California Jazz Foundation

Contributing Physician - Dr. Joseph Kahn
Original Board Member of the California Jazz Foundation

Gout is becoming much more prevalent than it used to be because we are living longer (it occurs more frequently as we age ),we are more obese, and our diet puts us at risk for Gout.

Kidney disease is the most common cause of Gout, but genetics may also be important.

Overproduction or decreased excretion of uric acid leads to an accumulation in the blood and results in uric acid crystals precipitating and getting deposited in the joints, skin, and kidneys causing arthritis, tophi (nodules under the skin),kidney stones, and kidney disease. Gouty arthritis is characterized by sudden acute attacks of pain in one or more joints interspersed with pain free intervals, often the joint at the base of the great toe is involved ,and it becomes swollen, hot, red, and exquisitely tender. Kidney stones are made up of uric acid crystals.

Treatment is with allopurinol or febuxostol, which inhibit the formation of uric acid, or probenecid to increase the excretion of uric acid. The flares(acute attacks)are treated with ibuprofen, Indocin, colchicine, or cortisone to relieve the pain, after which allopurinol is started to lower the blood level of uric acid and which should be maintained at 6 mg or less. If the uric acid level is
elevated, but there are no symptoms present, there is no need for treatment. Flares can occur due to the use of thiazide diuretics, alcohol,, red meat, organ meat( liver, sweetbreads, hearts,or brain), small fish(sardines,herring, anchovies), shellfish (shrimp, lobster, crab), mushrooms, asparagus, cauliflower, spinach, sweets, or fatty foods.

There is no cure but the complications of Gout can be controlled by the above measures.

Newer medications for the treatment of Diabetes
Byetta, Januvia, & Victoza

Byetta & Victoza are given by daily injections that stimulate the secretion of insulin in response to food ( this lowers the blood sugar). They also Inhibit the secretion of glucagon (which normally raises the blood sugar), they act on the stomach delaying the passage of food and they decrease the appetite which encourages weight loss.

All of these actions tend to lower cholesterol, lower blood pressure, and lower blood sugar. These effects are similar to those produced by a substance called GLP-1 that is produced by the intestine.

Januvia prolongs the activity of GLP-1 in the body making the GLP-1 more effective. Januvia comes in tablet form so that the diabetic patient does not have to give himself an injection as he/she would with Byetta or Victoza.

These medications rarely have side effects, and do not cause hypoglycemia.They are usually used with other antidiabetic medications and can result in much better control of diabetes. Importantly they decrease the risk of atherosclerosis (hardening of the arteries) ,which is the number one cause of death in diabetics.

The above content should not be considered a substitute for medical advice from your physician. You should talk to your medical professionals for diagnosis and treatment. None of the information represents or warrants that any particular drug or treatment is safe, appropriate, or effective for you.