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Posted: Tue Mar 04, 2008 10:01 am Post subject: uric acid levels, relapses and CRABs
Very interesting stuff...maybe part of how the CRABs work is related to uric acid.
Variation of serum uric acid levels in multiple sclerosis during relapses and immunomodulatory treatment.
Eur J Neurol. 2008 Feb 26 [Epub ahead of print]
Guerrero AL, Martín-Polo J, Laherrán E, Gutiérrez F, Iglesias F, Tejero MA, Rodríguez-Gallego M, Alcázar C.
Neurology Unit, Hospital Río Carrión, Palencia, Spain.
Uric acid (UA), a product of purine metabolism, may be an antioxidant, perhaps acting as a scavenger of peroxynitrite. Patients with gout have a reduced incidence of multiple sclerosis (MS). A number of studies found that patients with MS have low serum levels of UA, although it has not been established whether this represents a primary deficit or a secondary effect. UA has also been proposed as a marker of disease activity and response to immunosuppressive or immunomodulatory treatment.
We retrospectively reviewed 83 relapsing-remitting or secondary progressive MS patients (64 females and 19 males) followed in our Neurology Unit. We collected data concerning demographic variables as age and sex, and clinical variables as age of onset, clinical type, disease duration, EDSS score and total number of relapses. We considered UA levels in three different situations: during a relapse, during remission period and during remission period under immunomodulatory treatment [Interferon Beta 1a im (Avonex; Biogen Idec Inc., Cambridge, MA, USA), Interferon Beta 1a sc (Rebif; Serono Europe Limited, London, UK), Interferon Beta 1b (Betaferon; Bayer Schering Pharma AG, Berlin, Germany) or Glatiramer Acetate (Copaxone; TEVA Neuroscience LLC, Kansas City, MO, USA)]. A Wilcoxon matched pairs test was carried out to determine differences between groups. A P-value less than 0.05 was considered statistically significant.
In 33 patients, we were able to compare at least one UA value obtained during a relapse with at least one when remission without treatment. Mean serum UA levels were significantly lower when measured during a relapse (r: 0.39, P: 0.024). In 27 cases, we compared at least one remission value without treatment with at least one obtained during remission and immunomodulatory treatment. Mean serum UA levels significantly increased when determined during Interferon Beta or Glatiramer Acetate therapy (r: 0.84, P < 0.001).
Although we do not know exactly whether and how UA is involved in MS pathogenesis, our data suggest that UA might reflect disease activity or treatment response in MS.
Joined: Sep 11, 2007 Posts: 667 Location: southern California
Posted: Tue Mar 04, 2008 2:15 pm Post subject:
Very interesting!
Husband's been on inosine supplements for a year, as well as copax (GA).
His serum uric acid levels were low on diagnosis, and are now considered high normal. We keep our eye on it, since I didn't want to give the poor guy gout, along with MS.
best,
AC _________________ Husband diagnosed RRMS March 2007
pursuing endothelial healing
Copaxone, Swank, supplements, laughter
Joined: Mar 26, 2005 Posts: 590 Location: Northamptonshire, England.
Posted: Tue Mar 04, 2008 2:24 pm Post subject:
Hi Dignan,
That's an interesting find. It appears to confirm that uric acid levels are significant in MS although, as they say, whether causative or secondary remains to be seen. I take Inosine to raise my levels although I've never had them checked, which is a bit naughty.
The statements at the beginning of the article were a bit of a surprise to me though: I understood that it was absolutely established that UA IS a scavenger of peroxynitrite, IS an antioxidant, and that gout and MS are 100% mutually exclusive, so their hesitancy was unexpected, _________________ Dom
I raised this possibility with my wife's neuro, and even mentioned the theory that gout and MS and mutually exclusive. He was pretty dismissive - he commented:
"look at who gets gout - older men; look at who gets MS - young women; it's not surprising that people with gout don't have MS".
Joined: Sep 11, 2007 Posts: 667 Location: southern California
Posted: Tue Mar 04, 2008 5:39 pm Post subject:
Sorry, MJS...
not all neuros are open to "alternative" views.
Just got back from one year appointment with my husband's neuro. His 20 lesions are still there, but none enhancing (vs. 6 last year), and no new lesions after one year.
Uric acid has been part of his picture, with inosine supplements and copaxone treatment. He was low at dx, with several enhancing lesions and is now high normal, with no progression one year later.
His doc says to keep doing what we're doing, and she supported the inosine. We realize that nothing's guaranteed with MS, but we're hopeful today.
leave no stone unturned!
AC
ps Glad to see your smiling face, Dom! Missed you, but glad you've been composing. _________________ Husband diagnosed RRMS March 2007
pursuing endothelial healing
Copaxone, Swank, supplements, laughter
Joined: Jul 28, 2005 Posts: 1272 Location: Sydney, Australia
Posted: Wed Mar 05, 2008 3:21 am Post subject:
from memory it wasn't a 100% mutually exclusion between gout and MS.
Quote:
In the second study, the records of 20,212,505 outpatients enrolled in Medicare and Medicaid in 1995 were surveyed for patients with MS, gout, and both conditions together. As shown in Table 1, although the distributions of MS and gout in this population should lead to approximately 62 individuals with both diseases, only four such individuals were identified.
Joined: Mar 26, 2005 Posts: 590 Location: Northamptonshire, England.
Posted: Wed Mar 05, 2008 8:39 am Post subject:
Hi Cure,
I've just had another look, and it seems you can find reports that take either position: some say categorically that gout and MS are mutually exclusive; some say, " almost", or, " virtually". I've been thinking about it and come up with a scenario which might explain how the two conditions could coexist but still have uric acid at their base, (this is pure speculation on my part): supposing some people have wildly varying levels of uric acid in their bloodstream, the high periods could account for the build up of crystals and so the appearance of gout, then if it plummets dramatically an MS exacerbation could occur even while the symptoms of gout are still present.
AC,
Thanks for that, and I'm glad your husband is doing well. His doc sounds very approachable – I wish they all were – and I think the evidence is mounting that uric acid is a key player in MS. It's probably worth bearing in mind that a small number of people who take Inosine actually respond with a lowering of uric acid levels… just another reminder that there is probably never going to be a " one size fits all" solution.
By the way, " composing" is going to take up a lot of my time for the foreseeable future, however, I'm not planning to start decomposing for a while yet.
MJS,
Please convey my delight to your wife's neurologist at discovering that I can't possibly have MS. Last time I checked I definitely wasn't a young woman!
As you said… " sigh", _________________ Dom
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