Jun 1, 2017

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"They don't know how old I am. They found armor in my belly. From the Sixteenth Century. Conquistador, I think." That line from Locked in the Trunk of a Car by the Tragically Hip does sound painful, doesn't it? Armor in your belly? Really old armor? Something else really old and really painful is gout.

Gout is one of the earliest documented diseases. It was written about by the Egyptians in 2640 BC. In the last 4600 years it is still the only type of arthritis that is curable. I don't have gout yet, but I have all the risk factors. They include being male, being overweight and being over 40 years old.

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. Sometimes 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. But diet isn't the only cause of gout. 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 as well.

Often the first time someone knows they have gout is when their big toe hurts. The pain can be very severe and the joint pain can appear very suddenly and often 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. What do we try to do if someone complains of gout? First send them to the doctor to get a diagnosis. If it is gout, the doctor will probably give them a prescription for a non-steroidal anti-inflammatory drug (NSAID). The most commonly used one in gout is called indomethacin. This will reduce the pain and inflammation and hopefully make the current gout attack go away.

An older treatment for gout is called colchicine. Colchicine has been used to treat gout for centuries. In pharmacy school we were told colchicine works on gout, but that we didn't really know why. Now scientists are working out that the colchicine actual changes the structure of the microtubules inside the white bloods cells that move uric acid crystals around. Colchicine can be very effective for gout, but it has some rare but nasty side effects including bone marrow suppression. Because of these rare but serious side effects, colchicine is used as a second line treatment behind indomethacin.

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. In 2010, Health Canada approved the first new drug to treat gout in 40 years. It is called Uloric or febuxastat. It may reduce uric acid levels even better than allopurinol. But as it is a new drug, it is more expensive than allopurinol.

Recently, the has been some changes to using diet to prevent gout. In a study in the May 2017 British Medical Journal, Dr. Hyon Choi et al. looked at the effect of diet on whether or not men got gout. They looked at The Health Professionals Follow-up Study in which 44,444 men were followed for up to 26 years. The participants were regularly surveyed to see what they were eating. Dr. Choi and his team looked at the diets and rated those diets as to how similar they were to the DASH diet.

What is the DASH Diet? DASH stands for Dietary Approaches to Stop Hypertension. The DASH Diet includes reducing salt or sodium intake, eating lots of whole grains, vegetables, fruits, low fat diary and reducing the amount of saturated fats, meats and sugar. The DASH diet has been proven to reduce blood pressure as well as or better than taking a blood pressure pill.

When looking at the Heath Professional Follow-up Study, Dr. Choi's team found 1731 cases of gout among the participants. Dr. Choi's team also found the more DASH like a participant's diet was, the less likely he was to get gout. Why did the men with more DASH-y diets have less chance of getting gout? We don't know, but some analysis by the researchers seem to point to DASH like diets with lots of fruits and vegetables having the ability to lower uric acid levels.

I like this idea of recommending the DASH diet to people to prevent gout. What I have been telling people since pharmacy school is people should have a low purine diet to avoid gout. Low purine means things like avoiding beer, cheese, meat and seafood. I love all those things. Lots of people love those things. Many times when you ask someone to go on a low purine diet, they either didn't do it at all, or they substitute a lot of carbohydrates and refined sugars for the high purine foods. That doesn't help the overall health of the person. The DASH diet seems like it would be easier to follow, and we already know it reduces blood pressure. And that is great for people with gou,t as 74% of people with gout already have high blood pressure, many of them are overweight and 63% of them have metabolic syndrome.

There are usually certain body parts that are painful in gout attacks. Ooo fingers and toes, fingers and toe. Those forty things we share. Forty one if you include that fact that we still care. Pharmacists care about all your body parts. And my non-pharmaceutical recommendation of the day is to listen to the Hip.

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

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.

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

DASH Diet Preventing Gout British Medical Journal - http://www.bmj.com/content/357/bmj.j1794

Tragically Hip - Locked in the Trunk of a Car - https://www.youtube.com/watch?v=9-WBZMRFFkU

Tragically Hip - Boots or Hearts - https://www.youtube.com/watch?v=uER0SS6bJpw


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