GOUT

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

As usual, the best ideas I get for these articles comes from our customers. I had someone come up to the drive-thru and ask me what I knew about the new gout pill. I had to admit I didn’t know anything about any new gout pill and I would look into it. When I did a little research I also found some recent information about Vitamin C and gout. Let’s talk a little bit about what gout is first.

A gout attack or acute gouty arthritis happens when uric acid comes out of solution and crystals form in the joints or tissue. Uric acid is a normal ingredient in your blood that is formed by the normal break down of cells. Uric acid is also formed when you eat proteins with purine in them. Foods high in purine include anchovies, asparagus, consommé, herring, meat gravies, mushrooms, mussels, organ meats, sardines and sweetbreads. Usually in gout there is an imbalance in how much uric acid is formed from your diet and how fast your kidneys can eliminate it. So, if you eat a lot of purine rich foods and drink a lot of alcohol (alcohol causes your body to make more uric acid and your kidneys to eliminate less) you could get gout. Or if your kidneys don’t eliminate uric acid very well, you could get gout. Or if you inherited a gene that causes your body to make way too much uric acid you could get gout.

Symptoms of gout can happen suddenly. Most often you get a very sore joint suddenly. It often happens in the joint of the big toe, and often happens at night. The pain becomes worse and worse especially when touched or moved. The joint can get inflamed, swollen and warm and the joint can look red or purplish.

So what do we try to do if someone complains of gout? First send them to the doctor to make the diagnosis. The doctor will then give them a prescription for something like indomethacin. That will reduce the pain and reduce the inflammation and hopefully make the current attack go away. If a patient has several attacks per year, the doctor will then consider giving them something to reduce the number of attacks. That will usually be a drug called allopurinol. Allopurinol reduces the amount of uric acid your body produces. If you take it every day you will reduce the chance of your next attack. Allopurinol will not help reduce the pain in your current attack.

So what about Vitamin C and gout? Several studies have shown that high doses of Vitamin C reduce the patient's uric acid levels. However, that is not the same as reducing incidents of gout. So a group from Vancouver published a study in the March 9/09 issue of Archives of Internal Medicine. They followed a group of 46,994 men who didn't have gout from 1986 to 2006. They gave the men periodic questionnaires to determine if they had developed gout and how much vitamin C they took. The researchers found the more Vitamin C the men took, the less chance there was that they would develop gout.

This is interesting, but there were some limitations of the study. Studies with questionnaires are considered weaker than double blind placebo controlled trials, and the researchers didn't confirm the patients had gout by finding uric acid crystals in the joint fluid.

There is a new drug to reduce uric acid levels now available in the US. It is called Uloric or febuxastat. It may reduce uric acid levels better than allopurinol. It is not available in Canada yet. Also since it is a new drug, it will probably be more expensive than allopurinol if it becomes available here. The reason it seems to have made the news is its manufacturer claims it is the first new treatment for gout that the FDA has approved in 40 years.

As always if you have any questions or concerns about these or other products, ask your pharmacist.