Sep 25, 2012

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Alright. Bourbon blues on the street, loose and complete under skies so smokey blue green. I can't forsake a dixie dead-shake so we danced the sidewalk clean. The Tragically Hip is still my favorite band. I think I was 13 or 14 when I first heard them at my friend Peters house. The Hip were in his brothers record collection along with the Smiths and the Sex Pistols. Although Morrisseys voice was haunting on Meat is Murder, it is Gord Downeys lyrics that seem like theyve been with me forever.

Gout also seems to have been with us forever too. It is one of the earliest recognized diseases and 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. Risk factors for gout 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, consomm, 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 isnt the only cause of gout. If your kidneys dont 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.


I read about some interesting diet alone gout treatments. Milk (from cows not soy) seems to decrease uric acid levels. So does Vitamin C. These may be reasonable additions to your diet if you have gout. The bad news is beer makes uric acid levels go up. However wine does not seem to affect uric acid levels. The only good beer news is that beer makes uric acid levels go up more in women than men. This is good news for me because I like beer and Im not a woman. Women also get higher levels of uric acid if they drink fructose containing beverages. Making life style changes like drinking milk, taking vitamin C and reducing beer are important, but if some one has very high uric acid levels this probably wont fix the problem.


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 didnt 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. The first new drug to treat gout in 40 years 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.


Down the road, scientists are looking at injecting an enzyme called uricase into gout patients. This enzyme changes uric acid into a form that will be eliminated by the kidneys 10 times faster. However, these uricase treatments will be very expensive and there may be some safety issues.


When the pain of gout goes away it feels great. Its like going swimming Winnipeg River in my home town of Pinawa. Like when, I had my hands in the river, my feet back up on the banks. Looked up to the Lord above and said, "Hey, man thanks." Sometimes I feel so good, I gotta scream. She said, "Trevor baby, I know exactly what you mean"

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


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