In this episode, explore data from the major study proving uric acid crystals are present in the synovial fluid of patients with gout, as well as the tale of two rheumatologists who injected their own knees (while still working in the hospital) with uric acid to prove it is the trigger for inflammation in gout. The episode finishes with some ripping yarns about the history of the medications we use to treat this condition.  

• Intro :10
• Controversy surrounding uric acid’s role in gout :45
• “Game changing” paper published in 1961 2:07
  • The first description of pseudo gout 5:53
• How do you prove uric acid triggered the inflammatory response? 6:37
• One of my favorite studies 6:43
  • Faires and McCarty inject themselves with uric acid 7:49
  • Details of what they experienced 8:22
  • 4 hours later … 8:52
  • Both patients receive treatment 9:12
• Review of what we’ve discussed so far 10:06
• Let’s try and answer the question posited in The History of Gout, Part 1 10:35
• Colchicine – previously a medicinal plant 10:41
• A look at the history of urate-lowering therapy 12:59
  • Probenecid was developed to reduce the excretion of penicillin 13:18
  • The history of allopurinol 14:32
  • Don’t give allopurinol to patients on azathioprine 17:21
• The answer to the question posed in Part 1 17:49
• Summary 18:12

We’d love to hear from you! Send your comments/questions to [email protected].

References:

Barnett R. Lancet. 2018;391:2595.

Faires JS, Mccarty DJ. Lancet. 1962;280:682-685.  

Kippen I, et al. Ann Rheum Dis. 1974;33:391-396.

Marson P, Pasero G. Reumatismo. 2011;63:199-206.

McCarty DJ, Hollander JL. Ann Intern Med. 1961;54:452-460.

Nuki G, Simkin PA. Arthritis Res Ther. 2006;doi: 10.1186/ar1906.

Rundles RW. Arch Intern Med. 1985;145:1492-1503.

Shyambhavee, Behera BK. J Pharmacol Clin Toxicol. 2017;5:1098.

Storey GD. Rheumatology. 2001;40:1189-1190.

West JB. Am J Physiol Lung Cell Mol Physiol. 2014;doi:10.1152/ajplung.00223.2014.