Dr. Krasimir Kraev, MD: We are also increasingly seeing gout in women

Dr. Krasimir Kraev, MD, is a specialist in the rheumatology clinic at UMBAL “St. Georgi” and assistant at the MU – Plovdiv. In 2014 he completed his medical studies, in 2018 he acquired the specialty of rheumatology and in 2020 he defended the pedagogical and scientific degree of “doctor”. Dr. Kraev completed the joint echography course in the city of Oxford; MRI course in rheumatology in Munich and numerous Bulgarian and international courses and participation.

Conducts rheumatological consultations, preventive examinations, diagnosis and treatment of degenerative and inflammatory joint diseases, systemic diseases of connective tissue, musculoskeletal system, bones, joints and muscles, as well as echography of joints.

Dr. Krasimir Kraev explained the features of the disease gout and the new directions of its therapy. The genetic factor, a certain enzyme defect and excessive consumption of meat and alcohol are the main triggers for the development of this disease.

– Dr. Kraev, what is the correct definition of gout and what factors cause its occurrence and development?

– Gout is one of the inflammatory joint diseases and is caused by disorders in uric acid metabolism. The classic form of gout affects the big toe, but any joint can be affected. It is mainly accompanied by an increased uric acid level.

When we talk about an increase or decrease in a substance in the body, in this case we are talking about an increase, three reasons can be given: greater absorption with food, an enzyme defect or reduced excretion in the urine. Or more generally, an increase in uric acid is often a result of increased alcohol and meat consumption, especially red meat. Because they are very rich in purines and therefore nucleic acids.

A doctor explained how to prevent gout from developing

Otherwise, the disease gout has been around since the beginning of time. Cases of this disease, known as the king’s disease, were described as early as the Middle Ages. Pictures have been preserved from this time. I would just like to note that due to the extreme pain and to stop it, some sufferers have even cut limbs in the past.

– What role does the genetic factor play? You mention it in a scientific article of which you are a co-author. Are we talking about a predisposition to developing hyperuricemia?

– Hyperuricemia means an increase in uric acid, but not yet gout. We are talking about when this uric acid gets into the joint. The genetic factor is important. In my opinion, the main reason was, and from this followed the excessive consumption of meat and alcohol.

Gout is generally referred to as a disease that affects the joints. And it, and uric acid in particular, actually damages the heart, blood vessels and kidneys. The unpleasant thing in this case is that kidney failure can occur. This condition in turn reduces the function of the kidneys, which increases uric acid levels and unfortunately creates a vicious cycle.

Dr. Krasimir Kraev

– Why is the incidence of gout increasing?

– Especially because our way of life is changing. Yes, it is common and gout is also becoming more common in women. Not because they have started consuming more meat and alcohol, but because they are taking more care of themselves. Also due to the fact that estrogen levels decrease in women after menopause

These hormones themselves contribute to the excretion of uric acid and when their levels decrease, in some women uric acid increases, the so-called. female gout. And what is often forgotten: An increased uric acid level can also be present in psoriasis and psoriatic arthritis. It’s just that the plaques themselves predispose to their increase.

Gout begins suddenly with severe pain in the thumb, ankle, elbow and knee. The patient feels warmth, redness, swelling and severe pain. As well as inability to move in this joint. This severe pain forces the affected person to seek medical help; an ambulance is often even called.

– What is gout therapy? It mentions that it often fails to respond to both drug and non-drug controls?

– The classic approach is to initially try without medication, but only for a mild form of gout or for elevated uric acid levels. We start with diet and lifestyle changes, but unfortunately in 90% of cases this is not successful. From now on, it makes a big difference whether we treat the gout attack or the gout (the high uric acid levels).

For a gout attack, treatment includes corticosteroids and nonsteroidal anti-inflammatory drugs. However, the classic and most successful drug is colchicine, an extract from crocuses. This preparation has a very good effect because it lowers the amount of a pro-inflammatory cytokine that is released in gout.

To lower uric acid levels, we have completely different medications that should not be taken during an attack. Unfortunately, we often see this approach, but these medications make the attack worse. This is because the concentration of uric acid in the joints increases at the expense of its level in the blood.

If you have gout, you should not overexert yourself

– And what role will the new drugs play?

– New drugs aim to improve the excretion of uric acid or reduce its production. I would like to insert here that studies have been carried out using an enzyme called uricase, which was synthesized artificially.

This enzyme breaks down uric acid in animals, especially birds, in a further step. The expectations were very high, but in the end the product did not succeed. The other medications we use inhibit, or suppress, the production of uric acid. We also have medications that help excrete uric acid through urine.

The most commonly used drug currently is febuxostat, which also has the best safety profile. Which is particularly important for patients with kidney failure. It is even given to hemodialysis patients. Personally, this is the drug of choice for me.

We are currently conducting a study in our clinic at UMBAL “St. Georgi” on the role of febuxostat on these inflammatory cytokines. There is evidence that this supplement not only reduces uric acid but also helps reduce inflammation.

We are trying to prove that this is a complex treatment, but since we are only a small center for this, we will need larger studies on a global scale. After all, perhaps we will have results as early as September. We selected 30 patients to follow up to determine cytokine levels. We will send them to Sofia to the BAS for examination and then we will do statistics to see if this is true or not.

– It is important to find the right specialist…

– Yes, that is the most important thing. Many patients hesitate to take a German drug, perhaps the fact that it is not Bulgarian deceives them. It is a good medicine but sometimes it is quite harmful and toxic and should not be taken without consulting a doctor. However, the patients communicate with each other and some of them decide to give it a try.

– Can you give specific recommendations regarding the disease?

– If you have a family member who suffers from gout, check your uric acid levels first. And reduce your consumption of alcohol, red meat and junk food as much as possible. Also avoid legumes, they are very rich in purines and nucleic acids and can also increase uric acid. Look, gout itself is not a complicated disease, but it is very difficult to control and has serious symptoms. We have already said that it is one of the most severe pains described in human history.

It is important that patients adhere to the prescribed therapy. Because even if we prescribe the most effective medicines, it is very difficult if the patient does not follow our recommendations. By the way, gout patients are demonstrably intelligent people, bohemians. They understand that they need treatment, but at the same time they find it very difficult to change their lifestyle. I personally recommend febuxostat because even recalcitrant patients who continue to drink alcohol achieve fairly good control with this medication.

Yana BOYADJIEVA