hypertension, psoriasis, or congenital conditions such as Lesch-Nyhan syndrome. Excessive uric acid levels can also be caused by the use of some diuretics, particularly during their early use.

The treatment of gout is twofold; it must address both the acute painful phase as well as controlling the hyperuricemia. Initially, patients may be given colchicine or indomethacin to alleviate pain. After the acute attack has subsided, the underlying hyperuricemia may be addressed with allopurinol a drug that blocks the enzyme that creates uric acid in the body.

Central Florida Foot & Ankle Center, LLC

101 6th Street N.W.

Winter Haven, FL 33881

Phone: 863-299-4551

www.FLFootandAnkle.com

New Drug for the Treatment of Gout

This Tuesday, a federal advisory committee recommended the approval of Krystexxa, a new drug that has been in development by Savient Pharmaceuticals. In clinical trials, the drug has shown to be an effective treatment for gout.

The committee recommended the approval by a landslide 14-1 vote. The drug now must be approved by the Federal Drug Administration (FDA) before Savient can begin producing, distributing, and marketing the drug. In the past, the FDA has been known to follow the advice of the advisory committees. If Krystexxa is approved, it will be the second drug for the treatment of gout approved this year, after 40 years without innovation in this particular area. Uloric, which is manufactured by Takeda Pharmaceutical, was approved for use in February.

Gout, which is a form of arthritis, is caused by a buildup of uric acid in the body. This uric acid can then be deposited in the joints. The deposits are known as tophi. The big toe is particularly susceptible to this searing pain caused by tophi, but other joints, including joints in the hands and elbows can also be affected.

The uric acid that builds up in the body is commonly associated with diet, as it is a metabolism defect. Foods such as alcohol (especially beer), red meat, and some seafood are commonly associated with gout. For this reason, gout has often been referred to as the “disease of the kings”, as these foods were historically only available to the wealthy. However, these foods have become more and more accessible to a larger percentage of the population, making gout more common, and less known as a disease of the rich. Increased incidence of gout has sparked a new interest in the medical research community.

Krystexxa is a form of uricase, an enzyme responsible for degrading uric acid in the body. The drug works by attacking the tophi, and helping to dissolve the deposits. In clinical trials, about forty-percent of patients saw significant improvement while taking the drug. Some patients reported that the tophi dissolved completely, and that they were able to walk and use their hands again without pain.

There are some side-effects that have been reported with the use of Krystexxa, including an increase in the prevalence of cardiovascular complications and allergic reactions. Committee members state that it is unclear whether the increase in cardiovascular conditions, however, is due to the drug or due to chance, based on the small trial size. The FDA, nevertheless, is expected to approve the drug, as the striking benefits for patients with chronic gout outweigh the side-effects.

Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Phone: 863-299-4551
http://www.FLFootandAnkle.com