"Gregory Morrow" > writes:

> An "evergreen" subject... :
>
> http://www.nytimes.com/2009/06/13/he...t.html?_r=1&hp

Thanks, Greg. Very interesting article. Thanks to allupurinol, I
haven't had an attack in over 12 yrs, but it's nice to know medicine
is taking another look.

I think another reason for gout being on the rise is cuz in recent
years Americans have been exposesed --thanks to cooking shows-- to
more diverse and exotic foods. I'm quite sure my gout onset was due
to my love of salted anchovies, an item I didn't even know existed
till I ran across it on some cooking show (Julia?). Same with organ
meats, pates, and other foods long common to Europe, but heretofore
unseen in heartland meat/potatoes America.

nb

>
> June 13, 2009
>
> Disease of Rich Extends Its Pain to Middle Class
>
> By ANDREW POLLACK
>
> "Lonnie Matthews, a retired building maintenance engineer in Burlington,
> N.C., has something in common with King Henry VIII, Sir Isaac Newton and
> Benjamin Franklin. He has gout.
>
> Often called the "disease of kings" because of its association with the rich
> foods and copious alcohol once available only to aristocrats, gout is
> staging a middle-class comeback as American society grows older and heavier.
>
> The rising tide of gout - an extremely painful arthritis of the big toe and
> other joints - is leading the pharmaceutical industry to rediscover what it
> had considered a disease of the past. Companies are now racing to improve
> upon decades-old generic drugs that do not work well for everyone.
>
> Already this year the Food and Drug Administration has approved the first
> new gout drug in more than 40 years, a product called Uloric from Takeda
> Pharmaceutical.
>
> Another new drug, Krystexxa, made by Savient Pharmaceuticals of East
> Brunswick, N.J., will be reviewed for possible approval by an F.D.A.
> advisory committee on Tuesday.
>
> And several other companies are testing drugs in clinical trials.
>
> "It's kind of like the forgotten disease," said Barry D. Quart, chief
> executive of one of those companies, Ardea Biosciences of San Diego.
>
> Ardea discovered accidentally that an AIDS drug it was developing might work
> against gout. Now the company has shifted its focus to gout, envisioning
> annual sales of $1 billion if its drug is successful.
>
> That would mean a huge increase in spending on gout medicines, which had
> sales of only $53.4 million last year, according to IMS Health, a health
> care information company. Uloric, the drug from Takeda, sells a daily pill
> for at least $4.50 compared with 10 to 50 cents for the most commonly used
> generic, allopurinol.
>
> It is estimated that two million to six million Americans have gout.
> Although the disease becomes more common as people age, some men develop
> gout in their 40s and 50s, or even younger. It is three to four times as
> common in men as in women, in part because estrogen is thought to protect
> premenopausal women from the illness.
>
> Various studies suggest that the number of cases in this country has as much
> as doubled in the last three decades.
>
> "We have accumulated a lot of people with severe disease," said Dr. Robert
> A. Terkeltaub, section chief of rheumatology at the Veterans Affairs Medical
> Center in San Diego and a consultant to some of the companies developing
> gout drugs. And the typical case these days, is "not going to be someone who
> looks like Henry VIII," he said. "Now it's going to be some 80-year-old lady
> with congestive heart failure."
>
> One of the severe cases is Mr. Matthews, who had controlled his disease for
> many years with the generic allopurinol. But when he developed renal
> problems in 2006, he stopped taking allopurinol because it can be harmful to
> those with bad kidneys. After that, Mr. Matthews was bedridden or in a
> wheelchair and in such excruciating pain in many of his joints that he said
> he contemplated suicide.
>
> "It was like having a toothache so bad you can't stand it, all over your
> body," he said.
>
> Mr. Matthews, 76, says he found relief as a participant in a clinical trial
> of Savient's Krystexxa, the drug now up for review by the F.D.A.
>
> Gout is caused by the buildup of a chemical called uric acid in the blood.
> Uric acid is formed by the breakdown of purines, which are components of
> DNA, RNA and some other important molecules in the body.
>
> Some types of meat and fish, as well as beer, are particularly rich in
> purines and can raise the risk of gout. There is also evidence that sugary
> soft drinks raise the risk.
>
> When uric acid levels get too high, the chemical can form needlelike
> crystals that accumulate in joints.
>
> In the early stages of the disease, gout attacks, which can last several
> days and are excruciating, occur only rarely. But over time, the frequency
> increases and people can develop disfiguring and disabling lumps of the
> chalky white crystals, called tophi. Michael Clayton of Atlanta, who has
> severe gout, said he had to quit a job as general manager of a restaurant
> after customers complained about the tophi on his hands, which sometimes
> oozed liquid resembling Wite-Out.
>
> Many doctors and patients treat only gout attacks. They use either pain
> relievers like naproxen, steroids or colchicine - a crocus plant derivative
> that has been used for centuries.
>
> Many of the new drugs lower uric acid levels in the blood, meaning they can
> prevent gout attacks and keep the disease under control.
>
> A problem in getting doctors to prescribe chronic treatment for gout is that
> many patients are reluctant to admit they have the disease because of its
> association with gluttony.
>
> "It's part of society's view of gout that this is something self-inflicted,"
> said Dr. N. Lawrence Edwards, professor of medicine at the University of
> Florida.
>
> So the industry is trying to spread the word that genetics and other
> factors, not just diet, contribute to gout. Takeda and Savient bankroll the
> Gout and Uric Acid Education Society, which is led by Dr. Edwards and was
> formed in 2005 to raise awareness of the disease.
>
> Another reason that gout is shedding its image as a disease of the past is
> preliminary evidence - though still far from proof - that high uric acid
> levels might also contribute to modern-day ills like hypertension, obesity,
> heart disease, kidney impairment and diabetes.
>
> In one small study published last year, treatment with allopurinol reduced
> high blood pressure in adolescents.
>
> Right now, it is estimated that 15 million to 20 million Americans have
> elevated uric acid levels, known as hyperuricemia. But they do not have gout
> symptoms and are therefore not treated.
>
> If further studies prove that high uric acid levels contribute to other
> diseases, though, then "hyperuricemia" could be defined as a disease in its
> own right and millions of people might one day take drugs to lower uric acid
> levels, much as they now do to lower cholesterol.
>
> Paul Hamelin, president of Savient, said, "There's a huge amount of ground
> that nobody's ever plowed yet."
>
> </>