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Wednesday, June 1, 2011

Gout: Diagnosis, Management, Drugs Involves, and other features...

"waaan.. mai la urut tok ayah.. kaki sakit nie....", called Granpa. "Jap ye tok ayah.. nk pi amik myk urut sat...", i said. "tok, mane Pathlab pny keputusan yg tok wat mggu lepas? saye nk tgk sat.. awat la yg tok ayah xsehat beno nie...", asked me to my Granpa, wondering why he's looking so sick, and always complaints about his legs. "tu ha atas meja tu", he told me. When i open the file, I was so surprise to see his uric acid level was beyond normal range (4-6 if I'm not mistaken). It was 13!! That was quite high. I asked him to show me his hands. I was more surprise when i saw he had Swan-neck deformity (refer to pic) on his fingers!! I already knew that he had Rheumatoid Arthritis but I never thought it would be this bad. I'm worried that it may develop into other more serious problem, GOUT!!!

As for definition and an overview of Gout, you can click here or here.
Right now, my focus is on the principle of diagnosis, and treatment management of gout.

The basic rule of Diagnosis is base on these 7 variables explained by Emma Hitt (PhD) in her *articles.
"The 7 variables, which describe as "easily ascertainable in primary care," include male sex, previous patient-reported arthritis attack, onset within 1 day, joint redness, involvement of the first metatarsophalangeal joint (MTP1), hypertension or 1 or more cardiovascular diseases, and serum uric acid level of more than 5.88 mg/dL.

When I was in my first year, "asal ckp pasal gout je, mst kua satu drug name 'allupurinol' as the first line tx". Now, "dah advance.. sebut Gout, mcm2x drugs kua and lbey specific" for example; Xanthine oxidase inhibitors (eg Febuxostat, Allopurinol), Uricase Agents, Usricosuric Agent (eg Probenecid), and many more. As prophylaxis and ongoing treatment, Rilonacept has been proven be the best choice of drugs to reduced gout flares during urate-lowering therapy (Emma Hitt, PhD - retrieve from *Medscapes). Rinolacept is less effective to be given as early treatment.

p/s - (*) on hyperlink means that you need to have an account to view the journal.

Over the years, Allopurinol has been widely use for early treatment of gout. In 2009, Febuxostat was approved by FDA and its use has been increasingly favorable among physicians. However there's been issues raised on which is much more effective, and will give a better action while maintaining its therapeutic safety level.

A study of "Febuxostat VS Allopurinol" by Kevin Deane (MD) explains about which drugs is better. In his *articles (published in Medscape News), he states that:
"Febuxostat 80 mg daily is superior to allopurinol in lowering uric acid levels and that febuxostat 40 mg daily is equivalent to allopurinol in such patients. Overall, febuxostat was equally as safe as allopurinol. They also stated that in patients with mild-to-moderate renal impairment, febuxostat at any dose was superior to allopurinol in lowering uric acid levels,". He also states that the study indirectly indicate that febuxostat may be a reasonable alternative for patients with gout who CANNOT TOLERATE Allopurinol.

Well, there you go. You know who's your winner people. However, please bear in mind that,
Your GP might not want to use Febuxostat for several reason. Don't ever be shy to ask them why. If you guys had any grand parents who always complaints about "lenguh2x, xlarat, sakit kaki", better make a quick medical check up. Who knows, your little steps could make a big difference. I did brought my Granpa to see his doctors. I ask him to tell everything about his condition, and his diets. I found that most people just do not have the initiative to let the doctors know what they eat. And doctors doesn't even care to ask. That really makes me wonder. To my friends who took medical course, please do not be like that. It's disgrace to the entire professional healthcare workers if you just don't care. You might know a lot, but its a pity if you keep them to yourselves.

As what a wise man says;
"People just don't give a s*** about how much you know, until they know how much you care"

That's all for now guys. Thanks for your supports. Peace, and take care..!!

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