Ease Arthritis Pain

Easing Arthritis Pain

One of the most commonly used arthritis medications is a category called NSAIDs, or nonsteroidal anti-inflammatory drugs, which reduce both pain and inflammation. Popular over-the-counter NSAIDs include naproxen sodium, as well as ibuprofen, both of which are available under a wide variety of retail "store-brand" labels.

"Pain and swelling have a serious impact on quality of life for many arthritis patients," says Dr. John Tower, president and medical director of Arthritis Physicians LLC in Rochester Hills, Mich. "In combination with other therapies, NSAIDs like naproxen sodium and arthritis pain-relieving topical ointments can provide some symptomatic relief, and therefore can be an important part of a patient's treatment plan."

More information on treatments for arthritis at Southeast Sun

Gout Treatment maker expanding

Takeda Pharmaceutical Co. (4502), Asia’s largest drugmaker, agreed to buy closely held Multilab Industria e Comercio de Productos Farmaceuticos Ltda. for 500 million reais ($246 million) to gain a sales network in Brazil.

Multilab, based in Sao Paulo, has a well established distribution network of regional wholesalers and small- to mid- size independent pharmacies in emerging regions of the country, according to the statement. This is the second acquisition announced by Takeda this year after it agreed last month to buy closely held URL Pharma Inc. to gain a new gout treatment.

See Bloomberg for the remainder of the article about this pharmaceutical which makes gout treatments.

Gout Joke

A gout joke

Sam Weinstein and Patrick Simpson are sharing a hospital room because they both have gout in one of their legs. Gout is a very painful condition, so when the doctor walks in and begins to examine Patrick (who isn’t Jewish), he begins to scream and cry in pain as the doctor handles his leg.

Then the doctor goes over to the Jewish patient, Sam, and begins to examine his leg, but Sam doesn’t make a sound.

When the doctor finishes the examination and leaves, Patrick says to Sam, “You are the strongest, most stoic person I have ever met. To be in that much pain and not cry out is truly the greatest demonstration of the silent acceptance of suffering that I have ever witnessed.”

Sam smiles and says, “Actually, I can’t stand pain at all — that’s why I gave the doctor my good leg to look at.”

Yeah, a gout flare up isn't really a laughing matter, but its good to laugh, even when having a gout attack.

Stages of Gout

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) there are four stages of gout:

• Asymptomatic (without symptoms) hyperuricemia

• Acute gout, or acute gouty arthritis

• Interval or intercritical gout

• Chronic tophaceous gout

Tophaceous Gout

“Chronic tophaceous gout. This is the most disabling stage of gout. It usually develops over a long period, such as 10 years. In this stage, the disease may have caused permanent damage to the affected joints and sometimes to the kidneys."
Continue article at Empowher

I wonder if tophaceous is the stage I was at? I was blessed from time to time with a day or two where I had almost no pain or stiffness. But this was usually when it was transferring to a different joint. I am very fortunate that I never had gout in more than one joint at a time. It would switch from right to left and back again. And when it got my knees, it was just one knee at a time and no other joint.

Been gout free for over a year now and I ain't going back!

New Funding For Gout Sufferers

Funding for "gout capital of the world"

Arthritis New Zealand welcomes the new $6 million Pacific Innovation Fund, aimed at improving the health of Pasifika people.

Chief Executive Sandra Kirby says gout is a significant health issue for New Zealand’s Pasifika people.

“Gout is one of the most common forms of arthritis, and it is often said to be the most painful. Data from one primary health organisation in South Auckland shows that nearly 15 per cent of Pacific men have been diagnosed with gout. In fact, New Zealand has been called the ‘gout capital of the world’.

Read more at Scoop

Good news for those suffering from gout, and I second it being the most painful!

How to ease arthritis pain

For the 50 million American adults currently suffering from arthritis, symptom management is the name of the game. Although it's the leading cause of disability in the U.S., and the second most frequently reported chronic condition, there are currently no cures for the family of musculoskeletal disorders known as arthritis, according to the Arthritis Foundation. Therefore, arthritis treatment focuses on relieving symptoms and improving joint function.

The most common forms of arthritis include osteoarthritis, rheumatoid arthritis, lupus, gout and fibromyalgia.

Traditionally, the common signs and symptoms of arthritis (literally meaning "joint inflammation") may include joint pain, stiffness, swelling, redness and a decreased range of motion. There are numerous types of arthritis - more than 100 in all - and therefore many treatments, including prescription and over-the-counter medications, physical therapy, lifestyle and home remedies, surgery and alternative medicine. Many arthritis sufferers will benefit from some combination of these options.

Click on the Las Vegas Review to read the remainder of the article How to ease arthritis pain

Arthritis Sufferers likely to suffer anxiety, depression

Study finds 1/3rd those with Arthritis suffer from anxiety or depression

A new national study finds that one-third of people with arthritis also experience anxiety or depression. This combination of physical and mental impairments points to the complexity of chronic illness and the importance of working closely with physicians to document these conditions, according to Allsup, which provides Social Security Disability Insurance (SSDI) representation and Medicare plan selection services.

The study, reported this spring by the Centers for Disease Control and Prevention, analyzed data gathered from nearly 1,800 U.S. adults in the Arthritis Conditions and Health Effects Survey. The CDC noted that about 50 million adults have arthritis or other related conditions, such as rheumatoid arthritis, lupus, fibromyalgia or gout.

Read more at Houston Chronicle

More Gout Awareness Day news

May 22 is Gout Awareness Day: New gout recommendations highlight lifestyle changes as a key to managing acute gout symptoms

Gout & Uric Acid Education Society encourages gout patients to talk to their doctors about treatment options

 PITTSBURGH, May 22, 2012 /PRNewswire via COMTEX/ -- New recommendations from the American Society of Clinical Rheumatologists (ASCR), published in Postgraduate Medicine, highlight updated management recommendations for patients with acute gout. These new recommendations come at a time when the incidence of gout is soaring; 8.3 million Americans are estimated to be gout patients.


Read more at Market Watch

National Gout Awareness Day

Today, May 22nd is National Gout Awareness day.
In celebration I am

living gout free!

I hope that you will soon be as well.

For more information on becoming gout free, please check the other articles on this blog.

FDA Panel votes against gout drug Regeneron

U.S. drug advisers unanimously voted against Regeneron Pharmaceuticals Inc's experimental drug to prevent gout flares, based on studies that tested the drug for only 16 weeks.

A panel of outside experts to the U.S. Food and Drug Administration on Tuesday voted 11-0 against approving the injectable drug, called Arcalyst, because its clinical trials were too short to prove the treatment was safe, or that it would help patients over time.

Gout is a painful condition that occurs when the bodily waste product, uric acid, is deposited in the joints and soft tissues, causing inflammation and sometimes making it difficult to walk. It affects about 5 million to 6 million Americans.

Read more at Reuters

Gout is on the rise in Australia

Gout is an excruciatingly painful form of arthritis, but it can respond well to changes in lifestyle.

Recent research suggests that the rate of gout in Australia has been steadily rising since the 1960s, and now affects 70,000 Australians a year. The prevalence is particularly severe in men over 70. According to a recent study, gout affects 16.5 per cent of elderly men, which is the second-highest reported rate in the world.

While gout is most common in elderly and middle-aged men and post-menopausal women, it can affect people of any age. Gout is actually a form of arthritis or swelling of the joints, and usually affects the big toe, as well as the feet, ankles and knees. However, it can sometimes appear in the fingers, wrists and elbows as well.

Read more at Body And Soul

So we have seen about purines and how they affect the uric acid levels. But what are the underlying reasons for this?

Root causes of gout:

Rapid weight loss
Starvation

Injury
Surgery
Infection

Medications

Chronic lead exposure and lead-contaminated alcohol
uromodulin-associated kidney disease (UMOD)

Sleep Apnea

I have grouped these into semi-related groups so that they can be addressed more in depth

Rapid weight loss and Starvation

These are related in that when the body loses weight in a quick manner, the cells die off and are processed back into nutrients. This causes an elevated level of purines to be released into the system. While it is very important to maintain a healthy weight when suffering from gout, it is important to not over do your diet so as to lose weight too quickly. And of course, with all weight loss programs, one should always talk to your doctor. He can provide guidance, as well as the checkup you may need before starting out. After all, if you are a chronic gout sufferer, you probably haven't done much exercise recently. I know I sure hadn't!

Injury/Surgery/Infection

All of these can lead to localized damage to a joint which would make it more susceptible to arthritis in all its forms, including gout. For injury and surgery the most you can reasonably do is to give the proper rest and care. With any infection, it should be treated in an appropriate manner. However, I fear that once you have this type of damage there isn't much you will be able to really do about it.

Medications

Drugs, legal or illegal, can cause all manner of problems. And ironically, medicines specifically for gout can cause a flare up. It is said that the reason for this is the rapid reduction of uric acid is the reason that the flare up happens. One is also warned not to start uric acid reducing medicines while having a flare up as they can make it worse.

Lead exposure and kidney disease

The kidneys are the organ that removes the uric acid from your system. If they are impaired, perhaps because of a toxin like lead, or due to kidney disease, such as uromodulin-associated kidney disease or reduced kidney function as witnessed in those with some level of kidney failure, the amount of uric acid they will be able to remove will be reduced. If your kidneys are indeed operating at reduced efficiency, work with your doctor to address the situation. Additionally, those afflicted with gout are more likely to have kidney stones.

Sleep Apnea

Not something that most would think connected. Sleep apnea can be a root cause of gout because a person with sleep apnea stops breathing during the night. This causes cells to become oxygen starved and release purines into the bloodstream. Fortunately, there are many more options now than the dreaded sleep apnea mask. Find someone locally who deals with snoring and sleep apnea and talk to them about treatment options such as somnioplasty. With somnioplasty you are in and out in the same day on a nearly painless out-patient procedure. If you suspect you might have sleep apnea, get it checked out. It can cause gout, but also affects many other things and puts you at a greater risk of heart attacks and stroke along with a host of other rather horrible things. A Seattle area medical practice that deals with snoring and sleep apnea, among other things, check out NorthWest Face


Also check out this list of purine containing foods

Comprehensive list of purine containing foods

I've compiled the best list of purine containing foods that I could find to give a reference for others suffering with gout. Below you will find a list of common foods and the levels of their purines. If you are looking to restrict your intake of purines, this will be invaluable. I would suggest taking all animal sources over 125 or so and cut them out straight away. Others will counsel going much lower and you may indeed need to do that, but at the same time, it is very difficult to cut out all meat from your diet and you may find that you don't even need to. But all meat is not equal when it comes to purines. For example, sardines have have 399mg per 100g, but a steak (sirloin) sits at 110. In fact, fish seems to top the list of meats with the exception of organ meat. It might be worthwhile to cut that out for a time. 1 month should be sufficient to let your body catch up with your intake and let you know if you have lowered your purine intake enough.

Foods Containing Purines

Ultimate Food Purine Content list

Food	mg/100g
Yeast, Brewers	1810
Yeast, Bakers	680
Beef liver	460
Anchovies	411
Sardines	399
Herring	378
Sardines	345
Anchovies	321
Fish, Trout	297
Fish, Tuna in oil	290
Pork liver	289
Liver	286.4
Fish, Tuna	257
Salmon	250
Mackerel	246
Chicken liver	243
Chicken liver	243
liver, boiled	237
liver, broiled	236.1
Liver, chicken	236.1
Shrimp	234
Kidney	230.8
Blackeye peas	230
Chicken heart	223
Lentils	222
Beef kidney	213
Great northern bean	213
Liver, raw	202.2
Small white bean	202
Beef liver	197
Split peas	195
Mackerel	194
Lamb (muscle meat)	182
Fish, Halibut	178
Chicken breast (with skin)	175
Beef heart	171
Lamb heart	171
Pinto bean	171
Fish, Salmon	170
Pork (muscle meat)	166
Beef brain	162
Red bean	162
Turkey (with skin)	150
Large lima bean	149
Lamb liver	147
Shrimp (brown)	147
Baby lima bean	144
Tuna	142
Clams	136
Scallop	136
Squid	135
Ground beef (muscle meat)	133
Drumstick, chicken	132.3
Ham (cooked)	131
Poultry	130.7
Breast, chicken	130.7
Gizzard, chicken	130.5
lamb, roasted, chop	127.5
Lentil, seed	127
Thigh, chicken	126.5
Steak, broiled	121
Beef, chuck	120
Pork, roasted, chop	119
Haddock, broiled	118.7
Lobster	118
Fish, white, fresh	115.9
Mussel	112
Peas, chick (garbanzo)	110
Beef, sirloin	110
Fish, cod	109
Steak, boiled	107.8
Oysters	107
Steak, raw	105.9
Skin, chicken	104.6
Haddock, raw	101.7
Haddock, boiled	94.7
Oats, whole grain	94
Oyster	90
Frankfurter	89
Salmon	88
Pea, green	84
Brocolli	81
Peanuts	79
Cranberry bean	75
Clams	62
Crawfish	60
Mushroom	58
Banana	57
Garbanza bean	56
Corn	52
Mushroom, fresh	46.9
Asparagus	23
Potato	16
Bread, crusted	15.7
Bread, white	12.2
Wheat flour	11.5
Cottage cheese	8
Plain yogurt	7
Rice, cooked	5.9

Note: there are several instances of the term "liver" and different levels of purines given by these sources. Perhaps this is due to testing only a single source? I don't have an answer on that. However, I can state that with as high as liver shows on the list it is a food that should be cut out anyways.

Sources:
Ellington, Anna. Reduction of purine content in commonly consumed meat products through rinsing and cooking

Clifford, Andrew J. and Story, David L. 1976. Levels of Purines in Foods and Their Metabolic Effects in Rats. J. Nutr. 106: 435-442.

Brule, D. Sarwar, G., and Savoie, L. 1988. Purine content of Selected Canadian Food Products. Journal of Food Composition and Analysis 1(2): 130-138.

Brule, D., Sarwar, G. and Savoie, L. 1989. Effects of methods of cooking on free and total purine bases in meat and fish. Can. Insti. Food Sci. Technol. J. Vol. 22(3): 248 - 251.

Choi, H. K., Atkinson, K., Karlson, E. W., Willett, W., and Curhan, G.. 2004. Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men. The New England Journal of Medicine, Vol. 350(11):1093-1103.

Clifford, A. J. and Stroy, D. L. 1976. Levels of purines in foods and their metabolic effects in rats. Journal of Nutrition 106: 435-442.

Gibson, T., Rodgers, A. V., Simmonds, H. A. and Toseland, P. 1984. Beer drinking and its effect on uric acid. British Journal of Rheumatology, 23: 203 - 209.

Young, L. L. 1980. Evaluation of four purine compounds in poultry products. Journal of Food Science 45: 1064-67.

Where Are Purines Found?

Where are Purines found?

Lets start off with the overview:
Purines are found in high concentration in meat and meat products, especially internal organs such as liver and kidney. In general, plant-based diets are low in purines. Examples of high-purine sources include: sweetbreads, anchovies, sardines, liver, beef kidneys, brains, meat extracts (e.g., Oxo, Bovril), herring, mackerel, scallops, game meats, beer (from the yeast) and gravy.



A moderate amount of purine is also contained in beef, pork, poultry, other fish and seafood, asparagus, cauliflower, spinach, mushrooms, green peas, lentils, dried peas, beans, oatmeal, wheat bran, wheat germ, and hawthorn.

Higher levels of meat and seafood consumption are associated with an increased risk of gout, whereas a higher level of consumption of dairy products is associated with a decreased risk. Moderate intake of purine-rich vegetables or protein is not associated with an increased risk of gout.

Please note that the intake of plant based sources of purines are not associated with an increased risk. This is a bit odd, as you will see from the data below that some of these plant sources are every bit as high as the meats:

Relative Purine Levels

Food	mg/100g
liver, boiled	237
liver, broiled	236.1
Liver, chicken	236.1
Shrimp	234
Kidney	230.8
Blackeye peas	230
Chicken heart	223
Lentils	222
Beef kidney	213
Great northern bean	213
Liver, raw	202.2

The above is just a portion of the list compiled for the next post which has a pretty extensive list of purine containing foods and you will no doubt find it very valuable in your fight against gout.

As you can see, black-eyed peas, lentils and great northern beans are on the very high list, where anything over 100mg per 100g of food is considered high. Personally, I eat lentils on a regular basis, (with ham of course!) and have never had a reaction to it. I have eaten calf liver with no problems but I have a suspicion that dessicated liver (pill form) has given me flare ups, but I can't confirm that yet. I actually plan to test that soon but I am currently partaking of my primary trigger food right now (soda), so it will have to wait (besides, its dessicated liver. Trust me when I say it can wait! lol)

Next up: The best list of foods that contain purines

Causes of gout

So now that we have covered the symptoms of gout, its time to answer the question "What is the cause of gout?"

That answer is simple. The buildup of uric acid which crystallizes in a joint. These crystals are pointy and sharp which is the cause of the pain. Thats the short and simple answer. Now to expand upon the underlying causes behind that buildup of uric acid.



There are numerous things that can cause a buildup of uric acid in the body but can largely be broken down to two items.  Either the kidneys do not secrete enough uric acid, or too much uric acid is being created or a combination of the two. Now, it is possible that there are problems with the kidneys so that they do not process uric acid normally. This can be due to a mutation of the uromodulin (or UMOD) gene, which may also be referred to as  uromodulin-associated kidney disease. I will discuss this further in another post as this is a less likely root cause.

The bigger part of the equation is the buildup of excess uric acid. No doubt you have read of purines over and over again, but what you may not know is why purines are the bogeyman. Purines are necessary to life. As Wikipedia puts it: Aside from the crucial role of purines (adenine and guanine) in DNA and RNA, purines are also significant components in a number of other important biomolecules, such as ATP, GTP, cyclic AMP, NADH, and coenzyme A.

Most animals, in fact all mammals with the exception of humans produce an enzyme called uricase that breaks down purines so that they can be removed from the body. But as we don't, the purines get processed in the liver where they become uric acid. This then goes through the bloodstream until it is processed out by the kidneys. If the production of uric acid exceeds the rate of removal for a long enough period of time, the body will enter a state of hyperuricemia, which simply means elevated uric acid. Once in this state, the risk of gout increases greatly. The body starts to form the needle like monosodium urate (MSU) crystals which are what cause gout to be so painful.

Next up: Purines, where are they found

Gout and its symptoms

About Gout, Symptoms, Causes, Treatment and Relief

As a long time sufferer of gout I thought that I would create my own little piece of "blog.com" to help people who are suffering from gout find some relief. I myself suffered with it for over a decade and have finally gotten mine taken care of through watching my diet which I will discuss in a later post. But first things first, lets start by talking about things like "What is gout"

So tell me about gout, you say. Gladly. Well, not really. Honestly I wish that I was one of the many who didn't know and didn't care about gout. Why? Because its extremely painful and can be debilitating. But you already know that, so lets move on and give a simple definition. Gout is considered a form of inflammatory arthritis, where the "victim" often has recurring acute attacks, which are also known as "flare ups."

Symptoms

WebMD lists gout symptoms like this:

• Warmth, pain, swelling, and extreme tenderness in a joint, usually a big to joint. Symptoms sometimes start in a different joint, such as the ankle or knee.
• Pain that starts during the night and is so intense that even light pressure from a sheet is intolerable.
• Rapid increase in discomfort, lasting for some hours of the night and then easing during the next few days.
•  As the gout attack subsides, the skin around the affected joint may peel and feel itchy.

Other symptoms may include:

• Very red or purplish skin around the affected joint, which may appear to be infected.
• Limited movement in the affected joint.

Wikipedia puts it much shorter by saying:
 Gout can present in a number of ways, although the most usual is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint).


In my case, I would often wake one day with stiffness in my big toe which would grow over several days until walking was nearly impossible. This is because when you walk your toes bend upwards but due to the inability to move my big toe (or sometimes a middle toe.) So at best I was forced to hobble around. Eventually I purchased a cane which helped out tremendously with mobility and I highly recommend getting one. I actually have two, one for the house and one for the car so that I always had one near. They are less than $20 at any grocery store and are much more dignified than hobbling around!

Next up: Causes Of Gout.