Worldwide, gout has a prevalence of between 1.4% to as high as 7.3% in older men, and it is also the most commonly seen disease of the joints in older women (1) Deposition of monosodium urate crystal in the joints and soft tissues are the primary causes of the disease. In the community setting, pharmacists frequently encounter gout patients who come in for advice on their medications and on improving their conditions.

There are four must-know pieces of information for community pharmacists to better aid these patients:

1. High blood uric acid level may not necessarily lead to the development of gout


It is very common for many patients to become concerned when routine blood tests show high blood uric acid or hyperuricaemia. Although gout is caused by excessive uric acid, it does not automatically translate into the disease itself. The symptoms arise from the accumulation of uric acid crystal and not from dissolved uric acid in the blood. For some people, gout symptoms may never appear despite having a high blood level of uric acid (2).

The most reliable diagnostic test for gout is the joint fluid test where doctors will withdraw some fluids from the affected joint for close examination for urate crystals (2). Blood tests may be misleading as certain gout patients may experience a normal level of blood uric acid as well.

2. Allopurinol treatment is linked to an increased risk of Steven-Johnson Syndrome, especially in the Asian population


Allopurinol has been associated with high risk of developing Steven-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), along with other common drugs such as carbamazepine and cotrimoxazole . SJS and TEN are severe cutaneous adverse reactions (SCAR) towards certain medications, and both conditions will lead to severe morbidity or even death (3).

There is a certain degree of genetic pre-deposition in the risk of developing SJS or TEN after ingestion of allopurinol. HLA-B* 5801 was discovered by a group of Taiwanese scientists to significantly associate with allopurinol-induced SJS/TEN in the Han Chinese population. Following this discovery, a similar association was revealed in the Thai, the Japanese and the Korean population as well (3).

3. There is insufficient scientific evidence to support the use of celery as a natural remedy for gout


Celery is a popular natural remedy to treat gout and is widely available in health stores or certain pharmacies. However, the scientific evidence to support the use of celery to treat gout is lacking. The Natural Medicines Comprehensive Database concluded that there was “insufficient evidence” to rate the effectiveness of celery for gout treatment (4).

In addition, pharmacists should be aware that celery supplement is likely unsafe in pregnancy, and also for those who are breastfeeding. A large amount of celery intake may have adverse effects on the uterus, and there is a possibility that it can lead to miscarriage (4).

4. Gout may be precipitated by excessive intake of certain foods and drinks


Certain food with high purine content such as organ meats, anchovies and mushroom may lead to the development of gout when taken in large quantity for a prolonged period. Unfortunately, these foods are commonly seen in the Asian region. In Southeast Asia particularly, many culinary delicacies use anchovies and organ meats as one of the main ingredients.

Recently, there were also studies which indicate that high consumption of sugary soft drinks may precipitate the disease as well. This may due to the high-fructose corn syrup which is abundant in these drinks. Uric acid is a product of fructose metabolism (5). MIMS

Reference:
1. Yeap S, Goh E, Gun S. A Survey on the Initial Management of Spontaneous. Int J Rheum Dis. 2010;12:329–35.
2. Mayo Clinic. Gout - Test and diagnosis [Internet]. mayoclinica.org. 2015 [cited 2016 Jul 21]. Available from: http://www.mayoclinic.org/diseases-conditions/gout/basics/tests-diagnosis/con-20019400
3. Thong BY. Stevens-Johnson syndrome / toxic epidermal necrolysis: an Asia-Pacific perspective. Asia Pac Allergy. 2013;3:215–23.
4. WebMD. Celery [Internet]. WebMD. 2016 [cited 2016 Jul 18]. Available from: http://www.webmd.com/vitamins-supplements/ingredientmono-882-celery.aspx?activeingredientid=882&activeingredientname=celery
5. Shmerling R. All About Gout [Internet]. Harvard Health Newsletter. 2010 [cited 2016 Jul 19]. Available from: http://www.health.harvard.edu/newsletter_article/all-about-gout

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