Gout

[TG]

What a bastard!

Gout again in the foot regions. Hobbling around the house on crutches or whizzing round the kitchen on an office chair.

The irony is I was given a prescription for preventative medication and I got up in the morning I was supposed to go and get them with agonising foot pains.

Cant take the pills till the attack has passed. 

My doctor blames booze but he is a idiot. 

Interestingly I saw another doctor last year at Mrs TG's place of work and he said quite candidly that no-one really knows the actual cause.

So I am going to get pissed so I cant feel anything below the knees. 

[Barman]

What a bastard!

Gout again in the foot regions. Hobbling around the house on crutches or whizzing round the kitchen on an office chair.

The irony is I was given a prescription for preventative medication and I got up in the morning I was supposed to go and get them with agonising foot pains.

Cant take the pills till the attack has passed. 

My doctor blames booze but he is a idiot. 

Interestingly I saw another doctor last year at Mrs TG's place of work and he said quite candidly that no-one really knows the actual cause.

So I am going to get pissed so I cant feel anything below the knees. 

It seems that you have everything covered! 

[Nick]

I remarked to someone earlier that we all seem to be suffering at present

Pastis's knee
Our worms
Wenchy's nether regions
TMR ditto
Snoopy always
BM's sunburn
GOS in general

They are out to get us, I tells ya

[Barman]

I remarked to someone earlier that we all seem to be suffering at present

Pastis's knee
Our worms
Wenchy's nether regions
TMR ditto
Snoopy always
BM's sunburn
GOS in general

They are out to get us, I tells ya

I don't have sunburn... 

[Bar Wench]

I was going to say I don't have nether regions but that doesn't seem right! 

[Pastis]

Well, he's right about my knee but happy to say it seems to be repairing nicely, if slowly. Fortunately one of my sticks has a rubber ferrule.

[grumpyoldsoldier]

I remarked to someone earlier that we all seem to be suffering at present

Pastis's knee
Our worms
Wenchy's nether regions
TMR ditto
Snoopy always
BM's sunburn
GOS in general

They are out to get us, I tells ya

General Gos.. I like that it has  a certain ring.

Gout.. a link
http://arthritis.about.com/od/gout/Gout_Information_Causes_Diagnosis_Symptoms_Treatment.htm

[Nick]

Is a rubber ferrule a good thing, do we think?

[grumpyoldsoldier]

Depends on what it is attached to I would think

[Nick]

He seems to be pleased with it

[Pastis]

Indeed, I am pleased with the rubber ferrule; my other metal ones tend to skid on the pavement when pressure is applied 

However, the prognoscis (sp?) is not good 





In fact, fvckety fvckety fvckety fvckety fvckety fvckety fvckety fvck!

[Snoopy]

At the end of December the National Institute for Health and Clinical Excellence (NICE) approved the use of febuxostat as an option in the treatment of chronic hyperuricaemia in gout. NICE stipulates that febuxostat should only be prescribed for people who are "intolerant" of allopurinal or for whom allopurinol is contra-indicated (especially those with kidney failure). Allopurinol has for decades  been the mainstay treatment for gout and works by reducing by reducing the level of serum uric acid concentration in the blood.
At first glance this recommendation seems fairly straightforward but a closer reading of the guidance suggests a more complex picture. The guidance notes that the manufacturer's submission showed that febuxostat is more effective in lowering serum uric acid concentration than fixed-dose allopurinol (300mg per day). When comparing febuxostat at 80mg per day with allopurinol at 300 or mg per day,  no significant differences were found in the numbers of patients requiring treatment for gout flares. However, there was a higher number of patients taking 120mg febuxostat who required treatment.
The guidance expresses concern that the comparisons submitted to it may not be adequate as febuxostat is measured against fixed-dose allopurinol whereas both the European and British best practice guidance recommends that allopurinol be started at a low dose (50 or 100mg) per day and then raised until the therapeutic target is met. The recommended maximum dose is 900 mg per day. The guidance also acknowledges that the vast majority of doctors ignore this guidance and simply prescribe 300mg of allopurinol per day.
So, while the evidence submitted may not reflect best practice, comparing febuxostat with 300mg of allopurinol does give a more realistic picture in terms of how gout is actually treated. NICE also states that it took evidence from specialist doctors who pointed out that many people have high serum acid concentration but that comparatively few of these develop gout and that there was some uncertainty about the precise relationship between lowering serum uric acid concentration and improvement in gout symptoms. NICE nevertheless feels that it is reasonable to assume that gout symptoms begin to occur once serum uric acid levels go above 6mg per 100ml.
The European League Against Rheumatism's (EULAR) recommednations for the treatment of gout recommend that allopurinol should be started on a low dose (100mg per day) and gradually increased by 100 mg every two to four weeks if required, it lists the benefits of this "go low, go slow" approach as;

reduced likelihood of provocation of acute attacks;
reduced incidence of toxicity;
tailoring of the dose to suit individual requirements;
an emphasis on the importance of a sufficintly low target level of serum uric acid.
These all appear eminently sensible- we have to ask why they haven't been put into clinical practice.
I've gone into detail about this so that may readers may appreciate what a convoluted and complex process the approval of even fairly straightforward drugs is.  Patients often assume that medical science is fairly objective and precise whereas most of it is based on half-understood principles and partial data.

[Miss Demeanour]

I remarked to someone earlier that we all seem to be suffering at present

Pastis's knee
Our worms
Wenchy's nether regions
TMR ditto
Snoopy always
BM's sunburn
GOS in general

They are out to get us, I tells ya

That can be painful 

Glad to see theres nowt wrong with me - apart from spelling, grammar, general stupidity,  being a wumman etc etc etc 

[Snoopy]

I remarked to someone earlier that we all seem to be suffering at present

Pastis's knee
Our worms
Wenchy's nether regions
TMR ditto
Snoopy always
BM's sunburn
GOS in general

They are out to get us, I tells ya

That can be painful 

Glad to see theres nowt wrong with me - apart from spelling, grammar, general stupidity,  being a wumman etc etc etc 

Wait till BM's homebrew and figs have done their job. 

[Miss Demeanour]

Don't do figs  ...or homebrew...

Do you reckon I might have to bring my own food - could  I get a box of Cadbury's giant buttons past customs  ???