Rise in gout prevalence due to poor disease management

Gout is a form of arthritis where joints are inflamed due to the build-up of urate crystals. Most arthritis forms are not yet curable, and medication is generally prescribed to alleviate symptoms of pain and inflammation. However, gout is a curable condition when it is well managed. Gout treatment plans that involve regulating uric acid levels by preventing its accumulation and increasing its excretion, improves gout condition. When all the urate crystals have disappeared, gout has been cured.

However, the worldwide prevalence of gout has increased over the years. From the 2010 Global Burden of Disease study, the estimated global prevalence of gout was 0.08% [1, 2]. In China, the prevalence of gout and hyperuricemia, was 1.1% and 13.3% respectively [3]. In Vietnam, gout prevalence was 0.14% [4].

If gout is curable, why is the prevalence increasing?

The increase in gout prevalence indicates poor disease management and systematic failure in both medical and patient education [5].

“Gout is an extremely well-understood disease, where essentially ‘curative’ urate-lowering therapy is available, and 2 sets of sound international medical guidelines for management have been published in the last 15 months. Yet quality of care, and patient adherence to treatment, remain substandard, a disappointing and unacceptable circumstance for a disease clearly increasing in prevalence.” said Robert Terkeltaub, MD, professor of medicine at the University of California, San Diego, and rheumatology section chief at the San Diego Veterans Affairs Medical Center in California [5].

Gout increases the risk of mortality

Research found that gout sufferers and people with elevated uric acid levels have a 25% higher risk of premature death compared to someone without gout [6, 7]. The risk of death is increased by 9-13% for every 60 µmol/L increase in serum uric acid [7]. In addition, gout sufferers also have a 58% higher risk of cardiovascular death [6, 7].

To decrease mortality risk and extend life expectancy, gout sufferers need to actively manage and reduce their uric acid levels to a recommended level by their doctor, and maintain that level throughout life. Gout sufferers also need to control their comorbid conditions, including hypertension, heart disease and kidney disease [7].

The issues in gout management

Drug therapies

There are a number of drug therapies available for gout management, and each therapy has its own risk:

  1. Non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine function to alleviate gout symptoms of pain and inflammation. They do not lower uric acid levels to address the underlying cause of gout. In addition, these drugs are not recommended for the long term usage because they are associated with health risks (e.g. heart attacks and strokes) and side effects (e.g. nausea, vomiting, and diarrhea) [8].
  2. Allopurinol is a urate-lowering drug used for long term management of gout. This drug does not work immediately and it does not provide pain relief [9]. It is possible that allopurinol therapy can trigger an acute attack when treatment is commenced, stopped, or dosage is increased [9].

Lifestyle factors

An important aspect in gout management is for gout sufferers to avoid lifestyle factors that worsen gout condition. These factors include consuming drinks and foods that are high in purines, e.g. alcohol (especially beer), soft drink, red meat and types of seafood. Consumption of purines need to be avoided because they are converted into uric acid in the body, which further elevates already high uric acid levels in gout sufferers. In addition, alcohol lowers the kidney’s ability to excrete uric acid from the body and intensifies serum acid levels. The constant production of uric acid from purine consumption will ultimately nullify the effects of urate lowering therapies.

If gout sufferers do not make the required lifestyle changes, no improvement in gout will be observed, and they could face more serious consequences such as worsening of gout, and an increase in mortality risk.

Effective management of gout

Effective management and treatment of gout requires the combination of urate lowering therapy and lifestyle adjustments. Gout sufferers need to seriously commit to this treatment plan in the long term to see improvement in their gout condition.

Alternative therapies for gout

Due to the side effects associated with drug therapies, gout sufferers may be looking for alternative therapies for managing gout. There are commercially available herbs and nutrients that are efficacious for gout management (Table 2). These therapies are less associated with serious side effects observed in drug therapies, and can be used long term. They work to lower urate levels, and relieve symptoms of pain and inflammation.

Table 2. Alternative therapies for gout management

Therapy Description Therapeutic effect for gout Mechanism of action
Harpagophytum procumbens (Devil’s Claw) Herb traditionally used for arthritic pain
  • Provides anti-inflammatory and pain relief
  • Inhibits COX-2 enzyme. COX-2 is responsible for the synthesis of prostaglandins, a chemical that causes inflammation and pain.
Prunus cerasus (Tart cherry) A sour fruit with medicinal properties
  • Helps lower urate levels by inhibiting uric acid production
  • Antioxidant activity
  • Inhibits xanthine oxidase, the liver enzyme that is responsible for converting purine to uric acid.
  • Antioxidant support has been hypothesized to counteract metabolic syndrome, which has been linked to the etiology of gout
Apoum graveloens (Celery seed) An aromatic herb with medicinal properties
  • Helps lower urate levels by inhibiting uric acid production
  • Antioxidant activity
  • Inhibits xanthine oxidase, the liver enzyme that is responsible for converting purine to uric acid.
  • Antioxidant support has been hypothesized to counteract metabolic syndrome, which has been linked to the etiology of gout
Folic acid (Vitamin B9) Essential vitamin
  • Helps lower urate levels by inhibiting uric acid production
  • Inhibits xanthine oxidase, the liver enzyme that is responsible for converting purine to uric acid.
Vitamin C Essential vitamin
  • Helps lower urate levels by increasing renal clearance of uric acid
  • Antioxidant activity
  • Antioxidant support has been hypothesized to counteract metabolic syndrome, which has been linked to the etiology of gout
Potassium citrate Essential mineral
  • Prevents formation of uric acid crystals in the kidneys
  • Alkalizing agent. Antioxidant support has been hypothesized to counteract metabolic syndrome, which has been linked to the etiology of gout.

These 6 active ingredients have been combined together in the GOUTfighter formulation.

GOUTfighter – Formulated to relieve symptoms of gout

GOUTfighter is a comprehensive formula that exerts multiple actions to help relieve symptoms of gout, including inflammation, swelling and pain. In addition, it helps address the underlying cause of gout by lowering urate levels through 2 actions: (1) inhibiting uric acid production and (2) increase renal clearance of uric acid. This formulation was made based on traditional medicine and scientific research.

Proudly made in Australia, GOUTfighter is a product regulated by Therapeutic Goods Administration (TGA) – a division in the Australian Department of Health, and manufactured in Australia in compliance with the Good Manufacturing Practice (GMP) to ensure quality, safety and efficacy.

For more information about GOUTfighter, please read the product profile  or the information article.

References

  1. Smith, E., Hoy, D., Cross, M., Merriman, T. R., Vos, T., Buchbinder, R., Woolf, A. and March, L. The global burden of gout: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases 2014;73:1470-1476.
  2. Kuo, C. F., Grainge, M. J., Zhang, W. and Doherty, M. Global epidemiology of gout: prevalence, incidence and risk factors. Nature Reviews Rheumatology 2015; 11, 649–662.
  3. Liu R, Han C, Wu D, Xia X, Gu J, Guan H, Shan Z, Teng W. Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis. Biomed Res Int. 2015;2015:762820. doi: 10.1155/2015/762820. Epub 2015 Nov 10.
  4. Minh Hoa TT1, Darmawan J, Chen SL, Van Hung N, Thi Nhi C, Ngoc An T. Prevalence of the rheumatic diseases in urban Vietnam: a WHO-ILAR COPCORD study. J Rheumatol. 2003 Oct;30(10):2252-6.
  5. http://www.medscape.com/viewarticle/819441 Accessed 14/7/17
  6. http://blog.arthritis.org/gout/gout-risk-premature-death/ Accessed 26/10/17
  7. https://www.ul.ie/news-centre/news/ul-medical-school-researchers-find-increased-death-risk-in-subjects-sufferi Accessed 26/9/17
  8. http://www.health.harvard.edu/pain/pain-relief-taking-nsaids-safely Accessed 14/7/17
  9. https://rheumatology.org.au/ Accessed 7/2/2017
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