purine metabolism enzyme - Pseudogout
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Pseudogout

Pseudogout, or CPPD, is a disease very similar to gout. Gout and CPPD are often confused due to their similarities in onset. The cause of CPPD is unknown and seems to effect both men and women equally.


X-ray findings are similar with one exception. Individuals with CPPD with show small islands of calcium deposition in the lining of the joint referred to as calcinosis.


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 Diagnosing CPPD may only be made by testing a small sample of the synovial fluid from the affected joint. Gout and CPPD can be differentiated by specific testing and identification of the type of crystal.

However, gout sufferers are overwhelmingly (95%) male.

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Conventional treatment for the symptoms of gout is the anti-inflammatory drug colchicine. Isolated from the autumn crocus, colchicine has a strong effect to combat inflammation (though it has no effect on uric acid levels!). This provides most sufferers relief within the day, although the drug may be difficult for many to tolerate due to digestive side effects.

Foods that contain a high level of purine should be avoided, and these include red meats, organ meats and shellfish. There are several herbs that have proven benefits for painful joints. Celery seed and guaiacum are two very popular ones. These are usually combined with other herbs such as ginger, capsicum and sarsaparilla for better synergistic effect.

Treatment of acute attacks includes the use of non-steroidal anti-inflammatory medications such as Indocin or Clinoril. Control of pain may require a mild narcotic such as codeine. Recurrent attacks may be contolled by the use of an NSAID.

SIDE EFFECTS Of course Pegloticase has caused side effects, in the extension trial in about 1 in 5 patients. The developing company has said that most were mild, moderate, or controllable. But in some cases more severe side effects have been described as including chest and back pains, muscle cramps, sweating and flushes.

Pegloticase's answer to the excess uric acid level problem is to remove it by ingeniously converting uric acid into something else, a substance called Allantoin. Allantoin is more soluble and better excreted than uric acid. The principle comes from the way most animals do it. They do it by converting UA to Allantoin, but this is something humans cannot do naturally. Hence the formulation of Pegloticase.

To prevent gout attacks, the following lifestyle should be considered: ' Avoid alcohol, a major influence in initiating attacks. ' Follow a low-purine diet. This includes organ meats, meat, shellfish, yeast, and sardines, mackerel, etc. ' Reduce excess food intake including processed carbohydrates, excess fat and excess protein.

Other encouraging statements were that all extension trial patients who had responded earlier to treatment and who were on the every two week course maintained normal uric acid levels, (some were new joiners). 70% of those on an every four week course who had responded earlier to treatment, maintained normal uric acid levels.

Answer : GOUT is a common type of arthritis caused by an increased concentration of uric acid, a by-product of protein metabolism in the liver. It affects more men than women. Sudden attacks of severe joint pains occur when sharp crystals of uric acid (monosodium urates) form in the fluid surrounding a joint due to an elevated level of uric acid in the blood.

Treatment of CPPD The most significant consideration in the treatment of CPPD is controlling the frequency of attacks. Frequent attacks (more than one a year) will result in progressive erosion of the joint, leading to painful chronic arthritis. Isolated attacks (less that one a year) lead to minimal destruction of the joint. The frequency of CPPD attacks determines whether treatment is merely for each attack, or whether daily medication should be taken to lower levels of inflammation.

Celery seed (Apium graveolens) helps the kidneys dispose urates and other unwanted waste products as well as working to reduce acidity in the body. The seeds are also a carminative, with a mild tranquilising effect. Guaiacum is used in Europe, especially in Britain, to help with arthritic and rheumatic conditions. It has anti-inflammatory properties that help to reduce muscle aches, joint pains and swelling. It is also diuretic and speeds the elimination of toxins, which makes it valuable for treating gout.

In other patient groups there were reductions in attacks and improvement in tophi reduction. Tophi are those knobbly shaped, awkward looking, lumps of MSU crystals that often develop in longer term gout sufferers.

Pegloticase is getting closer to an application for approval by the U.S. FDA. Its developers hope to apply for a Biologics Licence Application in September 2008, and begin marketing it in 2009.

The first sign of gout is usually an intense pain during the night. The attack is commonly brought on following a day or evening of excess in alcohol, food, some drugs, or surgery. If the attack progresses, fever and chills will follow. Recurring attacks are common (90%), mostly occurring in the first year. While chronic gout is quite rare, gout sufferers do have a higher risk of kidney dysfunction and kidney stones.

To maintain healthy joints, you need to refrain from the consumption of rich fatty foods, refined carbohydrates and alcohol, as they can be converted by the body into inflammatory substances that can aggravate the condition.

In May 2008 the U.S. based company developing Pegloticase made another upbeat statement assessment of what they have learnt in its Phase 3 and open label extension trials. Note that Pegloticase still awaits approval from medical authorities so I am writing here about a new gout drug that is still under development.

 
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Increase your intake of foods high in dietary fibre (vegetables, fruits) and complex carbohydrates (oats, barley, bran). Reduce or avoid alcohol and caffeine consumption. Wheat, dairy products, corn, beef, tomato, potato, eggplant and peppers can aggravate arthritis. Light exercises like brisk walking help to keep the joint cartilage lubricated. Being overweight can burden the joints, especially the knees, thus aggravating the pain. Losing some weight will be of benefit.

TRIAL SUCCESS WITH DIFFICULT TO TREAT GOUT PATIENTS Pegloticase is significant because its trials have focused on gout patients who have not had success with other gout drugs, or who have medical conditions which prohibit the use of them. Thus it has been tackling harder-to-treat gout cases, not the easier ones. Hard to treat cases are a significant percentage of the gout sufferer universe.

In the world of natural gout remedies, uric acid's removal can be improved by making it more soluble. This is achieved by drinking lots of water and by raising body pH levels in various ways.

There are two main types of gout, primary and secondary. Most (90%) of gout sufferers fall into the 'primary' category. This is a pattern with a cause that is generally unknown (idiopathic), although there are some genetic patterns that can lead one to tend toward elevated uric acid. Secondary gout is identified when uric acid is elevated in response to some other disorder (such as kidney disease). Some medicines (such as aspirin and diuretics) can lead to the onset of gout attacks because they decrease the excretion of uric acid from the body.

Question : I WAS told by my doctor recently that I have gout. My uric acid level is high. Since this may be at an early stage as I just had the pain attack, how can I manage it? Are there any supplements that can help?

It has been having a decent degree of success. Elimination of gout attacks In its most recent statement the developing company's most significant remark was that the extension trial group receiving Pegloticase every two weeks, there were only four gout attacks among those who had been administered Pegloticase (8 mg) every fortnight for two months, in subsequent months. And none in this group had a gout attack after five months of Pegloticase treatment, in following months. All were patients who had been through a phase 3 trial.

If you find yourself or your loved one suffering from a gout attack, it is unlikely you would hesitate to seek professional help. The pain of an acute gout attack has been compared to the pain of childbirth.

31% of patients who had not reduced tophi at the end of these phase 3 trials did show tophi reduction in the extension trial. It would seem that the longer a gout sufferer is able to take Pegloticase the more successful it may be, in tophi cases at least.

Differential Diagnosis: The differential diagnosis for this condition should include;- fracture gout osteoarthritis infection of the joint

rheumatic fever

About the author:
Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle
surgeon. Dr. Oster is also board certified in pedorthics. Dr.
Oster is medical director of href=http://www.myfootshop.comMyfootshop.com and is
in active practice in Granville, Ohio.

Symptoms: The symptoms of pseudogout are similar to gout showing an abrupt onset and significant pain. Xray finding may resemble gout with juxtachondral (immediately next to the joint) erosions of the bone.

This suggests that progression of the disease may be contained in difficult-to-treat cases, and therefore may not cause other medical conditions such as kidney stones heart disease and hypertension.

Gout is caused by elevated levels of uric acid in the fluids of your body. These uric acid crystals deposit in joints, tendons and kidneys, damaging the tissues and causing inflammation and pain. The pain is a result of countless needle-like crystals that form from the excess uric acid.

HOW PEGLOTICASE WORKS What makes Pegloticase a very interesting, and more importantly, a hopeful new gout drug, is the way it works. All drugs used in gout try to cure or alleviate the disease by reducing the body's uric acid (UA) levels. They do this by either inhibiting its production or making it easier to remove.

Gout: A Foe for your Toe Gout is a misunderstood malady. Despite the intense pain that gout can bring, it is a condition that is rarely makes the glossy pages of a magazine. If you are ever personally hit with the sudden onset of gout, classically (50% of the time) seen as a sudden and excruciating pain in the big toe, you will have a newly found interest in the following information.

May was a good month for gout sufferers. Febuxostat, (EU trade/brand name Adenuric), the first new major drug medication for gout in over 40 years, was approved for marketing in member countries of the European Union.

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NB. The contents of this article contain medical information not medical advice. Please always discuss gout remedies with your doctor or other health care professional, before implementing any treatment.


 
 
     
 
 





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