Gout Pal Interactive

A recent comment from a reader about stubborn gout pain has set me thinking. I started writing a short comment reply, but as I thought about the problem, I realized that this subject deserves it’s own article.

Tom wrote about his stubborn gout pain:

I have used prescription NSAIDS (Ibuprofen,Indicin, etc.) to sucessfully treat a gout attack that affected my toes, ankles and knees.

Second and subsequent gout attacks did not respond to NSAIDS and I tried fresh cherries, dried cherries and cherry juice concentrate. The Cherries worked at first and then failed to give relief.

Next, I tried Colchicine and that worked - with gastric upset side-effects.

I’ve also noticed a difference in pain treatment response to different attacks. The pain is caused by a complicated immune response that scientists are only just beginning to understand.

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White horse courtesy of morguefile

What do horses have to do with gout?
Not much, unless you tend to overindulge in The White Horse pub, but there is a link.

The nice thing about having a gout news page, is that you often spot interesting news items. My attention was drawn to “Research Into Why Common Anti-Inflammatory Drugs Harm Intestines”.

Non-Steroidal Anti-Inflammatory Drugs, commonly called NSAIDs, play a significant role in managing acute gout (see acute gout management chart), but they cause stomach problems for many. As you may know, I seem to tolerate NSAIDs pretty well, but who knows if I am at risk, but have not yet had any side-effects. Many other gout sufferers are not so lucky

I nearly turned away when I read that this was research by Kansas State University’s College of Veterinary Medicine and that the research would benefit horses and other animals that require NSAIDs for ailments related to their athletic activities. Animals and athletics - not much interest for me then, until I spotted a quote from the research leader:

“We treat horses the same way we treat humans, and horses get the same side effects,” Lillich said.

So, although uric acid metabolism in horses is different from humans, they still suffer the same pain from inflammation that gout patients do. NSAIDs for pain relief have the same effects on horses as they do on gout sufferers. So any benefits from this research will help us gouty folk as well. And there are some benefits…

Lillich said the research he is doing at K-State will lead to better treatment for patients requiring nonsteroidal anti-inflammatory drugs.

“What we’re trying to do is get better at drug design,” Lillich said. “… Manufacturers will be able to make a drug with fewer harmful side effects.”

Great news for gout sufferers everywhere. And horses.

Gout pain relief is the first stage of gout management. The second stage is treatment to reduce uric acid, but this can cause more pain and many people miss this vital treatment because they cannot tolerate the pain. Recent discoveries regarding gout pain have suggested an alternative approach that may well lead to a new, more effective form of gout pain relief.

Many people mistakenly believe that uric acid crystals, commonly described as needle-like, cause pain in the same way that sticking pins in your body will. If you’ve studied my U-D-R-P model of gout pain, you will know that it is actually your immune system reacting to the crystals that causes swelling and pain in a similar way to fighting a virus. And the pain doesn’t only arise when something triggers these uric acid crystals to form.

A few days after your immune system has attacked uric acid crystals, swelling and pain subside as the crystals become hidden by white blood cells. But you need to reduce uric acid levels to get rid of gout, and whether you do this by diet or by drugs like allopurinol, those gout crystals that were hidden will become visible as they dissolve. This is why most doctors subscribe gout pain relief drugs such as colchicine or other anti-inflammatories (NSAIDS) at the same time as allopurinol. But many people simply cannot stomach these anti-inflammatory drugs and medical researchers are always on the look out for new approaches to gout pain relief.

Recent research into the immune system reaction to uric acid crystals has identified a protein called interleukin-1 (IL-1) as part of the problem. This has long been known to be a factor in rheumatoid arthritis, and a recent study, A Pilot Study of IL-1 Inhibition by Anakinra in Acute Gout, has treated gout patients with the rheumatoid arthritis drug, anakinra. Though this pilot study needs to be confirmed with randomized clinical trials, the authors conclude:

” In this pilot study involving 10 patients with gouty arthritis refractory to conventional therapies, anakinra given at 100 mg daily for 3 days rapidly relieved the inflammatory symptoms of gout. “

It’s good to see that deeper understanding of how gout pain is caused by the immune system has led to scientists looking for different types of treatment. It’s even better to see that applying existing drugs in new ways has led to a real possibility of a new, effective form of gout pain relief.