Gout is one of the most painful yet treatable forms of arthritis. Today, it's estimated that two to five million Americans have gout, with most men suffering a first attack between 40 and 50 years of age. Women develop it later, in the years following menopause.
For people who develop gout, approximately 10% inherit enzyme deficiencies that cause the overproduction of uric acid. More commonly, however, gout is associated with a variety of factors that negatively impact the kidneys, including aging, elevated cholesterol, obesity, diabetes, and high blood pressure.
For the first gout attack, a high dosage of a nonsteroidal anti-inflammatory drug (NSAID; 600 mg of ibuprofen three to four times daily or 25–50 mg of indomethacin three to four times daily) is often chosen as a first-line therapy because of its quick onset of action, its ability to relieve the pain and swelling of acute gout, and its good tolerability. Treatment is stopped when gout symptoms resolve. Many patients will have a long duration -- sometimes even years -- between their first and second attacks of gout.
The numbers are imprecise, but experts believe there are anywhere from 25,000-100,000 treatment-failure gout patients in the United States. These patients have no alternative therapeutic options for their gout other than symptomatic relief. For these patients with chronic active gout, three new medications may soon offer relief.
- Febuxostat (Uloric) -- Approved by the FDA in February 2009, Uloric is a new alternative for long-term management. This is especially good news for the nearly 20% of people with gout who have bad reactions to allopurinol (Zyloprim) and for those with kidney impairment that prevents them from using the drug.
- Rilonacept (Arcalyst), an injectable drug approved to treat rare autoinflammatory syndromes is now under study as a treatment for gout -- Arcalyst works by preventing interleukin-1 (IL-1) from attaching to cell-surface receptors and creating a flare in disease. Interleukin-1 is a protein secreted by many cells in the body; secreted in excess, IL-1 can trigger disease activity in gout.
- Pegloticase (Puricase) -- An injectable drug designed for people who have failed traditional gout therapy Puricase is currently awaiting FDA approval. Puricase is made from a pig enzyme called uricase. All mammals except humans and primates produce the uricase enzyme, which breaks down uric acid, leaving very low levels in the blood circulation. Uricase converts uric acid to the more water-soluble metabolite allantoin, which can be readily excreted.
