‘Horribly mismanaged’: Debate over gout treatment rages as cases surge

All around the world, gout prevalence is growing at an alarming pace, while gout treatment remains as “horribly mismanaged” as ever.

This rapid growth has spurred on a worldwide “gout epidemic,” James ODell, MD, Robert L. Grissom professor of internal medicine and vice chair and chief of rheumatology at the University of Nebraska Medical Center, in Omaha, who, told the attendees at the American College of Rheumatology Covergence 2021 annual meeting.

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Diuretics and Gout: Is there a connection?

High Blood Pressure, Prescription Diuretics, and Gout

What is high blood pressure?

High Blood Pressure, also called hypertension, is when blood puts too much pressure against the walls of your arteries. About 1 in 3 adults have high blood pressure, usually with no symptoms. But it can cause serious problems such as stroke, heart failure, heart attack, and kidney disease.

What lifestyle changes can help lower high blood pressure?

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Stress accelerates immune aging, study finds

Traumatic life events, discrimination prematurely weaken body’s mix of immune cells

Date: June 13, 2022

Source: University of Southern California

Summary: Stress — in the form of traumatic events, job strain, everyday stressors and discrimination — accelerates aging of the immune system, potentially increasing a person’s risk of cancer, cardiovascular disease and illness from infections such as COVID-19, according to a new study. The research could help explain disparities in age-related health, including the unequal toll of the pandemic, and identify possible points for intervention.

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Native Hawaiians have higher risk for gout, UH study finds

May 31, 2022, 12:30 PM HST Maui News

An analysis of nearly two decades of data of 92,000 people revealed Native Hawaiians had more than twice the risk of Whites participants of developing gout as older adults.

The new study by University of Mānoa researchers — and one of the largest multiethnic gout studies to date — was published in The Journal of Rheumatology.

Gout, a common and painful form of arthritis, is becoming more prevalent in the United States. But the differences in risk between populations remains largely understudied, especially for Native Hawaiians. This study helped shed some light on these differences. It also revealed black participants had the second highest risk, followed by Japanese participants.

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Uric Acid & Gout News: Hereditary Fructose Intolerance




Hereditary fructose intolerance is a disorder in which a person lacks the protein needed to break down fructose. Fructose is a fruit sugar that naturally occurs in the body. Man-made fructose is used as a sweetener in many foods, including baby food and drinks.

Causes



This condition occurs when the body is missing an enzyme called aldolase B. This substance is needed to break down fructose.

If a person without this substance eats fructose or sucrose (cane or beet sugar, table sugar), complicated chemical changes occur in the body. The body cannot change its stored form of sugar (glycogen) into glucose. As a result, blood sugar falls and dangerous substances build up in the liver.

Hereditary fructose intolerance is inherited, which means it can be passed down through families. If both parents carry a nonworking copy of the aldolase B gene, each of their children has a 25% (1 in 4) chance of being affected.

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Gout: The Other Gene That Affects Urate Levels and Gout Development

The ABCG2 gene belongs to a group of genes called the ATP-binding cassette family; genes in this family provide instructions for making proteins that transport molecules across cell membranes. In the intestines, the ABCG2 protein helps release (secrete) a substance called urate into the urine. Urate is a byproduct of certain normal biochemical reactions in the body. In the bloodstream it acts as an antioxidant, protecting cells from the damaging effects of unstable molecules called free radicals. Urate levels are regulated by the kidneys and, to a lesser extent, by the intestines.

The ABCG2 protein also transports certain drugs out of cells. For example, this protein clears some chemotherapy drugs from organs and tissues. Transport of these drugs allows them to have their intended effects and be eliminated from the body.

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Gout: Genes that Affect Urate Levels and Gout Development

The SLC2A9 gene provides instructions for making a protein called glucose transporter 9 (GLUT9). This protein is found mainly in the kidneys, specifically in structures called proximal tubules. These structures help to reabsorb needed nutrients, water, and other materials into the blood and excrete unneeded substances into the urine. Within the proximal tubules, the GLUT9 protein helps reabsorb or excrete a substance called urate. Urate is a byproduct of certain normal biochemical reactions in the body. In the bloodstream it acts as an antioxidant, protecting cells from the damaging effects of unstable molecules called free radicals. When more urate is needed in the body, the GLUT9 protein helps reabsorb it into the bloodstream. Most urate that is filtered through the kidneys is reabsorbed into the bloodstream; about 10 percent is released into urine.

The GLUT9 protein also plays a role in reabsorbing and excreting the simple sugar glucose.

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Gout: Genetics or Lifestyle Driven?

Genetic and genetic mutations can certainly play a role in disease, however, poor nutrition and a sedentary lifestyle can greatly increase the risk. Gout is a common condition, but it occurs more frequently in some populations than others. For example, gout occurs in 1 percent of people with Asian ancestry, 3 to 4 percent of people with European ancestry, and 6 to 8 percent of Indigenous (native) Taiwanese peoples and Māori from New Zealand.


In about 15 percent of people with gout, urate accumulates in the kidneys
and forms kidney stones . As the condition worsens, urate crystals can also be deposited under the skin or in other soft tissue, forming a nodule called a tophus (plural: tophi). These tophi often form in the hands, elbows, or feet. Tophi do not typically cause pain, but they can become inflamed, infected, or ooze fluid. Depending on their location, tophi can interfere with movements such as walking or gripping objects.

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Gout and Metabolic Disease: Can Probiotics help?

As we know, many studies have linked Gout with chronic inflammation and obesity.  Both conditions contribute a group of factors that increase the risks of heart disease, stroke, and diabetes – also known as metabolic syndrome.  Metabolic syndrome is a cluster of biochemical and physiological abnormalities affecting an estimated 50 million Americans.

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What can you do to alleviate Gout symptoms?

1) Try to get an accurate diagnosis if possible.

HOWEVER, these suggestions are accurate and helpful with any inflammatory attack and can be followed, regardless of a firm diagnosis. Blood testing can be very misleading. Arthrocentesis, or joint aspiration, is the only secure method of evaluating any crystallized deposits in the joints.

2) Take the right anti-inflammatory medications. Continue reading “What can you do to alleviate Gout symptoms?”