Huy Dang, DPM, a podiatry specialist in Centralia, Washington, talks about how his experience living with gout has impacted how he treats patients with gout. This is part two of a two-part interview.
DocWire News: How have treatments for gout changed since your diagnosis?
Dr. Dang: I think in the beginning, a lot of people saw the treatments for gout as just basically treating the acute gout attack and they weren’t effectively looking at treating the uric acid burden, which could be very, very problematic. I think what we’re looking at now is you need to treat the uric acid burden because there is so much more systems being affected by just the gout. If you take CT scans of gout affecting the human body, especially in these long-term uncontrolled gout patients, you’re seeing it affects every organ system other than the brain, which is relatively significant. And with any other systemic diagnosis like diabetes, they treat the patient overall. So with diabetes, protocols for diabetes [are] much stricter controls … and making sure that you get your eyes checked, making sure that you are looking for a peripheral neuropathy and everything else that goes with diabetes, the same needs to be done with gout.
And I think we are beginning to have stricter controls on what is controlled gout. We need to make sure that we’re getting the uric acid level below six and the concentration point above six, even though you may not be having gout attacks, you’re still depositing gout within the human body and you’re going to create larger issues. So I think really when we’re looking at gout, we’re looking at treatment options to try to make sure that we do control the uric acid burden and not allowing it to build up in the system, which the downstream cascade of that will be much larger systemic problems.
What do you see in the future of gout treatment – new treatments in the pipeline, new treatment strategies, etc.?
I think that the new treatments was working with things like Krystexxa or other uric acid lowering medications. Part of it, I think, is decreasing the uric acid burden down enough so that the oral meds can become more effective. I think I’ve also found that if we decrease the patients with the larger uric acid burdens, the oral medications later on can be much more effective because you’re not fighting this big, giant uphill battle. And you’re also freeing the ability of the patient to have a much more conducive life just to be able to do everyday living activities. I think also, this will affect surgical intervention, because if we can decrease the uric acid burden, especially the uric acid within joints, fusions or joint replacements are also going to be more viable options, instead of just looking at completely destroyed joints. But I think we have, in order to really look at some of these modulating disease modifying medications, that is what we need to look for in the future, is actually disease modifying medications, as opposed to just medications that are going to treat gout on an episodic basis.
Do you have any last comments that you wanted to share?
I think the future of treating this thing is coming around and coming very soon, especially with options available to us. There’s a lot of research right now going into what can accompany certain medications in order, so that we can complete therapy. I think my point though on this is that we should treat gout just like any other systemic issues, rheumatoid arthritis, diabetes, in which we have to actively go after the causes of it and seek to reduce the amount of damage that it will create downstream. If we do that, our patients will have much, much better pain control as well as less issues in other system organs.