What is known

[Terry]

What things are absolutely known to be true regarding the occurrence of MS?

I know:
More women than men
No gout
Higher incidence farther from the equator

What are the others?

Terry

[Nenu]

I had to look up gout (sadly, while I know the term, I really didn't know about the disease itself) and wow, I never knew that those with MS are never affected by gout. Interesting...

[Loobie]

I did not know about the gout thing either. It must be something that occurs after you get diagnosed because I have had an episode of gout in my big toe that hurt like a sum' bitch.

[Lyon]

I did not know about the gout thing either. It must be something that occurs after you get diagnosed because I have had an episode of gout in my big toe that hurt like a sum' bitch.

Of course it's almost impossible to prove that something NEVER happens, the mutual exclusivity between gout and MS is only something I've heard on this site.

I don't personally know of anyone with MS and gout but I'm not aware of any research neurologist saying that the two are mutually exclusive.

It must be something that occurs after you get diagnosed because I have had an episode of gout in my big toe that hurt like a sum' bitch.

Your situation is the best evidence I've seen so far.

It's FAR more certain that the MS process starts LONG before diagnosis than the certainty that gout and MS are mutually exclusive. You didn't mention how long before you were diagnosed that you had gout but I'd have to guess that if it was after your teens, you had MS at the same time you had gout. MS and gout might be a rare combination but it seems they aren't mutually exclusive.

Terry,
Good question but Certain is a strong word and there are few things in life that are certain, much less the world of MS research. "Highly likely" might be a better term, but even then the highly likely factors involves opinion.

I'm not 100% sure what you mean by "true regarding the occurrence of MS" but I'd add the increased permeability of the blood, brain barrier, lesions (by our definition MS isn't truly MS until diagnosed and for that, lesions are a requirement), inflammation...maybe more than an "autoimmune" disease, MS is an inflammatory disease. Myelin loss, axon death and brain atrophy....which is all kind of the same thing.

I'm the hygiene hypothesis guy so there are other things I consider highly likely, closer to certain than anything else in the world of MS research, but they aren't commonly held views so I'm not adding them

Bob

[CureOrBust]

The MS-Gout being mutually exclusive thing is misquoted very often. As far as I know, the relationship was via a statistical study of health insurance claims. There WERE cases of gout AND ms, it was simply that statistically, they would of expected many more cases in their large sample.

for the actual numbers http://www.pubmedcentral.nih.gov/articl ... able&id=T1

Code: Select all

Survey of the incidence of MS and gout

Patients                       Number         Probability 
Total                      20,212,505 
Gout                           36,733         0.0018 
MS                             34,607         0.0017 
Both gout and MS (predicted)       62         0.0000031 
Both gout and MS (actual)           4         0.0000002 

Proc Natl Acad Sci U S A. 1998 January 20; 95(2): 675–680.

So, the way I personally look at it is, that there is 15-16 times less cases than would be predicted statistically. Still not mutually exclusive.

I have had an episode of gout in my big toe

Did you get a reading on your uric acid levels at the time? What are your uric acid levels normally? During the Gout incident, how was your MS? OK, so the uric acid thing interests me. so shoot me.

[TwistedHelix]

There are conditions which can be mistaken for gout: some forms of arthritis and bursitis as well as calcium crystals in the joints can produce identical symptoms, and even serum uric acid levels can fluctuate and not be conclusive. Could it be that the tiny number of people who appear to have both conditions together have in fact been misdiagnosed as having gout?

[Lyon]

OK, so the uric acid thing interests me. so shoot me.

No one wants to shoot you Cure! At most we'll toss a few stones your way in the public square! Actually, I shouldn't kid about that. If there is anything that is universally sacred things on this site, it's interest in non mainstream ideas. I hope you noticed that I didn't say there was a lack of reasons to suspect uric acid/gout....I just had never heard researchers say gout and MS are mutually exclusive.

There are conditions which can be mistaken for gout: some forms of arthritis and bursitis as well as calcium crystals in the joints can produce identical symptoms, and even serum uric acid levels can fluctuate and not be conclusive. Could it be that the tiny number of people who appear to have both conditions together have in fact been misdiagnosed as having gout?

Two conditions that are hard to conclusively diagnose, in addition to my saying that Lou had MS at that point despite his not having been diagnosed yet? There are all kinds of things which might have fallen through the cracks.

Hopefully it's always in mind that I don't have MS and my interests are different than people with MS. People with MS would like any possible degree of relief right now, regardless of whether or not it involves a factor that is primary or secondary to the MS process. I don't have MS, I only have an obsession. Relief isn't even a consideration for me, and my only real interests involve (what seem to be) primary factors in the MS process and I quickly (maybe too quickly) discount factors which seem (to me) secondary to MS, and uric acid's relationship (if there is indeed a relationship) seems like one.

I shouldn't have gotten involved because I don't have a serious interest in the gout/ms relationship. I was just pointing out that the relationship isn't certain, or even generally accepted as being highly likely.

There WON'T be a tank of Michigan air heading to the Afuso homestead this month!

Bob

[Loobie]

I am totally unaware of my uric acid levels. I've never had them checked, or at least told they were checked in bloodwork, as far as I know. I have no idea if it was 'really' gout or not, but that's what my Dr. told me. From my gout ridden (and just dx'd with RA) brother in law, it sounded right. He has had episodes in his ankle and his knee. As bad as my big toe hurt during that week or so, I can't imagine what it would be like to have gout in a larger joint, but I can imagine not pleasant.

This episode was about 12 or 13 years ago and I've been dx'd since '01. Most people talk about looking back how they can now see signs before their initial symptoms that made them go get checked out. I am an exception to that. I was Joe Athlete right up to the time of my ON, so I have really no idea if I had any activity before that first episode or not. The only thing similar was how fatigued I would get when forced to go on "shopping excursions". I know there's a punch line in there somewhere but I'm serious. I could run 10 miles, but put me in a mall or an outlet mall and after about an hour I would have to sit down. Now that could have been some fatigue stuff that I was pushing through during athletics but more noticeable in a leisure walking kind of thing. But I imagine it also had a lot to do with my massive aversion to shopping. Vive le internet! for shopping is my motto.

[Wonderfulworld]

Bob this article http://www.blackwell-synergy.com/doi/ab ... 08.02087.x
cites a "reduced incidence" rather than mutual exclusivity. Found a 1977 German article that fluffily suggests mutual exclusivity of gout and MS (along with bronchial asthma) - but that sounds ridiculous.

[Lyon]

Thanks for the link WW. I didn't expect it to be so recent! (April 2008).
Bob

[Wonderfulworld]

I didn't expect it to be so recent! (April 2008).

Hah Bob, I may have porridge for brains most of the time, but sometime, a few neurons fire the right way and super-librarian fires into action

[Lyon]

Hah Bob, I may have porridge for brains most of the time,

I not only didn't say that and didn't think it, but I'm not going to agree with it either!

Besides, we're all entitled to an occasional porridge brain day!
Bob

[DIM]

How purines (inosine is the first) help in nerve regeneration which is more important than what known medicines do by reducing relapses:

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http://en.wikipedia.org/wiki/Guanosine_triphosphate

Sorry for the long links!

[CureOrBust]

It seems fairly well known that uric acid is low for MS sufferers, and even lower during a relapse. What I am wondering is, does uric acid lower after the relapse commences, or does it drop before the relapse occurs? if its the second, then its possibly a biological predictor for a relapse. I have visions of home uric acid testers (like diabetics have for glucose) which could prepare people for a relapse, possibly instigating more aggressive preventative treatment. And these could be sold to people with Gout as well (so it broadens the manufacturers market). Also, when I looked for if uric acid levels dropped before a relapse, I hit a lot of studies finding it also predicted stroke in diabetics (but in an inverse relation). So if the existing glucose devices were modified to also measure uric acid, it would extend its current market.

[Lyon]

What I am wondering is, does uric acid lower after the relapse commences, or does it drop before the relapse occurs?

Hi Cure,
Other than going by the opinions of the patients, there is no scientific way to identify the start and end of a relapse.

To put the accuracy of patient opinion in question, most lesions are "silent" and the patient never even recognized it as an exacerbation/relapse. That isn't the makings for an accurate gauge of the beginnings and end of exacerbation

Bob