Gout is a very painful and debilitating inflammatory arthritis condition affecting millions of people worldwide

Gout - the low down

Gout is where crystals of monosodium urate (MSU) cause a very painful auto-inflammatory response in the big-toe or other joints. There are approximately 17.6 million patients with gout in the US, EU and Japan with around 1,500,000 patients affected in the UK (~2.5%) and numbers affected are growing (2014 study).

The main factor that correlates with having gout is high levels of uric acid in body / blood (hyperuricemia), affecting ~20% of people in a recent US study. However, only some of the people with hyperuricemia develop gout (around 1-in-5, ~4% overall incidence, US study).

There are three main phases of gout:

• • Acute attack - very painful, normally 3-7 days
  • Prophylaxis - intermediate prevention, post attack ongoing can be over years
  • Serum urate lowering - long term treatment, can take up to 6 months for urate levels to lower and up to 33 months for tophi and mono-sodium urate deposits to dissolve

Currently available treatments focus on:

• • Stopping the inflammation and initial pain (immediate treatments can include anti-inflammatory medicines such as NSAIDs)
  • Preventing the next attack (‘prophylaxis’ - lower levels of anti-inflammatories and diet change) 
  • Lowering the urate levels in body (longer-term treatment - urisuric prescription drugs such as allopurinol and changes in diet/ drinking more water) and waiting for the mono-sodium urate (MSU) crystals to dissolve 

There are no current treatments directly targeting the actual cause of gout – the MSU crystals.

Schematic of a (toe) joint with gout (MSU) deposits

The above diagram shows a representation of a joint that is affected by gout. The crystals of mono-sodium urate (MSU) are located within the synovial fluid or surrounding tissues/ cartilage. Where the MSU crystals form a larger deposit, this is referred to as a 'tophi'. The presence of these crystals can cause immediate acute painful episodes ('gout attacks') and also cause longer-term damage to the joints and repeat attacks at later dates.

Application of transdermal gel to increase the solubility of MSU crystals in-situ

The MedCryst approach is to apply a gel that will be absorbed through the skin (transdermal) that will increase the in-situ solubility of the MSU crystals. This will help eliminate future painful gout attacks and shorten the time for the patient to achieve full recovery. As the MedCryst formulation is based on excipients that have already been proven to be safe, this treatment should be available 'over-the-counter' and will provide an effective treatment for a currently un-met medical need.

Application of ultrasound (confocal) to help the MSU crystals break up and dissolve

The MedCryst formulation can also be applied with concurrent use of a low-energy ultrasound 'massager' which is already tried and tested on the market. This will encourage the MSU crystals to dissolve within the body, and be removed via natural processes. A specific device could be developed to focus the energy directly where the crystal deposits are located and to fit the spatial requirements of the joints.