Tophi Gout Treatment Will Improve

The general public doesn't know it, but some gout sufferers do. At long last we are in a good period for new gout treatments. In fact gout treatment looks rosier now than ever before in the known history of the disease. And that's over 2, 000 years.

Febuxostat has been approved by the European Medicines Agency (EMEA) for sale in EU countries, and many other countries should follow, although it has not been approved in the U.S. and it's not known at present when it will be. The developers of pegloticase will apply later in 2008 to the FDA for U.S. approval.

And at the European League Against Rheumatism (EULAR) meeting in Paris in June 2008 new anti-gout compounds, currently called RDEA806 and RDEA594, were presented. In an early human study they have demonstrated potent reduction of uric acid (UA), the excess of which is a cause of gout in most cases. RDEA594 will be developed as a uric acid reducing drug medication, but it has many years of trials ahead of it before approval can come.

TOPHI GOUT TREATMENT

One of the most encouraging things about febuxostat (EU trade name: Adenuric) and pegloticase is their ability in many cases to dissolve tophi. Tophi are the unsightly lumps of MSU crystals which develop in the bodies of gout sufferers after several years if there is no gout cure or sufficient alleviation to stop tophi growing.

They usually first appear in toes, but also in hands, ankles, elbows, knees, body tissues and other locations. Even inside the kidneys and heart, although this is rare. They may be benign, they may not. If they aren't, they can burst out of the skin, become ulcerated and septic - perhaps leading to that dangerous condition sepsis (septicemia) - destroy joints and grow into bone. Their appearance in long term gout sufferers is not inevitable. About 25% of all gout sufferers have some degree of tophi.

Tophi's growth can be halted, and tophi dissolved, if blood uric acid levels can be reduced to the 6 mg/dL, (357 mmol/L) or below, mark. Studies have shown that this frequently happens at or below this level.

Short of surgical removal, which does sometimes become necessary to stop the problems noted above, lowering uric acid levels is the only way of dealing with tophi.

In phase 3 trial extensions both febuxostat and pegloticase have been successful against tophi, but success has taken time. Febuxostat had little effect after six months and the EMEA's assessors were not clear that it had been very successful after one year. But after a two year trial extension (i.e. three years in total) febuxostat delivered a complete tophi removal success rate of over 50%. Pegloticase, for which less data is currently available than for febuxostat, and which has not been approved anywhere yet, has also been more successful in trial extensions.

HOW LONG DOES IT TAKE?

Much depends on the size, number and location of tophi in the body, patient compliance with treatment, and starting treatment UA levels. Febuxostat has so far shown most success after three years of treatment. And the statements the developers of pegloticase have made also suggest that the longer the treatment, the more effective against tophi it will be.

NATURAL GOUT REMEDIES

The addition of natural gout remedies - diets, special foods such as cherries, drinking water as if you are a gas guzzling car, improving body pH levels with baking soda (bicarbonate of soda) and other alkalizing agents, and vitamins, has not been tested with these medications. But I suspect that, if it is safe for them to be used, they will be of extra help, and so play a part in treating tophaceous gout, maybe faster than the drug medications alone.

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