Increasing drug dose helps to cure gout

Health researchers at the University of Otago, Christchurch have established that thousands of gout sufferers may have been taking too lower dose of the most commonly used drug to effectively manage or cure this form of arthritis.

Gout is a painful affliction which affects thousands of New Zealanders, particularly Mâori, is often difficult to treat and can lead to almost complete immobility in some sufferers.

One of the main difficulties in managing gout is that it has been a challenge for doctors to tailor the right dose of the main frontline drug, allopurinol, to the needs of particular patients because of current clinical guidelines.

Research by rheumatologist, Dr Lisa Stamp, from the UOC has found that by increasing the dose of allopurinol for patients, above the current medical guidelines, 86% of gout sufferers reduce the level of uric acid in the blood to a level where the disease is less likely to occur or is cured altogether.

"Excessive uric acid, above 0.36mmol/L tends to produce painful bouts of gout. But the problem is that the current medical guidelines have been set at such a low level that it’s quite difficult to reduce uric acid and control gout," she says. "The concern has always been the possibility of negative side effects."

Stamp’s research shows that over 12 months most patients’ gout improved because uric acid levels dropped below the critical level when dosage of allopurinol was increased above recommended levels; and importantly with few if any side effects.

"For the first time this research presents the possibility that this painful illness can be better controlled or cured by varying the dose to each individual patient’s uric acid levels with little risk of major side effects," she says.

Gout is a painful and potentially disabling form of arthritis that has been recognised since ancient times. Initial symptoms usually consist of intense episodes of painful swelling of single joints, most often in the feet and particularly the big toe. With many people it restricts their lives and limits their mobility.

Dr Stamp recently presented the results of her study to a major conference in Philadelphia, USA, convened by the American College of Rheumatology.

This study was funded by Arthritis New Zealand and the Canterbury Medical Research Foundation.

(Source: University of Otago: 73rd Annual Scientific Meeting of the American College of Rheumatology, Philadelphia: October 2009)