Question
My 94 year old mother has had severe gout for about 15 years. The terminal phalanges of her hands are eroded, she has little movement in her fingers,she is riddled with tophi and has wounds on two fingers that will not heal, in spite of being on antibiotics for the last 12 months. She has very limited use of her hands. She had an allergy to allopurinol (skin rash) about 10-12 years ago so treatment has been limited to 6omg /day of colchicine The solution that is proposed is amputation above the knuckles. My question is this, is there anything less dramatic that can be done. Are there new drugs/treatments available. Or is this all hopeless?
Answer
Unfortunately, the new drug febuxostat which acts like allopurinol to reduce the level of uric acid in the blood, was not approved by the FDA. The company was given an “approvable letter” which means that the FDA has requested more information. We were expecting the drug to be out by now. Probencid is a possibility, but your mother needs to have adequate kidney function which is doubtful given her age. Local care of the skin and tophi by a good plastic surgeon may be the only therapy available.
