Gout's Silver Lining

Probenecid has an unexpected benefit

The first and only gout attack occurred in my 40's when I began drinking a glass of red wine every day for health reasons. After a month of this regimen my left foot hurt so much I couldn't walk. The diagnosis was gout, which my father and brothers all suffer from. I thought I had avoided gout, but alas, I had the gene after all.

Gout is caused by high concentrations of uric acid that crystallize in joints, resulting in painful inflammation. Known triggers include organ meats, shellfish, and alcohol. Drinking plenty of water to dilute and flush the uric acid out of one's system is the way to avoid gout, and probenecid is often prescribed to aid in uric-acid reduction. Your humble blogger has been on probenecid for over 20 years.

Researchers have discovered that probenecid may be an effective treatment for COVID-19:

[Georgia professor of infectious diseases Ralph] Tripp found probenecid blocks the virus from replicating and infecting individual cells, a major discovery.

“Because it works on the whole cell, not the virus, you can’t get resistance to the drug,” Tripp said.

Tested on ten individuals in Florida with COVID-19, researchers found after the individuals were given probenecid symptoms eased in three days instead of weeks.

Funding for large clinical trials must follow, but the outlook is that a drug that has helped with gout for four decades may be what’s needed to stop the suffering from COVID-19.

I've been upping a daily supplement of Vitamin D to help ward off the coronavirus, and now it just may be that I have been regularly taking a drug that affords additional protection. Maybe I did luck out genetically with gout, just not in the way that I thought.

Another silver lining: High uric-acid levels of gout sufferers may afford protection against Alzheimer's disease.

Health Check-up

(GIF from rebloggy)

I was prepared to make excuses. The doctor wanted me to lose five pounds, and I was doing so well until the lockdown.

For the past four months I sat at home, watching TV, web-surfing, and snacking. I walked 3-4 miles every day until my knee started hurting, so I stopped. The gym is shut down, and my ancestors gave me the gene for arthritis.

It's not my fault.

The doctor read aloud the blood test results. Triglycerides and blood sugar had improved, but LDL ("bad") cholesterol was higher. He raised the atorvastatin dosage to 20 mg per day. The painful knee was probably the beginning of arthritis, so he ordered an X-ray to make sure.

For the first time in years I didn't have to go on a diet, and I haven't yet crossed the line to diabetes. We scheduled an appointment for next July, another sign of optimism. All in all it was a good session.

Advancements in Brain Science

Gout and Alzheimer's
My genetic predisposition to gout has a silver lining; gout correlates with a lower incidence of Alzheimer's disease. In a study covering nearly 300,000 British patients over five years

Those with gout, whether they were being treated for the condition or not, had a 24 percent lower risk of Alzheimer’s disease.

The reason for the connection is unclear. But gout is caused by excessive levels of uric acid in the blood, and previous studies have suggested that uric acid protects against oxidative stress. This may play a role in limiting neuron degeneration.

(WSJ illustration)

Finger-fiddling and Creativity

Certain kinds of hand movements have an impact on cognitive functioning, improving focus or sparking fresh thinking or faster learning, according to several recent studies.

Manipulating a smooth stone or a string of beads that are pleasing or soothing to touch can evoke “the timeless, ancient human practice of meditative ritual” and screen out extraneous stimuli.

The generations that preceded ours didn't have the technological tools, but they were arguably better thinkers. Perhaps it was because they were always fiddling with cigarettes, matches, lighters, and smoking paraphernalia.

Elder Sex and Cognition

Older men and women who were satisfied with their sexual relationships and considered sexuality an essential component of aging performed better on tests of cognitive function than those who felt sexuality and intimacy were unimportant.

The Dutch study covered 1,747 men and women, average age 71.

Yes, dear, my gerontologist prescribes daily treatment.

Toxic in High Doses

My extended family has a genetic predisposition to gout, which is caused by the body’s inability to flush uric acid. Crystals build up in the joints, and the painful swelling in the knees and feet can immobilize the worst cases for a week. Gout has been around for centuries, and so has its treatment by colchicine, a plant derivative.

In 2009 the Food and Drug Administration granted an exclusive marketing license on this venerable medication to a company named URL Pharma.

The price rise is a consequence of a Food and Drug Administration effort to improve the safety of long-used but unapproved drugs, with a trade-off often made between drug affordability and safety. [snip]

"It's not a new product. It's been out for hundreds of years. To all of a sudden have to pay $125 or $150 a month, after it only cost $5 or $10 a month, [bold added] is a real problem," said Stanley Cohen, a Dallas doctor who is the president of the American College of Rheumatology.

URL Pharma conducted “scientific” studies that confirmed what doctors have long known about colchicine; it can be toxic in high doses and/or over extended periods. For its trouble URL Pharma was awarded with a regulatory shield that has enabled it to sue small producers, who have stopped production.

The sudden financial squeeze on gout sufferers can be hard on elderly patients on fixed incomes, like members of my family. Another example of what happens when a powerful government agency, meaning to do well, expands its reach into an area that had previously escaped its attentions.