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A New Gout Drug. Febuxostat wins marketing approval in the European Union

It has taken a very long time for a major new gout drug to be developed and approved. Probably the best gout news in over 40 years, is that Febuxostat, which has been given the trade/brand name of Adenuric, has been approved by the European Medicines Agency for marketing in European Union (EU) countries.


When treating turf toe be sure to recognize the fact that there is no nerve innervation in articular cartilage. Pain associated with stage one turf toe (hallux limitus) is either synovial pain or bone pain. If we recognize that painful stage one turf toe (hallux limitus) may be due to bone pain, we then realize that turf toe should be treated aggressively to insure the long term viability of the joint.


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  Noted possible side effects dizziness, drowsiness, diarrhoea, rashes, headaches, hypertension and liver function abnormalities - considered mild ones. In trials none of these side effects were reported in more than 3.5% of trial patients. The most common were liver function abnormalities.

How Gout Works Gout is characterized with excruciating pain in the joint at the base of the big toe. In fact, about three-quarters of gout sufferers suffer from this excruciating pain affecting the toe. The other areas of the body gout might affect include: the elbows, shoulders, hands, wrists, knees and feet. The gout sufferer's joints will become swollen and inflamed and a fever could also develop. Most often, gout symptoms can last for days (2-5 days). Simply stated, gout is caused by higher levels of uric acid in the blood. There are several reasons for this happening including: overweight, too little activity, too much alcohol, various medications, genetics, or even a health disease (hypertension, etc). Whatever the cause, you can cure your gout if you begin your treatment today!

Your uric acid levels will have to be high. If you have gout but normal or slightly raised uric acid levels as some do, it is unlikely to be prescribed.

References: Lombardi, C.M., Silhanek, A.D., Connolly, F.G., Dennis, L.N., Keslonsky, A.J. First Metatarsophalangeal Arthrodesis for Treatment of Hallux Rigidus: A Retrospective Study. J. Foot Surg. 40:3, 137-143, 2001


Symptoms: Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step. Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

Is the onset of turf toe always the same? Turf toe that is the result of functional hallux limitus is going to be insidious in onset. Functional hallux limitus will usually be seen in younger athletes as they attempt to increase their activity. It may not occur during the first athletic season, or the second, but when it does begin to cause pain, the onset will be more frequent and more severe, varying with activity. This profile of onset is simply due to the fact that the athlete is recreating the injury with every step.

What's the actual physical change that takes place in the joint with turf toe? As an easy analogy, consider the changes that takes place when an apple falls from a height and is damaged. The skin of the apple appears intact but the underlying pulp is damaged. In the case of turf toe (hallux limitus), think of the skin of the apple as the cartilage of the joint and the damaged pulp of the apple is the subchondral bone. Mild cases of turf toe (hallux limitus), result in little damage to the subchondral bone and will merely exhibit signs of inflammatory change within the joint. Most authors would refer to these cases as stage one turf toe (hallux limitus). More severe cases result in damage to the joint surface, the subchondral bone or both. These are the stage two and three cases of turf toe (hallux limitus) that show visible change on x-ray. As the subchondral bone becomes increasingly damaged, it will create an uneven supporting surface for the cartilage. An increase in activity results in uneven loading of the joint due to the compression injury of the subchondral bone.

2. Keep your toe elevated when resting/sleeping. Allow gravity to reduce the inflammation on the gout inflicted joint. 3. Try to stay off the joint with gout. Any pressure exerted on the area will cause more pain and further damage to the area.

At 120 mg it has reduced UA levels to the target of 6.0 mg/dL in over 60% of study patients. At 80 mg the numbers were around 51%. Allopurinol at a 300 mg dosage in most participants achieved this is 22% of study patients. Hence the excited buzz in rheumatology circles since these kinds of results became apparent in its trials. At or below 6.0 mg/dL gout is more likely to be cured or managed better.

So what takes the tart cherry so legendary to fighting joint pain? Although food scientists are not absolutely certain on the specific compound that is 100 of the nutritional value of the tart cherry. The leading super fruit company in the U.S. is Fruit Advantage. The company offers a complete line of super fruit capsules including tart cherry capsules.

Unger, K., Rahimi, F., Bareither, D., Muehleman, C. The Relationship Between Articular Cartilage Degeneration and Bone Changes of the First Metatarsophalangeal Joint. J. Foot Surg. 39:1 24-33, 2000

It is recommended that NSAIDs or Colchicine are used along with Adenuric. This is because, as with Allopurinol, on a course of Febuxostat, there may be an initial increase in gout flares. If this happens you must battle through the attacks and continue taking Adenuric.


Anatomy: The great toe joint, or first metatarsal joint consists of two bones. The proximal bone is the first metatarsal and the distal is called the proximal phalanx or hallux. These two bone move against each other in an up and down motion through what we refer to as the sagital plane. Biomechanics: The motion of the great toe joint is dependant upon the plantarflexion of the first metatasal. If the first metatarsal is limitied in its' ability to plantarflex, the joint will jam resulting in funtional hallux limitus, which as we know is one of the causes of turf toe.

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Remember when you could sleep the whole night without a flare-up of gout? Do you remember what it was like to not have to wince with pain when you walk? Fortunately, gout is treatable and curable and these 6 suggestions will get you on the right path to treat your gout symptoms.

Approval in one country does not mean approval in another, but the fact that the European Medicines Agency has approved it will carry weight when the medical authorities in other countries consider its approval.

Treatment of turf toe varies with the type of healthcare provider and includes the use of rest, shoe modifications, orthotics, steroid injections and surgery. The success of non-surgical care will vary with the degree of injury, the rate at which the injury is healing and how much osteoarthritis has occurred. We see varying degrees of success with orthotics that promote plantarflexion of the first ray, effectively treating metatarsus primus elevatus and peroneus longus dysfunction. Simple arch supports can make a significant difference in the symptoms of turf toe. Should our patient not respond to conservative care in a reasonable time period, we are not reluctant to suggest surgical revision to address the problem whether it be revisions of the joint defect, shortening of a long first metatarsal or structural revision of metatarsus primus elevatus. As mentioned before, the clinical appearance of dorsal lipping or visible radiographic changes are suggestive of moderately advanced osteoarthritis, a condition that is only repaired by joint revision or replacement.

Think of turf toe (hallux limitus) as an isolated case of osteoarthritis limited to the first MPJ. Whether the injury is acute or due to repetitive loading, the result is a load that is applied to the subchondral bone that is greater than what the bone can tolerate. As the injury progresses, a series of micro fractures will develop in the subchondral bone. The typical soft spongy character of the metaphyseal bone changes to become brittle and hard. The result is that the articular cartilage looses its' underlying support and becomes susceptible to damage. Juxtachondral eburnation, osteophytes, lipping, spurring; call them what you like, but what you see on your x-ray is the slow progressive destruction of the joint.

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Turf toe gets no respect. Let's take a closer look at the causes of turf toe and see how to treat it more effectively. Turf toe is actually a form of hallux limitus. Hallux limitus is classically described as pain and progressive decrease in the range of motion of the first metatarsal phalangeal joint (MPJ). The onset of hallux limitus is due to the following:

According to the National Arthritis Foundation, one in five American adult's suffers from arthritis. This means almost 45 million American's feel this excruciatingly pain consistently. In addition, as the population ages, the number of people experiencing arthritis pain is expected to increase dramatically. So with all of the prescription drugs available to help fight joint pain, why is a tiny fruit grown in Northern Michigan get so much attention from gout and arthritis suffers?

WHO WILL BE PRESCRIBED IT? The recommended dose is one 80 mg daily tablet. If after two weeks there is no reduction in UA levels, your doctor may increase the dose to 120 mg daily. Patients will need another serum UA test after two weeks treatment to find out how well it's doing. In trials it has usually worked quickly, within a couple of weeks.

BENEFITS In large trials Febuxostat (Adenuric) has outperformed Allopurinol, the most common gout medication for long term treatment. Like Allopurinol, it works to lower uric acid production by inhibiting xanthine oxidase, an enzyme required to produce uric acid. In two major studies it reduced uric acid (UA) in more gout sufferers, and more patients reached the target 6.0 mg/dL level more quickly, than did those on Allopurinol.

4. Avoid ice and heat. Unlike other types of pain, gout will often hurt more with exposure to heat or ice. 5. Drink water! Water will help the body flush excess uric acid thus decreasing your chance of gout. Drink 10-12 glasses of water per day.

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.

You will not need to be on a low purine diet, and more good news is that it can be prescribed for the elderly. Kidney and liver disease In trials it has performed quite well with patients who have mild kidney disease. 44% of patients achieved the target at an 80 mg dosage, more at higher dosages. Better results than Allopurinol. If you have mild kidney disease (renal impairment) or mild liver problems (hepatic impairment) your doctor will judge whether Adenuric/Febuxostat can be taken safely.

And it may cause side effects of course. See the bottom of this article. Febuxostat (Adenuric) is not unfortunately a treatment for gout pain. It won't be used instead of NSAIDS like Indomethacin, Colchicine, and corticosteroids.

Tophi If you have tophi, it's heartening to know that Febuxostat has been shown to have success against tophi. Measured tophi areas reduced in many patients with tophi. The presence of tophi will be an additional factor in favour of a decision to prescribe Febuxostat (Adenuric).

The Tart Cherry - Mother Nature's Joint Pain Solution For years, the tart cherry has been the source of legend and folklore. The natural pain relieving properties has been handed down from generation to generation for natural joint pain relief. Just as the old saying goes, "an apple a day will keep the doctor away", tart cherry believers may soon be saying, "Twenty cherries day will keep the pain away". In fact, according to research from Michigan State University, as few as twenty cherries can make a difference in relieving inflammation in the body.

Other conditions - synovitis, crystal deposition diseases such as gout, systemic arthritis, external physical influences such as Dupytren's contracture, etc.

If you have severe kidney or liver problems Febuxostat is not recommended since it has not been tested in these patient groups. It is not recommended for people with heart disease or children.

According to the National Arthritis Foundation, one in five American adult's suffers from arthritis. This means almost 45 million American's feel this excruciatingly pain consistently. In addition, as the population ages, the number of people experiencing arthritis pain is expected to increase dramatically. So with all of the prescription drugs available to help fight joint pain, why is a tiny fruit grown in Northern Michigan get so much attention from gout and arthritis suffers?

This approval applies only to EU countries. Febuxostat has not yet been approved in the United States. If you are reading this from a non-EU country, or the US, you can check with your doctor to find out whether, or when, Febuxostat will be approved in your country.

About the author:
Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle
surgeon. Dr. Oster is also board certified in pedorthics. Dr.
Oster is medical director of href=http://www.myfootshop.comMyfootshop.com and is
in active practice in Granville, Ohio.

Nomenclature: First MPJ - the big toe joint Metatarsus primus elevatus - a functional or structural position of the first metatarsal First metatarsal - the foot bone making up the proximal portion of the big toe joint Hallux - the great toe

Generally, Febuxostat has been more effective when UA levels are below 10.0 mg/dL (595 mmol/??mol). However, even if they have been above this level, it has reduced UA levels down to the target in about 40% of study patients at an 80 mg dosage, and by more at higher dosages.


Differential Diagnosis: The differential diagnosis of turf toe includes; Arthitis Fracture Gout Joint infection Joint or bone tumor Synovitis

IT'S NOT PERFECT In trials its success rate in reducing UA levels down to the important 6.0 mg/dL (357 mmol/??mol) level was not 100%. About 35% of trial patients did not achieve the target. This may have been partly because so many gout sufferers are not UA over-producers, the problem Febuxostat addresses, but under-excretors of uric acid.

It will also only be used in gout patients who have chronic hyperuricemia (high UA levels) and gout. So if you're a gout sufferer who lives in a European country that's a member of the EU, you can ask your doctor's opinion about whether Febuxostat is suitable for you.

Ronconi, P., Monachino, P., Baleanu, P.M.,Favilli, G. Distal Oblique Osteotomy of the First Metatarsal for the Correction of Hallux Limitus and Rigidus Deformity. J. Foot Surg. 39:3, 154-160, 2000

But before we go any further, we need to understand that the terms turf toe and hallux limitus aren't really synonymous. The fundamental difference between the two terms is the patient population that they affect. Turf toe is a term used in athletic circles referring to any injury of the great toe joint. Consequently, discussions about turf toe will focus on the first two causes of hallux limitus mentioned above; functional hallux limitus and direct physical injury. On the other hand, when we discuss hallux limitus, we're actually referring to a broader, 'non-athletic' patient population and need to include all three causes of hallux limitus.

Turf toe caused by a direct injury to the joint may or may not be obvious. Athletes may not remember an incident of pain since they're often distracted by the event or game in which they're involved. The onset of direct injury to the joint may be abrupt, but also may be insidious becoming increasingly more painful as the season progresses. The joint pain will subside with rest only to recur with increased activity. It's not unusual to see symptoms of turf toe resolve in the off season only to recur with renewed exercise.

5 Tips to Treat Your Gout 1. Find a pair of shoes that fit comfortably. Try finding a wider shoe that will offer more room for your toe.

Functional hallux limitus - biomechanical function that results in metatarsus primus elevatus and subsequent repetitive jamming of the first MPJ. Direct physical injury - injury to the articular cartilage or subchondral bone. These injuries may be due impaction injuries or hyperextension/flexion of the first MPJ.

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Joe Barton writes for Barton Publishing Inc., a natural health company specializing in educating people of safe, affordable natural remedies. To see how you can naturally treat your gout in hours... guaranteed! Click here: Cure Your Gout Website


 
 
     
 
 





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