Some May Be Vulnerable to Severe Skin Reaction While Using Gout Drug

TUESDAY, Oct. 1, 2019 — Some gout patients with heart or kidney disease might be more susceptible to severe skin reactions while taking the gout medication allopurinol, researchers report.

“Our findings suggest that heart disease, like chronic kidney disease, is a risk factor for allopurinol-associated severe cutaneous adverse reactions that warrants adoption of precautionary measures against these reactions,” said researcher Dr. Hyon Choi, from the Department of Rheumatology, Allergy and Immunology at Massachusetts General Hospital in Boston.

Gout is form of inflammatory arthritis that develops in people who have high levels of uric acid in their blood. The acid can form needle-like crystals in joints and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling.

An earlier study found a link between heart disease and an increased risk of hospitalization for people who had a severe skin reaction to allopurinol.

For the latest study, Canadian and U.S. researchers used data from nearly 5 million people in British Columbia. More than 130,000 of these people were on allopurinol. Of these patients, those with heart disease and chronic kidney disease had a higher risk of severe skin reactions than those without such conditions.

People with the genetic marker HLA-B*5801, which is more common in Asian and black people, have a significantly higher risk of this adverse reaction than people without the mutation.

The report was published Sept. 30 in the CMAJ.

The U.S. Food and Drug Administration recently warned patients about the risk of cardiovascular events from the gout medication febuxostat, so the number of prescriptions for allopurinol will probably increase, the researchers noted.

But severe skin reactions are rare, and allopurinol plays an important role in managing gout, they added.

“Physicians who prescribe allopurinol should look for these risk factors so that they may consider initiating lower-dosage allopurinol and other precautions, which may prevent this rare but serious adverse reaction,” Choi and his co-authors concluded in a journal news release.

More information

For more on gout, see the Arthritis Foundation.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Genes, Not Diet, May Be Key to Gout Flare-Ups

By Robert Preidt

HealthDay Reporter

THURSDAY, Oct. 11, 2018 (HealthDay News) — Although many people suffering from painful gout flare-ups point to diet as the culprit, new research suggests DNA plays a much bigger role.

The findings challenge the long-held belief that diet is the major factor in gout, a joint disease that causes extreme pain and swelling. Gout is caused by hyperuricemia — high blood levels of uric acid, which forms crystals that collect around the joints.

In the study, New Zealand researchers analyzed genetic and diet data from nearly 17,000 American men and women of European ancestry.

The investigators found that diet was much less important than the individual patient’s genes in deciding whether or not they would develop hyperuricemia.

The findings “are important in showing the relative contributions of overall diet and inherited genetic factors” in gout, wrote a team led by Dr. Tony Merriman of the University of Otago.

In a related editorial, rheumatologist Dr. Ed Roddy, of Keele University in the United Kingdom, said the findings have important psychological implications for patients.

That’s because people with gout often face stigma due to the misconception that gout is a “self-inflicted” condition, caused by unhealthy lifestyle habits. That, in turn, can make some patients reluctant to seek medical help.

But the new research “provides important evidence that much of patients’ preponderance to hyperuricemia and gout is [genetic and] non-modifiable, countering these harmful but well-established views and practices,” Roddy said.

For centuries, diet was considered the main risk factor for gout, and recent studies suggest that certain foods such as meat, shellfish, alcohol and sugary soft drinks are associated with a higher risk of gout, while other foods such as fruit, vegetables, low-fat dairy products and coffee may protect against gout.

But other studies have also shown that genetics plays an important role in gout.

Dr. Waseem Mir is a rheumatologist at Lenox Hill Hospital in New York City. The new findings are “consistent with what I see in clinical practice,” he said.

“There is a lot of misunderstanding amongst patients as to why they are getting gout attacks. Diet seems to play little role even in clinical practice,” he said.

“What we learn from this study is that it is a genetic problem and needs to be addressed with medication and not just diet in most cases,” Mir added.

The study was published online Oct. 11 in the BMJ.

WebMD News from HealthDay

Sources

SOURCES: Waseem Mir, M.D., rheumatologist, Lenox Hill Hospital, New York City;BMJ, news release, Oct. 10, 2018

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