Gout epidemiology and comorbidities

A novel zinc ferrite nanoparticle protects against MSU-induced gout arthritis via Nrf2/NF-κB/NLRP3 pathway

AIMS

Gouty arthritis (GA), a prevalent and intricate form of inflammatory arthritis, affects individuals across all age groups. Existing therapeutic agents for GA are associated with substantial adverse effects. The overarching objective of this study is to identify an efficacious and biocompatible intervention strategy for GA.

MATERIALS AND METHODS

In this investigation, we developed a zinc ferrite nanoparticle (ZFN) characterized by outstanding catalytic activities in anti-inflammatory and antioxidative processes, along with negligible biotoxicity. ZFN features low-content Zn2+ doping, which effectively overcomes the issue of low biocompatibility commonly encountered in Zn-based nanoparticles. Both in vitro and in vivo experimental models were utilized to comprehensively evaluate the effects of ZFN.

KEY FINDINGS

The experimental results demonstrate that ZFN exhibits remarkable efficacy in alleviating inflammation and oxidative stress both in vitro and in vivo. It exerts its therapeutic effect on GA by modulating the NF-κB signaling pathway, suppressing the activation of the NLRP3 inflammasome, and activating the Nrf2 pathway.

SIGNIFICANCE

The protective effect of ZFN against GA holds great promise for the clinical translation of biocompatible inorganic nanoplatforms in the treatment of GA. This finding offers a potential alternative to the currently available medications, thereby providing new insights and possibilities for the management of GA.

Efficacy and safety of Chinese herbal compound in the treatment of acute gouty arthritis: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The present study aimed to comprehensively assess the efficacy and safety of Chinese herbal compounds in the management of acute gouty arthritis (AGA).

MATERIALS AND METHODS

A systematic search was performed across multiple databases, including PubMed, The Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP, and Wanfang, from their inception until December 1, 2024, to identify relevant randomized controlled trials (RCTs) involving Chinese herbal compounds for AGA. Two independent researchers were responsible for the retrieved literature screening, data extraction, and quality evaluation. A meta-analysis of RCTs that fulfill the inclusion criteria will be executed utilizing Stata 14.0 software. The quality of the outcomes will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

A total of 28 studies, encompassing 2100 participants, were included in the analysis. The meta-analysis showed that compared with conventional Western medicine, Chinese herbal compounds significantly enhance the overall efficacy of AGA treatment (RR = 1.11, 95 %CI (1.05, 1.16), P < 0.00001; Level of evidence: very low). It also demonstrated improvements in the Visual Analogue Scale (VAS) (SMD = -1.46, 95 %CI(-2.17, -0.75), P < 0.00001; Level of evidence: very low), serum uric acid levels (SMD = -0.67, 95 %CI (-1.00, -0.33), P < 0.00001; Level of evidence: very low), blood sedimentation levels (SMD = -0.71, 95 %CI (-1.08, -0.33), P < 0.00001; Level of evidence: very low), C-reactive protein (CRP) levels (SMD = 0.89, 95 %CI(-1.33, -0.45), P < 0.00001; Level of evidence: very low), and the traditional Chinese medicine syndrome score(SMD = -0.93, 95 %CI (-1.37, -0.49), P < 0.00001; Level of evidence: very low). Additionally, a reduced incidence of adverse effects was noted (RR = 0.26, 95 %CI (0.18, 0.39), P < 0.00001; Level of evidence: moderate). Subgroup analysis revealed that regardless of whether the treatment duration was less than or more than 1 week, Chinese herbal compounds were effective in improving the total effective rate of AGA treatment, VAS scores, serum uric acid levels, blood sedimentation levels, CRP levels, and Traditional Chinese medicine symptom scores, while simultaneously decreasing the occurrence of adverse reactions.

CONCLUSION

Chinese herbal compounds demonstrated superior efficacy and safety compared to conventional Western medicine in treating AGA. However, further validation through multicenter, high-quality RCTs is warranted to strengthen this conclusion.

Estimation of Hair Toxic and Essential Trace Element and Mineral Profiles of Patients with Chronic Gout

The objective of the present study was to evaluate hair levels of toxic and essential trace elements and minerals in male and female patients with chronic gout. A total of 223 examinees aged from 27 to 82 years old including 116 healthy controls (64 women and 52 men) and 107 patients with gout (56 women and 51 men) were enrolled in the current cross-sectional study. Analysis of hair toxic and essential trace element and mineral content was performed using inductively-coupled plasma mass-spectrometry. The obtained data demonstrate that hair B, Fe, I, and Mo levels in gout patients were 67%, 8%, 46%, and 21% higher in comparison to the respective control values. Hair Cr and V content in patients was more than twofold higher than in the controls. Hair Mg and Zn levels were found to be 34% and 11% lower when compared to the respective control values. Hair toxic metal and metalloid content was also significantly affected in gout patients. Specifically, hair Al, As, and Pb levels were 24%, 43%, and 33% higher in gout patients than in healthy controls, respectively. Analysis of covariance demonstrated that sex also had a significant influence on hair trace element and mineral levels in gout patients. Specifically, gout-associated overaccumulation of hair trace elements including was more profound in male than in female patients. It is assumed that trace element dysregulation may contribute to gout development and progression, especially in men. However, further studies are required to elucidate this association and the underlying molecular mechanisms.

[Gout : From the diagnosis to guideline-based treatment]

Gout is an autoinflammatory disease triggered by chronic hyperuricemia and causes extremely painful joint inflammation. If left untreated gout can lead to irreversible joint damage and significantly impair the quality of life of affected patients. In addition to classical diagnostic methods, such as serum uric acid measurement and joint aspiration, imaging techniques, such as ultrasound and dual-energy computed tomography (CT) are becoming increasingly more important. The treatment of acute gout attacks focuses on nonsteroidal anti-inflammatory drugs (NSAID), glucocorticoids and colchicine. The long-term management involves uric acid-lowering treatment with xanthine oxidase inhibitors (e.g., allopurinol). Another key element of treatment is flare prevention during the first months of uric acid-lowering treatment to minimize the risk of further gout attacks. As gout is a chronic disease adherence to the intake of uric acid-lowering medications is crucial for long-term treatment success.

Global prevalence of metabolic syndrome in patients with gout: A systematic review and meta-analysis

Background: Evidence increasingly supports the association of gout with metabolic syndrome (MetS). Studies have indicated that the prevalence of MetS among patients with gout ranges from 17 to over 70 percent. Aim: The purpose of this study was to establish the global prevalence of MetS in patients diagnosed with gout. Methods: To obtain studies related to the title, we systematically searched PubMed, Scopus, Web of Science, Embase, Science-Direct, and Google Scholar search engine to find all relevant articles that were published until the end of November 2023. Obtain and carry out the necessary evaluations. The I2 index was used to examine the heterogeneity of studies and the Random Effects model was used to analyze the data. Results: Following evaluation, we discovered 19 studies (23 findings), revealing an overall prevalence of MetS in gout patients as 46.8% (95% CI: 38.6-55.2%). On a regional level, subgroup analysis indicated the highest prevalence of MetS was in the American continent, with a rate of 60.6% (95% CI: 44.8-74.5%). In terms of the tool used for MetS measurement, the subgroup analysis showed the maximum prevalence rate of 54.6% was associated with the International Diabetes Federation criteria tool. Conclusion: The results of this research showed that MetS is common among gout patients; therefore, policymakers should reduce the consequences and costs of this condition by focusing on these patients and performing appropriate and timely treatment and training.

J-Shaped Association Between Non-HDL Cholesterol to HDL Cholesterol Ratios and Gout in US Adults With Gout

Background and Aim

This study aims to assess the potential association between NHHR and gout risk among the US adult population.

Methods and Results

Utilizing data from the NHANES spanning from 2007 to 2018, we performed a cross-sectional analysis. A weighted multivariable logistic regression model, generalized additive model (GAM) and a restricted cubic spline model were applied to elucidate the association between NHHR and gout risk. In addition, subgroup and sensitivity analyses were conducted to ensure the stability of our findings. This study cohort included 27,731 participants. Multivariate logistic regression analysis indicated a significant correlation between NHHR and the likelihood of gout. This association was sustained after accounting for a range of potential confounding confounders. The risk of gout was observed to escalate with increasing quartiles of NHHR quartiles, with a 67% increased risk in the fourth quartile. Both RCS and curve fitting results indicated a J-shaped relationship between NHHR and gout. The association remained significant in several subgroup analyses. The interaction test did not yield statistically significant effects on this association.

Conclusion

The NHHR is nonlinearly correlated with the risk of gout in US adults. Further investigation research into the role of NHHR in gout could offer new perspectives on the prevention and treatment of gout. However, additional large-scale prospective studies are necessary to validate and reinforce these results.

Association between advanced lung cancer inflammation index and acute gouty arthritis in Dalian, China: a cross-sectional study

Introduction

Acute gouty arthritis (AGA) is an inflammatory joint disease. The advanced lung cancer inflammation index (ALI) evaluates inflammation. This study investigates the association between ALI and AGA.

Methods

We included 652 participants in this cohort study, dividing them into two groups: those with AGA and a control group without AGA. We employed logistic regression to examine the ALI-AGA relationship, using restricted cubic splines (RCS) to assess dose-response relationships, performing subgroup analyses, and conducting interaction tests. K-fold cross-validation was applied for model assessment. Receiver operating characteristic (ROC) curves were applied to visualize and compare the predictive value of ALI and other inflammatory indices for AGA.

Results

Among the 652 participants, the AGA group exhibited significantly lower ALI values compared to the control group. Multivariate logistic regression identified an inverse relationship between ALI and AGA. RCS analysis indicated an L-shaped non-linear relationship between ALI levels and AGA, with inflection points at an ALI of 23.38. Subgroup analyses showed no significant interactions between ALI levels and AGA after stratifying by age, hypertension, coronary heart disease (CHD), and diabetes (DM). The results from the ROC curves indicate that ALI may serve as a better predictor of AGA.

Conclusion

This cross-sectional study found a significant inverse correlation between ALI levels and AGA prevalence. Moreover, the ALI could serve as a more accurate diagnostic tool for AGA and offer a novel approach for further investigating the relationship between inflammation and AGA.

Risk of Sudden Sensorineural Hearing Loss in Patients with Gout: A Population-Level Study in a South Korean National Health Screening Cohort

Background: Gout, characterized by serum uric acid accumulation, prompts inflammation, leading to tissue damage and comorbidities. Prior studies reported a higher risk of hearing loss in gout patients; however, the specific risk of sudden sensorineural hearing loss (SSNHL) remains unclear. Method: This population-based study assessed SSNHL incidence and risk in patients aged ≥ 40 years with or without gout, excluding those with prior SSNHL, within the Korean National Health Insurance Service Health Screening Cohort (2002-2019). A total of 24,508 gout patients were matched 1:4 with 98,032 controls by age, sex, income, and region. SSNHL incidence was compared, and Kaplan-Meier curves with log-rank tests evaluated cumulative incidence over 200 months. Hazard ratios (HRs) were calculated using stratified Cox models adjusted for patient characteristics. Results: SSNHL incidence was slightly higher in the gout cohort vs. controls (1.70% vs. 1.96%, SD = 0.02). Kaplan-Meier analysis revealed significantly higher cumulative SSNHL incidence in gout patients (p = 0.009). Patients with gout had a significantly higher risk of developing SSNHL in both the unadjusted (HR [95% CI]: 1.14 [1.03-1.27]; p = 0.010) and adjusted Cox models (1.13 [1.02-1.26]; p = 0.021). Subgroup analyses indicated higher risk in gout patients aged <60 years, males, non-smokers, non-drinkers, moderately-high income, normal BMI, Charlson Comorbidity Index score of 0, or fasting blood glucose < 100 mg/dL (all p < 0.05). Conclusions: Korean adults with gout, particularly younger, healthier patients, face increased SSNHL risk. Early, effective gout management may help mitigate this risk.

Effects of Baicalin on Gout Based on Network Pharmacology, Molecular Docking, and in vitro Experiments

Purpose

Baicalin is a flavonoid of Scutellaria baicalensis Georgi. It possesses antipyretic, analgesic, and anti-inflammatory effects. It has great potential to treat gout. A network pharmacology approach, molecular docking and experimental validation were applied to investigate the pharmacological mechanisms of baicalin in treating gout.

Methods

The potential targets of baicalin were retrieved from the TCMSP, PharmMapper, STITCH, and Swiss Target Prediction databases. The gout-related targets were retrieved from the DrugBank, TTD, and Genecards databases. Then, the potential targets and signaling pathways were acquired via protein-protein interaction (PPI), as well as the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Subsequently, the key targets were selected to dock with baicalin based on molecular docking. Finally, in vitro experiments were conducted to further validate the predictions.

Results

A total of 318 potential targets of baicalin and 752 gout-related targets were screened. TNF, VEGFA, MMP9, PTGS2, and TLR4 might be the hub therapeutic target genes. The TLR4/NF-κB signaling pathway might be the foremost pathway in baicalin against gout. Moreover, molecular docking showed that baicalin combined well with TNF, VEGFA, MMP9, COX-2, and TLR4, respectively. The results of cell experiments suggested that baicalin could reduce the levels of inflammatory cytokines by inhibiting the TLR4/NF-κB signaling pathway in MSU-stimulated THP-1 cells and regulate the expression of these hub targets.

Conclusion

These results revealed that baicalin possesses "multitarget, multipathway, multilevel" regulatory effects. From a therapeutic standpoint, baicalin may be a promising anti-inflammatory agent for alleviating gout.

Enhanced and Sustained Transdermal Delivery of Oxypurinol Using Thermosensitive Gel Combined with Polymeric Solid Microneedles

Gout is a pathological condition caused by monosodium urate crystal deposition in tissues. Allopurinol, the first-line therapy, inhibits xanthine oxidase but may be ineffective due to reduced conversion to oxypurinol (OXY). Current delivery routes for OXY, including oral and intravenous routes, have drawbacks such as poor solubility and patient discomfort. This study developed a delivery system integrating thermosensitive gel (TRG) containing OXY with polymeric solid microneedles (PSMNs). Molecular docking demonstrated high-affinity binding interactions between OXY and Pluronic (-2.5). The TRG, formulated with Pluronic F127 and F68, was assessed for gelation temperature, pH, spreadability, and bioadhesive strength. PSMN, made from poly(vinyl alcohol) and polyvinylpyrrolidone K-30 with citric acid, was evaluated for mechanical strength and skin penetration. In vitro hemolysis activity, drug release, and ex vivo permeation studies were conducted. Molecular docking results showed stable binding with an affinity of -2.5 between the ligands of OXY and Pluronic. The TRG formulation exhibited promising characteristics for transdermal drug delivery. PSMN demonstrated good mechanical strength and was able to penetrate up to 504 μm. Hemolysis testing showed that PSMN and TSG were safe with a hemolysis ratio of less than 5%. In vitro drug release studies showed a high OXY release of 2.24 ± 0.26 mg with the highest concentration of Pluronic F68, displaying a sustained release profile. Ex vivo permeation studies showed a significant difference (p < 0.05) between OXY permeation without and with PSMN combination. PSMN increased OXY permeation by 79-81% compared to permeation without PSMN. This study successfully developed a TRG formulation combined with PSMN to enhance transdermal delivery of OXY. These results suggest a promising new route for OXY delivery, potentially offering a more efficient and user-friendly treatment for chronic gout. Further in vivo studies are needed to evaluate the efficacy, pharmacokinetics, pharmacodynamics, drug interactions, and toxicity for further clinical applications.

Analysis of the efficacy of multidisciplinary integration based on 3D reconstruction technology for the treatment of gout stone

OBJECTIVE

This study investigates the efficacy of multidisciplinary fusion therapy based on 3D reconstruction technology for the treatment of gouty stone by comparing the efficacy of multidisciplinary fusion therapy with pharmacologic therapy.

METHODS

This study is a cohort study.Patients who underwent gout stone surgery at the Affiliated Hospital of Qingdao University from November 2020 to November 2022 were included in this study, totaling 85 to form the MDT surgery group, and matched among gout stone patients in the outpatient clinic during the same period to form the medication group. Patients in the 2 groups were followed up for 6 months to compare baseline and follow-up data.

RESULTS

Both groups experienced a decrease in uric acid levels and an increase in SF-36 scores during follow-up. After adjusting for confounders, multifactorial logistic regression showed that the uric acid attainment rate of patients in the MDT surgery group was 4.011 times higher than that of the drug group (OR: 4.011, 95% CI: 1.595, 10.086, P = 0.003); the proportion of patients with an increase in SF-36 in the MDT surgery group was 4.976 times higher than that of the drug group (OR: 4.976, 95% CI: 2.243, 11.040, P < 0.001); the proportion of patients treated with high-dose medication in the MDT surgery group was 1.8% of that of patients in the drug group (OR: 0.018, 95% CI: 0.002, 0.148, P < 0.001); and the proportion of patients in the MDT surgery group who developed frequent gout was 2.8% of that in the drug group (OR: 0.028 95% CI: 0.003, 0.2398, P = 0.001). the proportion of patients in the MDT surgery group who developed abnormal liver function was 0.317 times higher than that in the drug group (OR: 0.317, 95% CI: 0.121, 0.831, P = 0.019).

CONCLUSION

The multidisciplinary integration of 3D reconstructive techniques for gout stone treatment resulted in an increase in uric acid compliance, a decrease in the frequency of gout and the appearance of liver impairment; and a greater benefit in terms of improvement in the quality of life of the patients after treatment.

Synovial fluid dual-biomarker algorithm accurately differentiates osteoarthritis from inflammatory arthritis

Osteoarthritis (OA) prevalence increases as the population ages. Diagnosing osteoarthritis often occurs in the late stages when cartilage degradation is severe, making it difficult to distinguish from other types of arthritis. Accurate differentiation of primary osteoarthritis from other arthritic conditions is crucial for effective treatment planning. A new diagnostic test has been developed that uses a dual-biomarker algorithm to inform osteoarthritis diagnosis. Synovial fluid from patients with confirmed primary osteoarthritis showed elevated levels of cartilage oligomeric matrix protein. However, this biomarker alone could not distinguish primary osteoarthritis from other inflammatory conditions that also cause cartilage deterioration. Therefore, a combinatorial algorithm using cartilage oligomeric matrix protein and Interleukin-8 concentrations was developed to differentiate primary osteoarthritis from inflammatory arthritis. Clinical decision limits for cartilage oligomeric matrix protein concentration and the cartilage oligomeric matrix protein to Interleukin-8 ratio were established and validated using 171 human knee synovial fluid specimens. The osteoarthritis algorithm demonstrated clinical sensitivity and specificity of 87.0% and 88.9%, respectively. This is the first report of a biomarker test that can differentiate primary osteoarthritis from inflammatory arthritis with a high degree of accuracy.

Genetically Predicted Plasma Metabolome Mediates the Causal Link Between Immune Cells and Risk of Gout

BACKGROUND

Gout is a prevalent metabolic disorder characterized by a multifaceted process of development. Recent research has emphasized a robust correlation between the immune response and gout. Nevertheless, it is still uncertain if this connection is causative. Hence, the objective of this study was to investigate the causal relationship between immune cells and gout, while also analyzing the role of the plasma metabolome as metabolic mediators in this biological process.

METHODS

This study explored the causal link between different subtypes of immune cells and gout using two-sample Mendelian randomization (MR). To confirm the reliability of the findings, reverse MR analysis, steiger test and sensitivity tests were conducted. A two-step mediation analysis was used to gain insight into the role of plasma metabolites as intermediate mediators.

RESULTS

This two-sample, bidirectional, two-step MR analysis found a nominal causal link between 33 immune cells as well as 47 known plasma metabolites and gout. Reverse MR analysis and sensitivity tests demonstrated the reliability of the MR results. In addition, we found that Tetradecadienedioate (C14:2-DC) played a partially mediating role in the CD4 on activated CD4 regulatory T cell and gout pathways, with a mediating proportion of 13.16%, (95% CI = 0.65%-25.67%, p = 0.034).

CONCLUSION

The objective of our research was to investigate the possible causative connection between immune cells and gout. Our findings indicate that certain plasma metabolites may play a role in mediating this association. This study offers novel insights and sources of information that may contribute to the early detection and proactive measures to avoid gout in the future.

Healthcare burden of public hospital gout admissions in New South Wales, Australia

BACKGROUND AND AIMS

In New Zealand, the Māori and Pacific Islander population has a higher rate of hospital admissions for gout; however, we lack data for these population groups who reside in Australia. This study examined the pattern of hospital gout admissions in New South Wales (NSW), the most populous state of Australia, with a particular focus on the Māori and Pacific Islander population.

METHODS

This was a retrospective cohort study exploring the pattern of gout admissions in NSW public hospitals in the financial years 2017/2018 to 2019/2020. All patients aged ≥20 years, admitted to hospital with gout as the principal diagnosis between 1 July 2017 and 30 June 2020, were included in this study. Outcomes measured included the number and costs of these hospital admissions. Crude and age-standardised admission rates were calculated.

RESULTS

Western Sydney Local Health District (LHD) and South Western Sydney LHD had the highest number of hospital admissions with a principal diagnosis of gout (n = 537 and 788 admissions, respectively) in the 3-year study period. Māori and Pacific Islanders had higher rates of admissions due to gout (109.9 admissions per 100 000 people, compared to 20.0 for non-Māori/non-Pacific Islanders) and were of younger age.

CONCLUSIONS

This study highlights the ethnic and geographical disparities in gout hospital admissions in NSW, with the Māori and Pacific Islander population of Western and South Western Sydney disproportionately affected. Culturally appropriate gout management strategies may be needed in the Māori and Pacific Islander population to address the large number of gout cases in western and southwestern Sydney.

[Colchicine-Phoenix from the ashes]

Colchicine is an anti-inflammatory herbal medicine with a history stretching back thousands of years. It is a cornerstone in the acute and prophylactic treatment of gout and has secured a permanent place in the standard pharmacological repertoire for familial Mediterranean fever, pericarditis, neutrophilic dermatoses, Behçet's disease and severe aphthous ulcers refractory to oral treatment. The US Food and Drug Administration (FDA) has recently approved colchicine to reduce the risk of myocardial infarction, stroke, coronary revascularization and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular diseases. The recommendation level for cardiovascular prophylaxis was raised from IIb to IIa in the current European Society of Cardiology (ESC) guidelines from 2024. Clinical studies in recent years also demonstrated an effect for acute coronary syndrome and atrial fibrillation. This review article highlights the efficacy and safety profile of colchicine and provides insights into recent and potential future evidence-based fields of application.

Ultrasound stimulated perfluorobutane microbubbles cavitation enhanced the therapeutic effect of colchicine in rats with acute gouty arthritis

Objective

This study aimed to explore whether cavitation generated by ultrasound-stimulated microbubbles (USMB) can enhance the therapeutic efficacy of colchicine and diminish its gastrointestinal side effects in rats with acute gouty arthritis (AGA).

Materials and methods

The rat AGA model was established by injection of Monosodium urate (MSU) crystals. The rats were randomly divided into 6 groups (A: control group, B: model control group, C: cavitation group, D: high dose colchicine group, E: cavitation + low dose colchicine group, F: cavitation + high dose colchicine group) according to whether they were given cavitation and different doses of colchicine. The effect of cavitation on blood perfusion was analyzed by comparing contrast-enhanced ultrasound (CEUS) and the area under the curve (AUC) of CEUS with the ankle joint of right hind limb. The AGA symptoms were assessed by referring to the degree of ankle joint swelling within 24 h and the gait score. The infiltration of neutrophils was determined using the hematoxylin-eosin (HE) staining method. For the evaluation of vascular inflammation and dilation, plasma interleukin-1β (IL-1β) and endothelial nitric oxide synthase (eNOS) served as the key indicators. Besides, the severity of gastrointestinal adverse reactions is determined by analyzing the gastrointestinal reaction scores.

Results

When compared with groups A, B, and D, the AUC was markedly higher in groups C, E, and F (all P < 0.05). In groups E and F, the degree of ankle swelling, gait scores, and the level of plasma IL-1β in AGA rats were lower, while the concentration of plasma eNOS was higher compared to the group D (all P < 0.05). HE staining findings demonstrated that the integration of cavitation and colchicine played a positive role in reducing neutrophil infiltration in the ankle joint synovium and mitigating the gastrointestinal reaction score in AGA rats. In contrast to groups D, E, and F that were given colchicine, group E had a substantially lower gastrointestinal reaction score, with statistically significant differences observed in pairwise comparisons (all P < 0.05).

Conclusion

In rats with AGA, cavitation generated by USMB exerted a remarkable effect on augmenting the blood perfusion of the ankle joint. This, in turn, not only amplified the anti-gout efficacy of colchicine but also reduced the dosage of colchicine. Concurrently, it effectively mitigated the associated gastrointestinal side effects.

Mechanism of Biqi capsules in the treatment of gout based on network pharmacology and experimental verification

ETHNOPHARMACOLOGICAL RELEVANCE

Gout is a crystal-related arthropathy caused by monosodium urate (MSU) deposition, resulting from purine metabolism disorders and hyperuricemia (HUA). Gout belongs to the traditional medicine category of Bi syndrome. Biqi capsules (BQ) is a traditional Chinese medicine formula used to treat Bi syndrome. The BQ prescription is derived from the ancient prescription of Hua Tuo, a famous physician in the Han Dynasty.

AIM OF THE STUDY

To study the effect and mechanism of BQ in treating acute gouty arthritis (AGA) and HUA.

MATERIALS AND METHODS

Analyzing BQ's signaling pathways for gout treatment via network pharmacology. The HUA model was induced orally with adenine and potassium oxonate. The rat AGA model was established by MSU injection. In vitro, MH7A and RAW 246.7 cells were treated with LPS and MSU. Serum uric acid, creatinine, and urea nitrogen levels were evaluated. Kidney and ankle joint pathology was observed via HE staining. Inflammatory signaling pathway proteins, epithelial-mesenchymal transition (EMT) pathway proteins, and uric acid metabolism-related proteins were detected by Western blot.

RESULTS

1780 potential targets for gout treatment were identified, and 1039 target proteins corresponding to BQ's active ingredients were obtained. Pathway enrichment analysis revealed BQ improved gout mainly through inflammatory pathways. Experimental results showed BQ could reduce serum uric acid level and increase uric acid clearance rate by regulating the expression of adenosine deaminase (ADA), and organic anion transporter 1 (OAT1) and glucose transporter 9 (GLUT9) in HUA mice. BQ could improve renal function and injury by inhibiting the NLRP3 pathway in HUA mice' kidneys. Additionally, BQ could alleviate ankle joint swelling and synovial injury, inhibit the TLR4/NLRP3 pathway, and reduce levels of inflammatory factors including interleukin 6 (IL-6), interleukin 1β (IL-1β), and tumor necrosis factor-alpha (TNF-α) in AGA rats. The main component of BQ, brucine, could inhibit the activation of NLRP3/NF-κB pathway induced by MSU and reduce the expression level of inflammatory factors (IL-6, IL-1β, and TNF-α) in macrophages. Brucine could inhibit the activation of the EMT pathway and reduce the expression level of inflammatory factors (IL-6, TNF-α) in human fibroblast-like synoviocytes (MH7A cells) induced by MSU.

CONCLUSIONS

BQ effectively reduced serum uric acid levels, improved kidney and joint damage, and ameliorated the inflammatory response caused by MSU. Its main component, brucine, effectively improved the inflammatory response and reduced the invasive ability of synoviocytes induced by MSU.

A comprehensive analysis of trends in the burden of gout in China and globally from 1990 to 2021

Gout is a prevalent metabolic disorder characterized by urate crystal accumulation in joints, leading to acute arthritis and tophi formation. Despite advancements in management, the incidence and prevalence of gout have been increasing globally, particularly in China. This study analyzed data from the Global Burden of Disease Injuries and Risk Factors Study (GBD) to evaluate trends in gout from 1990 to 2021. Statistical analyses were conducted using R and Joinpoint software, while the ARIMA model was employed for forecasting future trends. Our findings revealed a global increase in gout incidence from 93.097 per 100,000 in 1990 to 109.075 per 100,000 in 2021, with cases rising from 3,983,109 to 9,401,585. In China, incidence increased from 122.522 to 151.612 per 100,000, with cases growing from 1,182,498 to 3,079,836. Similarly, global prevalence rose from 536.545 to 653.816 per 100,000, while in China, it increased from 640.679 to 810.359 per 100,000. Disability metrics, including YLDs and DALYs, also demonstrated significant increases both globally and in China. Our analysis indicated that middle-aged and elderly populations, particularly males, are at higher risk for gout. These findings underscore the urgent need for enhanced prevention and management strategies, specifically targeting high-risk populations. Effective public health policies and interventions are crucial to mitigate the escalating burden of gout and improve the quality of life for affected individuals. This study relied on secondary data from the GBD, which may be subject to biases in data collection and reporting. Additionally, variations in diagnostic practices and healthcare access across regions could influence the accuracy of reported trends. Future research should address these limitations by incorporating primary data and exploring region-specific factors contributing to gout prevalence and incidence.

Association between serum iron status and gout: results from the NHANES and Mendelian randomization study

Aims. Previous observational studies have provided inconsistent evidence for the association between serum iron status and the risk of gout. Moreover, it remains uncertain whether the observed association is causal or due to confounding or reverse causality. This research aimed to investigate the association of serum iron status indicators with the risk of gout and to further examine the causal relationship by the Mendelian randomization (MR) method. Methods. We first conducted a cross-sectional study from the National Health and Nutrition Examination Survey 2017-2018, including a total of 4635 participants. The association of serum iron status indicators with gout risk was evaluated using a multivariable logistic regression model. Furthermore, a two-sample MR study using genetic data from large-scale genome-wide association studies of serum iron status indicators (246 139 individuals) and gout (discovery: 13 179 cases and 75 0634 controls; replication: 5292 cases and 368 788 controls; 2115 cases and 67 259 controls) was conducted to infer causality. Inverse-variance-weighting (IVW) was applied as the main method of MR analysis. A series of sensitivity analyses were used to evaluate the robustness of their relationship. Results. In the cross-sectional study, there was no significant relationship between serum iron status indicators and gout risk. However, IVW results showed that genetically predicted serum iron and transferrin saturation (TSAT) were significantly associated with the increased risk of gout in the discovery analysis [odds ratio (OR): 1.21; 95% confidence interval (CI): 1.10-1.32; P = 9.80 × 10-5 for serum iron and OR: 1.16; 95% CI: 1.08-1.25; P = 7.14 × 10-5 for TSAT]. The replication analysis provided similar results compared with the discovery analysis. Conclusion. Our study provides support for potential causal associations between serum iron and the altered risk of gout. Further investigations are warranted to elucidate the biological processes through which iron influences susceptibility to gout.

Risk of myocardial infarction and heart failure in gout patients: a systematic review and meta-analysis

BACKGROUND

Gout is a metabolic disease caused by decreased blood uric acid excretion and purine metabolism disorders. Long-term and persistent metabolic dysfunction gradually affects other organ functions and is the main factor inducing Myocardial Infarction (MI) and Heart Failure (HF), seriously affecting the health of patients. This study adopts a meta-analysis to analyze the risk of MI and HF in gout patients.

METHODS

Clinical research literature related to gout complicated with MI or HF was searched in databases such as PubMed, Embase, Web of Science, Cochrane Library, etc. through computer retrieval before March 2023. Literature content was carefully read and retrieved, and screening was conducted based on inclusion and exclusion criteria. Relevant data were extracted from the final screened literature, and a forest map was drawn using RevMan 5.3 software for meta-analysis.

RESULTS

After searching in various databases, 2519 articles were obtained. After screening, 8 articles were finally included for meta-analysis. Among the 22 included literature, 9 analyzed the risk of gout and MI, and heterogeneity tests showed P = 0.20 and I2 = 28%. Fixing effects analysis showed RR = 4.60, 95%CI = 4.39-4.82, and P < 0.001. Nine articles analyzed the risk of gout and HF, and heterogeneity tests showed that P = 0.13 and I2 = 37%. Fixing effects analysis showed RR = 2.71, 95%CI = 2.61-2.82, and P < 0.001. Eight studies compared the incidence of MI or HF between male gout and non-gout patients. Heterogeneity tests showed P = 0.21 and I2 = 28%, while fixing effects analysis showed RR = 1.98 and 95%CI = 1.89-2.01, with P < 0.001. Four articles statistically compared the incidence of MI or HF between female gout and non-gout patients. Heterogeneity tests showed P = 0.15 and I2 = 43%. Fixing effects analysis showed RR = 1.70, 95%CI = 1.57-1.83, and P < 0.001. Thirteen studies compared the incidence of MI or HF in gout patients of different genders. Heterogeneity tests showed P = 0.37 and I2 = 7%. Fixing effects analysis showed RR = 0.03, 95%CI = 0.03-0.03, and P < 0.001.

CONCLUSION

Compared to non-gout patients, gout patients are more prone to MI or HF and are not affected by gender. However, among gout patients, women have a higher risk of MI or HF than men.

Current Status of Gout Arthritis: Current Approaches to Gout Arthritis Treatment: Nanoparticles Delivery Systems Approach

The deposition of monosodium urate (MSU) crystals within joint spaces produces a painful inflammatory condition known as gout, a specific form of arthritis. The condition calls for a combined curative and preventive management model. A new development in the approach to gout is that of NLRP3-targeted biologic agents, such as monoclonal therapies, to provide more accurate treatment by blocking specific pro-inflammatory cytokines. Nanoparticle drug delivery enhances biological availability and delivery to targets, which may increase therapeutic efficacy and decrease general toxicity. The preventive approach again cannot be ignored, mainly keeping up certain modifications in diet and weight, along with pharmacological therapies to reduce uric acid (UA) levels and to decrease the frequency of acute attacks. The advancement of genetic profiling of patients and biomarker discoveries drives the trend towards building individualized medicine and care, quickly gaining ground as the most effective method of delivering treatments to individual patients, moving away from one-size-fits-all treatments. The following paper aims to provide an updated account of the management of gout with a focus on recent developments, in order to enhance these approaches, the quality of life for patients with gout, and the standard of gout treatment.

Systemic inflammation response index association with gout in hyperuricemic adults: NHANES 2007-2018

Background

Hyperuricemia is the underlying condition of gout. Previous studies have indicated that specific strategies may be effective in preventing the progression of hyperuricemia to gout. However, there is a lack of widely applicable methods for identifying high-risk populations for gout. Gout is linked to inflammation, especially in the hyperuricemic population. Systemic inflammation response index (SIRI) is a novel method for evaluating an individual's systemic inflammatory activity. However, the association between SIRI and gout in the hyperuricemic population has not been studied.

Methods

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018.SIRI was log2-transformed before analysis. Multivariable logistic regression, subgroup analysis, and smooth curve fitting were employed to comprehensively evaluate the correlation between SIRI and gout prevalence in the hyperuricemic population. Additionally, we compared SIRI with other inflammatory markers.

Result

A total of 6,732 hyperuricemic patients were included, of which 3,764 were men. After adjusting for all covariates, SIRI was found to be significantly positively correlated with gout prevalence in the female group ([OR = 1.385, 95% CI (1.187, 1.615), p < 0.001]), and its diagnostic performance was superior to other inflammatory markers. In the male group, the correlation between log2-SIRI and gout prevalence was not significant ([OR = 0.994, 95% CI (0.892, 1.108), p = 0.916]). But there were significant positive correlations in the 20-45 age group ([OR = 1.362, 95% CI (1.021, 1.818), p = 0.036]). Subgroup analyses revealed that the results were largely consistent when the individuals were divided into different subgroups (FDR adjusted p for interaction >0.05 for all).

Conclusion

Our study suggests that the Systemic Inflammation Response Index (SIRI) has potential as a predictive marker for gout risk in hyperuricemic women. However, given the higher gout prevalence in men, the potential of SIRI as a predictive marker for gout risk in this population may be limited. Subgroup analyses, however, indicated that the relationship between SIRI and gout prevalence, as well as its statistical significance, varied across different age groups. Future research could further explore this association by investigating the relationship between SIRI and gout prevalence in different age cohorts.

An update on the pharmacotherapy of gout

INTRODUCTION

Gout is a common form of acute inflammatory arthritis caused by the deposition of monosodium urate crystals within synovium of joints. This leads to severe pain, reducing quality of life for patients with this condition.

AREAS COVERED

This review summarizes the treatment of both acute flares of gout and urate-lowering therapy based on guidance from various major international societies. We have also covered new emerging therapies that have not yet reached clinical practice.

EXPERT OPINION

Standard pharmacotherapies for gout flares include the options of colchicine, NSAIDs and oral or intramuscular corticosteroids, with IL-1 inhibitors newly established as an option for flare refractory to standard therapies. Urate-lowering therapies aim to prevent gout flares, with an emphasis on treat-to-target strategy; the escalation of therapies until the target serum uric acid is reached. Initial treatments include allopurinol and febuxostat, with uricosuric agents, probenecid, sulfinpyrazone and benzbromarone, as adjuncts. There are also emerging therapies in development. However, there is increasing personalization of treatment, adjusting pharmacotherapy depending on comorbidities, such as chronic kidney disease and ischemic heart disease, as well as patient preference.

Target Serum Urate Achievement and Chronic Kidney Disease Progression in Patients With Gout and Kidney Disease

Importance

Clinicians often approach urate-lowering therapy (ULT) cautiously in patients with gout and impaired kidney function because they are concerned about the risk of progression to severe or end-stage kidney disease. However, evidence from randomized clinical trials of this association remains inconclusive.

Objective

To evaluate the association between achieving target serum urate level with ULT and progression of chronic kidney disease (CKD) to severe or end-stage in patients with gout and impaired kidney function.

Design, Setting, and Participants

This was a cohort study using the target trial emulation approach using data from a general practice database (IQVIA Medical Research Database) for 2000 to 2023. Eligible patients were 40 to 89 years old and had gout and CKD stage 3. Data analyses were performed from November 2023 to September 2024.

Exposures

Lowering serum urate level to target level (<6 mg/dL) using ULT.

Main Outcomes and Measures

Severe or end-stage kidney disease, determined by an estimated glomerular filtration rate of less than 30 mL/min/1.73 m2 on at least 2 occasions more than 90 days apart within 1 year, or at least 1 Read code (per the Refined Etiology, Anatomical Site, and Diagnosis classification) for CKD stages 4 or 5, hemodialysis, peritoneal dialysis, or kidney transplant. The prespecified noninferiority margin of the hazard ratio (HR) was set at 1.2, comparing those who achieved the target serum urate level with those who did not.

Results

Among the 14 792 participants (mean [SD] age, 73.1 [9.5] years; 9215 men [62.3%] and 5577 women [37.7%]) with gout and with CKD stage 3, the 5-year risk of severe or end-stage kidney disease was 10.32% for those who achieved the target serum urate level and 12.73% for those who did not. Compared with those not achieving the target level, the adjusted 5-year risk difference and HR of severe or end-stage kidney disease for patients achieving the target serum urate level was -2.41% (95% CI, -4.61% to -0.21%) and 0.89 (95% CI, 0.80 to 0.98), respectively.

Conclusions and Relevance

The findings of this cohort study indicate that in patients with gout and CKD stage 3, lowering serum urate level to less than 6 mg/dL vs 6 mg/dL or greater using ULT was not associated with an increased risk of severe or end-stage kidney disease. These findings support optimizing ULT to achieve target serum urate levels when treating patients with gout and impaired kidney function.

Evaluating the drug-drug interactions of SHR4640 on repaglinide and midazolam in healthy subjects

BACKGROUND

SHR4640, a highly selective URAT1 inhibitor, was evaluated to investigate its inhibitory effects on CYP2C8 and CYP3A4 in vivo clinical trial. This study assessed the pharmacokinetic (PK) impact of SHR4640 when co-administered with the CYP2C8 probe substrate repaglinide and the CYP3A4 probe substrate midazolam.

RESEARCH DESIGN AND METHODS

In this single-center, randomized, double-blind, placebo-controlled study, participants were randomly allocated in a 1:1:1 ratio to SHR4640 Group A, SHR4640 Group B, and placebo group and received oral repaglinide, midazolam, SHR4640 or placebo at specific times. The primary endpoints included the main PK parameters of repaglinide and midazolam, both alone and in combination with SHR4640 (AUC0-inf, AUC0-t, and Cmax).

RESULTS

The increase in the area under the concentration-time curve (AUC) for repaglinide, when co-administered with SHR4640, was less than 1.25-fold, while the AUC for midazolam exhibited a slight increase of 46%.

CONCLUSIONS

SHR4640 exerts a weak inhibitory effect on the AUC of CYP enzyme probe substrates and has minimal potential for drug-drug interactions and presents a favorable safety profile.

CLINICAL TRIAL REGISTRATION

www.clinicaltrials.gov identifier is NCT06196580 (Name: PK Effects of SHR4640 on Repaglinide and Midazolam, and the Impact of SHR4640 on QT Interval).

Gout and Hyperuricemia: A Narrative Review of Their Comorbidities and Clinical Implications

Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate crystals in the joints due to elevated serum uric acid levels. Its prevalence and associated healthcare burden have been rising in recent decades, a trend expected to continue. It is crucial to recognize that gout and hyperuricemia are not merely causes of painful joint flares, but systemic metabolic disorders linked to a broad spectrum of comorbidities such as cardiovascular diseases, chronic kidney disease, diabetes, insulin resistance, steatotic liver disease, osteoarthritis, and respiratory and eye diseases. Numerous risk factors for gout and hyperuricemia have been identified, with recent research uncovering further associations with other conditions. To optimize patient outcomes, gout and hyperuricemia must be addressed through a holistic approach that accounts for these risk factors while providing comprehensive management of related comorbidities affecting various organ systems. This review summarizes the current knowledge on the risk factors, comorbidities, and clinical implications of gout and hyperuricemia. Future research should focus on improving patient outcomes by tailoring treatments individually and addressing the underlying metabolic comorbidities of gout with multimodal treatment.

Association of Klotho and Gout in Middle-Aged and Older Adults: National Health and Nutrition Survey (2007-2016)

BACKGROUND

Klotho, which is known to negatively regulate metabolic disorders and kidney disease, has a role in gout that remains unclear. This research explored how klotho levels correlate with the prevalence of gout.

METHODS

Participants aged 40 to 79 from the National Health and Nutrition Examination Survey (2007-2016) were examined in both lines. The connection between klotho levels and gout was analyzed through weighted multivariate logistic regression. Restricted cubic splines were used to assess linearity and investigate the dose-response relationship. To ensure the stability of the results, subgroup and sensitivity analyses were conducted.

RESULTS

In total, 9660 individuals participated, with the weighted sample size calculated at 88,892,738.77. The group included 47.79% males (4793), with the median age being 57.00 years. Upon adjusting for all covariates, the multivariate analysis indicated an odds ratio of 0.51 (95% confidence interval [CI]: 0.33~0.78, p = 0.003) for the likelihood of occurrence of gout. When compared with the lowest klotho quartile Q1 (≥151.3, <655.3 pg/mL), the adjusted odds ratios for the subsequent quartiles Q2 (≥655.5, <800.9 pg/mL), Q3 (≥801.0, <991.6 pg/mL), and Q4 (≥991.7, ≤3998.5 pg/mL) were 0.97 (95% CI: 0.68~1.38), 0.78 (95% CI: 0.50~1.21), and 0.48 (95% CI: 0.32~0.73), respectively. Analyses focusing on subgroups and sensitivity confirmed these results.

CONCLUSIONS

This research found a negative correlation between serum α-klotho concentrations and the occurrence of gout. Those with the highest levels of klotho exhibited the lowest likelihood of gout, indicating potential importance for future studies and clinical uses.

Effect of Xanthohumol from Humulus lupulus L. Against Gouty Bone Damage in Arthritis of Rats Induced by Mono-sodium Urate

Xanthohumol (XAN) is an isoprenyl flavonoid from Humulus lupulus L. known for beer brewing, and an osteoprotective agent due to its active improvement in bone loss of osteoporosis. This study was first time to investigate its effects on anti-gouty bone injury in rats of gouty arthritis (GA) induced by monosodium urate (MSU). Results showed that XAN could significantly exert anti-inflammatory activity by alleviating swelling degree of joints, reducing serum level of inflammatory factors, improving inflammatory injury and degrading the Markin's score in lesion joint. Meanwhile, XAN could also fight against gouty bone damage by improving pathological changes of bone tissue and parameters of bone micro-structure. Moreover, XAN could even promote bone formation by effectively enhancing expression of Runx2 and OPG, while inhibit bone resorption with depressing matrix metalloproteinase-9 (MMP-9), MMP-13 and CTSK expression, reducing RANKL secretion, and abating the ratio of RANKL/OPG. Therefore, it was the first time to reveal the mechanism of XAN against gouty bone injury via inhibiting RANKL/OPG/RANK signaling pathway. Above all, this study provided potential strategy for the treatment of GA, and further contributed to research and resource development for hops.

Effects of dietary factors on hyperuricaemia and gout: a systematic review and meta-analysis of observational studies

This study aimed to gather the best evidence on the relationship between dietary factors and hyperuricaemia and gout. We searched databases including PubMed, Embase, Cochrane, and Web of Science from database creation to July 2023. Meta-analysis showed that consumption of alcohol (OR: 1.41, 95% CI: 1.29-1.55; 1.60, 95% CI: 1.33-1.93, respectively), red meat (OR:1.27, 95% CI: 1.18-1.37; 1.32, 95% CI: 1.18-1.47, respectively), fructose (OR: 1.29, 95% CI: 1.21-1.38; 1.65, 95% CI: 1.36-2.01, respectively) and seafoods (OR: 1.40, 95% CI: 1.20-1.64; 1.29, 95% CI: 1.00-1.67, respectively) were positively associated with the risk of hyperuricaemia and gout, while vegetables (OR: 0.78, 95% CI: 0.71-0.85; 0.96,95% CI 0.74-1.24, respectively) were inversely associated. Dairy products (OR: 0.69, 95% CI: 0.61-0.78) and nuts (OR: 0.75, 95% CI: 0.60-0.93) were also inversely associated with the risk of hyperuricaemia. Soy products (OR: 0.86, 95% CI: 0.75-0.98) and coffee (OR: 0.56, 95% CI: 0.39-0.81) were negatively associated with the risk of gout.

Exploring genetic links between blood metabolites and gout susceptibility

BACKGROUND

Gout, a prevalent form of inflammatory arthritis, has a complex etiology where the causal relationship between metabolites and the disease remains underexplored. This study aims to elucidate the impact of genetically determined blood metabolites on gout.

METHODS

Employing a two-sample bidirectional Mendelian randomization analysis, we examined the association between 1400 blood metabolites and gout. Causal associations were determined using the inverse variance weighted (IVW) method with false discovery rate (FDR) correction. Sensitivity analyses encompassed weighted models, MR-Egger, weighted median, and MR-PRESSO approaches. MR-pleiotropy and Cochran's Q statistic were utilized to evaluate potential heterogeneity and pleiotropy. Additionally, metabolic pathway analyses were conducted to pinpoint relevant pathways.

RESULTS

Of the initial 4 serum metabolites identified, 3 known metabolites-hexanoylglutamine levels, mannose content, and the phosphate to mannose ratio-were found to be causally associated with gout, along with 55 serum metabolites identified as potential predictors of gout (PIVW < 0.05). Furthermore, we discovered 3 metabolic pathways implicated in gouty attacks.

CONCLUSION

Our findings, derived from Mendelian randomization, indicate that the identified metabolites and pathways may serve as biomarkers for clinical screening and prevention of gout. Additionally, they offer novel insights into the mechanisms of the disease and potential drug targets. Key points • Conducted a comprehensive Mendelian randomization study involving 1400 blood metabolites to explore their genetic impact on gout development and progression • Identified three key metabolites-hexanoylglutamine, mannose, and the phosphate-to-mannose ratio-with causal associations to gout, highlighting their potential use as biomarkers for early detection and risk stratification • Discovered 55 additional serum metabolites as potential predictors of gout, offering new insights into the pathophysiology of the disease and identifying high-risk individuals • Revealed three novel metabolic pathways involved in gout attacks, providing new therapeutic targets for precision medicine in gout treatment.

Effect of Hepatic Impairment on the Pharmacokinetics and Pharmacodynamics of SHR4640, a Selective Human Urate Transporter 1 Inhibitor

This parallel-group, open-label Phase I study evaluated the effect of mild to moderate hepatic impairment on pharmacokinetics (PK), pharmacodynamics (PD), and safety of a single oral dose of SHR4640. Participants with mild or moderate hepatic impairment were enrolled, with each cohort consisting of eight individuals, alongside eight well-matched controls with normal hepatic function. The participants were administered 10 mg SHR4640, and blood samples were collected for PK evaluation over 72 h. Additionally, serum uric acid (sUA) levels were measured to assess PD changes. Safety was evaluated through adverse events, laboratory tests, vital signs, and electrocardiograms. The Cmax of SHR4640 decreased by 15.0% in the mild hepatic impairment group (geometric least squares means of the ratios [GMR] = 0.850, 90% CI: 0.701-1.03) and by 17.5% in the moderate hepatic impairment group (GMR = 0.825, 90% CI: 0.681-1.00). These reductions were not statistically significant compared to the normal hepatic function group. AUC0-t and AUC0-inf were similar across all groups, indicating that overall exposure to the drug was not clinical significantly affected by hepatic impairment. Apparent clearance and volume of distribution of SHR4640 showed no association with the severity of hepatic impairment as measured by the Child-Pugh score. There were no significant differences in the changes in sUA levels from baseline across different levels of hepatic function. SHR4640 is well tolerated in participants with mild or moderate hepatic impairment. Mild and moderate hepatic impairment did not have a clinically relevant impact on PK, PD, and safety of SHR4640. SHR4640 can be used in patients with mild to moderate hepatic impairment without the need for dose adjustment.

Impact of gout on cardiovascular disease mortality: a meta-analysis

BACKGROUND

Several epidemiological studies have suggested that gout patients have a higher risk of cardiovascular disease mortality than healthy people. In contrast, the association between gout and cardiovascular disease (CVD) mortality was not obvious in other studies. In the present study, we aimed to investigate the relative risk for CVD mortality in gout patients in comparison to healthy controls.

METHODS

Literature published before March 2023 was searched in Google Scholar, PubMed, and the Web of Science. We summarized the impact of gout on CVD mortality with a meta-analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) regarding the impact of gout on CVD mortality were summarized with STATA 12.0 software.

RESULTS

Compared to individuals without gout, those with gout had higher mortality risks for CVD during follow-up, with a random effects model showing a risk of 1.30 (95% CI 1.15 to 1.48, p < 0.001; p-value for Cochran Q test < 0.001, I2 = 95.9%). Similarly, subjects with gout had a mortality risk of 1.28 (95% CI 1.12 to 1.46, p < 0.001; p-value for Cochran Q test = 0.050, I2 = 50.2%) for coronary heart disease (CHD) mortality during follow-up using the same statistical model. Furthermore, using a fixed effects model, individuals with gout had a mortality risk of 1.13 (95% CI 1.00 to 1.27, p = 0.049; p-value for Cochran Q test = 0.494, I2 = 0.0%) for myocardial infarction (MI) mortality during follow-up.

CONCLUSION

In conclusion, this meta-analysis provides evidence supporting a markedly increased mortality risk from CVD and CHD as well as MI in patients with gout relative to reference subjects without gout.

Identification of key genes in gout and atherosclerosis and construction of molecular regulatory networks

Background

Gout is a type of chronic inflammatory disease linked to the accumulation of monosodium urate crystals, leading to arthritis. Studies have shown that patients with gout are more likely to develop atherosclerosis, but the specific mechanisms involved remain unknown. The purpose of the research was to explore the key molecules and potential mechanisms between gout and atherosclerosis.

Methods

Gene expression profiles for gout as well as atherosclerosis were obtained from the Gene Expression Omnibus (GEO) database, then differential analysis was utilized to identify common differentially expressed genes (DEGs) between the two diseases. The analysis of functional enrichment was conducted to investigate the biological processes that the DEGs might be involved in. The Cytoscape software was utilized to develop a protein-protein interaction (PPI) network as well as identify hub genes, while LASSO analysis was employed to select key genes. The TRRUST database was utilized to forecast transcription factors (TFs), and the miRTarBase database was utilized to forecast miRNAs.

Results

Four key genes, CCL3, TNF, CCR2, and CCR5, were identified. The receiver operating characteristic (ROC) curves showed that the areas under ROC curve (AUC) for these four key genes in both gout and atherosclerosis were greater than 0.9. The analysis of functional enrichment revealed that the DEGs were primarily involved in "regulation of T-cell activation", "chemokine signaling pathway", and other biological processes. The TRRUST prediction results indicated that RELA and NFKB1 are common regulatory transcription factors for CCR2, CCR5, CCL3, and TNF. The miRTarBase prediction results showed that hsa-miR-203a-3p is a common regulatory miRNA for TNF and CCR5.

Conclusion

This study preliminarily explored the potential key molecules and mechanisms between gout and atherosclerosis. These findings provide new insights for further research into identifying potential biomarkers and clinical treatment strategies for these two diseases.

Gout in pregnancy: Obstetric and neonatal outcomes

OBJECTIVE

The pregnancy, delivery, and neonatal outcomes of pregnancies complicated by gout have yet to be evaluated in a population-based study. We sought to evaluate the obstetric and neonatal outcomes in pregnant patients with gout using a national population database.

METHODS

This is a retrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). All women who delivered or had a maternal death in the USA (2004-2014) were included in the study. Pregnancy, delivery, and neonatal outcomes were compared between women with an ICD-9 diagnosis of gout to those without.

RESULTS

Overall, 9 096 788 women met the inclusion criteria. Of these, 168 women (1.8/100000) had gout. Patients with gout, compared to those without, were more likely to be older and obese and to have chronic hypertension, pregestational diabetes mellitus, and thyroid disease. Pregnant women with gout were more likely to develop gestational diabetes mellitus (aOR 1.78 [95% CI 1.17-2.72], P = 0.008), to require operative vaginal delivery (aOR 3.26 [95% CI 2.03-5.22], P = 0.0001), and to experience venous thromboembolism (aOR 8.47 [95% CI 2.06-34.82], P = 0.003) compared to pregnant patients without gout. Patients with gout were more likely to deliver a neonate with congenital anomalies compared to those without gout (aOR 3.38 [95% CI 1.24-9.20], P = 0.02).

CONCLUSION

Gout in pregnancy, or pregnancies complicated by a history of gout, are associated with increased risk of gestational diabetes mellitus, pulmonary embolism, and neonatal anomalies.

Performance of novel multiparametric second-generation dual-layer spectral detector CT in gouty arthritis

OBJECTIVES

This study aimed to compare the performance of different dual-energy computed tomography (DECT) technologies in detecting monosodium urate (MSU) crystals and evaluate the potential clinical value of novel second-generation dual-layer spectral detector CT (dlDECT) in gouty arthritis.

METHODS

Using data collected from a tertiary hospital, we examined the diagnostic accuracy of different DECT technologies for the diagnosis of MSU. We used two standards: (1) demonstration of MSU crystals in synovial fluid (gold) and (2) 2015 ACR/EULAR gout classification criteria (silver). Furthermore, six novel spectral parameters derived from dlDECT were quantitatively calculated and analyzed for MSU diagnostic efficiency.

RESULTS

Of the 243 patients with 387 joints, 68 (27.98%) had synovial fluid analysis. Compared with the gold standard, MSU diagnostic accuracy statistics for dlDECT, dual-source DECT (dsDECT) and rapid kilovolt peak switching DECT (rsDECT) were as follows: area under the curve (AUC): 0.85, 0.80 and 0.75, respectively. Findings were replicated compared with the silver standard. Multiparametric analysis in dlDECT demonstrated the highest MSU detection rate (92.86%), significantly higher than rsDECT (42.08%) and dsDECT (85.80%). Among novel parameters in dlDECT, Calcium-suppressed index 25 (CaSupp-I 25) exhibited the best performance in distinguishing materials (MSU, muscle, and bone), with an AUC of 0.992. The differentiation was also aided by histograms, scatter plots, and attenuation curves.

CONCLUSION

The novel dlDECT is likely not inferior to other DECT technologies in MSU detection, especially its spectral parameter CaSupp-I 25. Multiparameter analysis showed the potential value for detecting MSU crystals in gouty arthritis, providing valuable clinical insights for gout diagnosis.

KEY POINTS

Question The performance of different DECT technologies in detecting monosodium urate (MSU), and the value of dual-layer spectral detector CT (dlDECT) in gouty arthritis remains unclear. Findings The dlDECT was likely not inferior to other DECT technologies in MSU detection, and its multiparametric analysis provided valuable information for MSU diagnosis. Clinical relevance Novel dlDECT may improve the accurate detection of MSU crystals in gouty arthritis compared to other DECT technologies, providing valuable clinical insights and potentially improving patient outcomes for more precise gout diagnosis.

Perspective of Dutch Patients with Gout on Continuation or Discontinuation of Urate-Lowering Therapy During Remission: A Mixed-Methods Study

OBJECTIVE

Long-term gout management is based on reducing serum urate by using urate-lowering therapy (ULT). A lifelong treat-to-target approach is advocated, although a ULT (taper to) stop attempt can be considered (treat-to-avoid symptoms approach) during remission. Exploring the beliefs of patients with gout on long-term ULT strategies during remission is important for optimizing gout management. We aimed to identify factors that influence the decision for continuation or discontinuation of ULT and to determine their relative importance according to patients with gout in remission.

METHODS

A mixed-methods design was used. First, semistructured interviews (substudy 1) were conducted to identify barriers and facilitators for the (dis)continuation of ULT using inductive thematic analysis. Afterwards, these barriers/facilitators were summarized into neutrally phrased items and used in a maximum difference scaling study (substudy 2) to determine their relative importance using the rescaled probability score.

RESULTS

Substudies 1 and 2 included 18 and 156 patients, respectively. Substudy 1 yielded 22 items within 10 overarching themes. Substudy 2 revealed that the perceived risk of joint damage and gout flares and that ULT use gives some assurance were the most important items. The costs, ease of receiving ULT, and its practical use were the least important items.

CONCLUSION

These results can aid shared decision-making and provide input for what is important to discuss with patients with gout in remission when they consider ULT discontinuation. The emphasis should be on the risk of having gout flares and joint damage, not so much on facilitating how easily medication is received.

Arthroscopic shoulder surgery for gouty long head of biceps tendinitis: a case report

OBJECTIVE

The objective of the case report is to analyze the clinical manifestations and imaging features of gouty long head of biceps tendinitis, and to summarize the methods and effects of shoulder arthroscopic surgery.

CLINICAL PRESENTATION AND INTERVENTION

The clinical data of a 39-year-old Han Chinese female with gouty long head of the biceps tendinitis was retrospectively analyzed, and the clinical manifestations, imaging features, and diagnosis and treatment were analyzed. The patient presented with pain and limited movement of right shoulder joint. Computed tomography showed irregular high-density shadows above the glenoid and adjacent to the coracoid process of the right shoulder. Magnetic resonance imaging revealed superior labrum anterior and posterior injury with edema in the upper recess and axillary sac. After arthroscopic surgery, the "tofu residue" tissue of the long head of the biceps was removed, and the postoperative pathological examination proved that it was gout stone.

CONCLUSION

Gouty long head of the biceps tendinitis is a rare disease. Arthroscopic surgery can probe the structural lesions of shoulder cavity in all aspects, improve the surgical accuracy, and reduce the trauma.

A comprehensive review on recent xanthine oxidase inhibitors of dietary based bioactive substances for the treatment of hyperuricemia and gout: Molecular mechanisms and perspective

Hyperuricemia (HUA) has attained a considerable global health concern, related to the development of other metabolic syndromes. Xanthine oxidase (XO), the main enzyme that catalyzes xanthine and hypoxanthine into uric acid (UA), is a key target for drug development against HUA and gout. Available XO inhibitors are effective, but they come with side effects. Recent, research has identified new XO inhibitors from dietary sources such as flavonoids, phenolic acids, stilbenes, alkaloids, polysaccharides, and polypeptides, effectively reducing UA levels. Structural activity studies revealed that -OH groups and their substitutions on the benzene ring of flavonoids, polyphenols, and stilbenes, cyclic rings in alkaloids, and the helical structure of polysaccharides are crucial for XO inhibition. Polypeptide molecular weight, amino acid sequence, hydrophobicity, and binding mode, also play a significant role in XO inhibition. Molecular docking studies show these bioactive components prevent UA formation by interacting with XO substrates via hydrophobic, hydrogen bonds, and π-π interactions. This review explores the potential bioactive substances from dietary resources with XO inhibitory, and UA lowering potentials detailing the molecular mechanisms involved. It also discusses strategies for designing XO inhibitors and assisting pharmaceutical companies in developing safe and effective treatments for HUA and gout.

Patient Experience with Chronic Refractory Gout and Its Impact on Health-Related Quality of Life: Literature Review and Qualitative Analysis

INTRODUCTION

Patients with chronic refractory gout face a considerable burden of disease due to unexpected flares characterized by severe and debilitating pain, which can lead to chronic pain and joint damage. This study aimed to understand the symptoms and impacts of chronic refractory gout on health-related quality of life (HRQoL).

METHODS

A targeted literature review was conducted to identify and review key articles describing the symptoms and impacts of gout, and articles examining the psychometric performance of the Medical Outcomes Survey Short Form-36 (SF-36) and Health Assessment Questionnaire-Disability Index (HAQ-DI) in gout. Qualitative interviews were conducted with 20 participants with chronic refractory gout. The results were used to develop the conceptual model and determine the appropriateness of the SF-36 and HAQ-DI in evaluating HRQoL in this population.

RESULTS

Most frequently reported symptoms included bodily pain (n = 18, 90.0%), joint swelling (n = 18, 90.0%), joint tenderness (n = 18, 90.0%), and joint pain (n = 16, 80.0%). Most frequently reported impacts were difficulties climbing a flight (n = 20, 100.0%) or several flights of stairs (n = 20, 100.0%), climbing five steps (n = 19, 95.0%), completing chores (n = 19, 95.0%), and running errands and shopping (n = 19, 95.0%). All assessed items from SF-36 and HAQ-DI were reported by ≥ 25% (n = 5) of participants and mapped sufficiently to concepts elicited by participants.

CONCLUSIONS

Patients with chronic refractory gout report symptoms and impacts that are highly bothersome and burdensome to everyday life. Items included in the HAQ-DI and SF-36 mapped directly to these symptoms and impacts and are relevant to understand the burden of disease of chronic refractory gout.

Global burden of musculoskeletal disorders in children and adolescents from 1990 to 2021: a joint point regression and decomposition analysis

The study aimed to investigate the pattern and trend of Musculoskeletal (MSK) disorders in people aged 5-19 years from 1990 to 2021. The data was sourced from the Global Burden of Disease study 2021. The Age-standardized DALYs rates (ASDR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized incidence rate (ASIR) and their corresponding average annual percent change (AAPC) for MSK disorders were evaluated by sex, region, and sociodemographic index (SDI) quintiles. Globally, the ASPR of MSK disorders among children and adolescents increased per 100,000 population from 3048.66 (95% confidence interval [CI]: 2336.68-3887.02) in 1990 to 3105.46 (95% CI: 2421.09-3904.95) in 2021 (AAPC 0.06 [95% CI: 0.05-0.07]). In 2021, individuals aged 15-19 experienced the highest burden compared to those aged 5-9 and 10-14. In 2021, high SDI countries had the highest ASIR, ASPR, ASDR of MSK disorders. The AAPC of ASPR in high SDI countries showed a stark contrast to that in low SDI countries for the same period (AAPC 0.48 vs. AAPC -0.03). From 1990 to 2021, in low SDI and low-middle SDI countries, the increase in DALYs was primarily due to population growth. However, in middle SDI, high-middle, and high SDI countries, the increases were mainly due to epidemiological changes. Globally, patients aged 10-14 experienced better care compared to those in the 5-9 and 15-19 age groups. Specific preventive health measures are needed for females and adolescents aged 15-19 in high SDI countries.

Microneedle transdermal drug delivery as a candidate for the treatment of gouty arthritis: Material structure, design strategies and prospects

Gouty arthritis (GA) is caused by monosodium urate (MSU) crystals deposition. GA is difficult to cure because of its complex disease mechanism and the tendency to reoccur. GA patients require long-term uric acid-lowering and anti-inflammatory treatments. In the past ten years, as a painless, convenient and well-tolerated new drug transdermal delivery method, microneedles (MNs) administration has been continuously developed, which can realize various drug release modes to deal with various complex diseases. Compared with the traditional administration methods (oral and injection), MNs are more conducive to the long-term independent treatment of GA patients because of their safe, efficient and controllable drug delivery ability. In this review, the pathological mechanism of GA and common therapeutic drugs for GA are summarized. After that, MNs drug delivery mechanisms were summarized: dissolution release mechanism, swelling release mechanism and channel-assisted release mechanism. According to drug delivery patterns of MNs, the mechanisms and applications of rapid-release MNs, long-acting MNs, intelligent-release MNs and multiple-release MNs were reviewed. Additionally, existing problems and future trends of MNs in the treatment of GA were also discussed. STATEMENT OF SIGNIFICANCE: Gout is an arthritis caused by metabolic disease "hyperuricemia". Epidemiological studies show that the number of gouty patients is increasing rapidly worldwide. Due to the complex disease mechanism and recurrent nature of gout, gouty patients require long-term therapy. However, traditional drug delivery modes (oral and injectable) have poor adherence, low drug utilization, and lack of local localized targeting. They may lead to adverse effects such as rashes and gastrointestinal reactions. As a painless, convenient and well-tolerated new drug transdermal delivery method, microneedles have been continuously developed, which can realize various drug release modes to deal with gouty arthritis. In this review, the material structure, design strategy and future outlook of microneedles for treating gouty arthritis will be reviewed.

A systematic review of single nucleotide polymorphisms affecting allopurinol pharmacokinetics and serum uric acid level

Aim: To summarize the effects of single nucleotide polymorphisms (SNPs) on the pharmacokinetics of allopurinol to control uric acid levels.Methods: A comprehensive search was conducted in PubMed, Web of Science and Scopus databases from inception to January 2024, includes 17 articles focusing on SNPs and pharmacokinetics of allopurinol and oxypurinol.Results: A total of 11 SNPs showed a significant association with pharmacokinetics of allopurinol and oxypurinol, as well as their potential clinical implications.Conclusion: SNPs in ATP-binding cassette super-family G member 2 (ABCG2), solute carrier family 2 member 9 (SLC2A9), solute carrier family 17 member 1 (SLC17A1), solute carrier family 22 member 12 (SLC22A12), solute carrier family 22 member 13 (SLC22A13) and PDZ domain containing 1 (PDZK1) genes were associated with allopurinol clearance, while SNPs in aldehyde oxidase 1 (AOX1) genes involved in metabolism of allopurinol. SNPs in gremlin 2, DAN family BMP antagonist (GREM2) gene impacted uric acid control, but the specific mechanism governing the expression of GREM2 remains unknown. Our study indicated that the identified SNPs show contradictory effects, reflecting inconsistencies and differences observed across various studies.

Integrative multi-target analysis of Urtica dioica for gout arthritis treatment: a network pharmacology and clustering approach

Urtica dioica (stinging nettle) has been traditionally used in Chinese medicine for the treatment of joint pain and rheumatoid arthritis. This study aims to elucidate the active compounds and mechanisms by which it acts against gout arthritis (GA). Gout-related genes were identified from the DisGeNet, GeneCards, and OMIM databases. These genes may play a role in inhibiting corresponding proteins targeted by the active compounds identified from the literature, which have an oral bioavailability of ≥ 30% and a drug-likeness score of ≥ 0.18. A human protein-protein interaction network was constructed, resulting in sixteen clusters containing plant-targeted genes, including ABCG2, SLC22A12, MAP2K7, ADCY10, RELA, and TP53. The key bioactive compounds, apigenin-7-O-glucoside and kaempferol, demonstrated significant binding to SLC22A12 and ABCG2, suggesting their potential to reduce uric acid levels and inflammation. Pathway enrichment analysis further identified key metabolic pathways involved, highlighting a dual mechanism of anti-inflammatory and urate-lowering effects. These findings underscore the potential of U. dioica in targeting multiple pathways involved in GA, combining traditional medicine with modern pharmacology. This integrated approach provides a foundation for future research and the development of multi-target therapeutic strategies for managing gout arthritis.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40203-024-00254-9.

Gout comorbidities: results from the Korean National Health and Nutrition Examination Survey

OBJECTIVES

Gout is associated with several comorbidities. This study aimed to evaluate the prevalence of comorbidities in the Korean adult population with gout and investigated the association of gout with these comorbidities.

METHODS

Data from 15,935 (weighted n = 39,049,167) participants aged 19 years and older in the Korean National Health and Nutrition Examination Survey from 2019 to 2021 were used for analysis. Weighted prevalence and odds ratios (OR) of comorbidities in individuals with gout were compared to a non-gout population.

RESULTS

The weighted prevalence of gout was 2.1% (weighted n = 808,778). Among individuals with gout, 66.5% had metabolic syndrome, 54.9% had hypertension, 41.2% had hypercholesterolemia, 19.1% had diabetes, 13.5% had chronic kidney disease (CKD), 4.1% had myocardial infarction or angina, 3.8% had stroke, and 2.8% had rheumatoid arthritis (RA). After adjusting for socioeconomic and lifestyle characteristics, gout was independently associated with the increased prevalence of metabolic syndrome (male OR = 2.0, 95% confidence interval (CI): 1.5-2.8; female OR = 3.7, 95% CI: 1.5-9.2), hypercholesterolemia (male OR = 1.9, 95% CI: 1.4-2.5; female OR = 3.1, 95% CI: 1.3-7.5), CKD (male OR = 4.5, 95% CI: 2.7-7.3; female OR = 11.5, 95% CI: 4.1-32.1), and RA (male OR = 2.8, 95% CI: 1.1-7.1; female OR = 3.1, 95% CI: 1.1-8.7) compared to the non-gout population.

CONCLUSIONS

Gout was associated with several comorbidities, including RA, in both males and females. These results suggest that the prevention and treatment of comorbidities at the individual level, carried out by clinicians, and knowledge of these comorbidities would help guide health policies for the Korean population.

Cutting-edge microneedle innovations: Transforming the landscape of cardiovascular and metabolic disease management

Cardiovascular diseases (CVDs) and metabolic disorders (MDs) have surfaced as formidable challenges to global health, significantly imperiling human well-being. Recently, microneedles (MNs) have garnered substantial interest within the realms of CVD and MD research. Offering a departure from conventional diagnostic and therapeutic methodologies, MNs present a non-invasive, safe, and user-friendly modality for both monitoring and treatment, thereby marking substantial strides and attaining pivotal achievements in this avant-garde domain, while also unfurling promising avenues for future inquiry. This thorough review encapsulates the latest developments in employing MNs for both the surveillance and management of CVDs and MDs. Initially, it succinctly outlines the foundational principles and approaches of MNs in disease surveillance and therapy. Subsequently, it delves into the pioneering utilizations of MNs in the surveillance and management of CVDs and MDs. Ultimately, this discourse synthesizes and concludes the primary findings of this investigation, additionally prognosticating on the trajectory of MN technology.

Gout and erectile dysfunction: Increased carotid intima-media thickness is independently associated with greater likelihood for erectile dysfunction

Objectives

The study aimed to compare gout patients and healthy subjects in terms of erectile dysfunction, carotid intima-media thickness (CIMT), and other variables and to investigate the relationship between CIMT and erectile dysfunction.

Patients and methods

This cross-sectional study was conducted with 134 male gout patients (median age: 56 years; range, 48 to 62 years) and 104 healthy males (median age: 47 years; range, 40.5 to 54.5 years) between September 2022 and June 2023. Age, comorbidities, height, weight, laboratory results, gout treatment data, insulin resistance evaluated by the homeostatic model assessment for insulin resistance, presence and severity of erectile dysfunction evaluated by the six-item International Index of Erectile Function erectile function domain (IIEF-EF), and CIMT measured by ultrasound were assessed.

Results

Hypertension, hyperlipidemia, greater insulin resistance, erectile dysfunction, and bilaterally increased CIMT were significantly more common in the gout group. The mean IIEF-EF score of gout patients was significantly lower than that of controls. Multivariable logistic regression revealed increased CIMT as the sole parameter independently associated with erectile dysfunction (p=0.010). When both groups were categorized into CIMT-based subsets, erectile dysfunction was present in 97.9% of patients with coexistence of gout and increased CIMT (≥0.9 mm), a significantly higher proportion compared to the other three subsets (p<0.001).

Conclusion

Increased CIMT was the only factor independently associated with a greater likelihood of erectile dysfunction in patients with and without gout; however, coexistence of gout and increased CIMT appears to result in a significantly elevated risk for erectile dysfunction.

Uncovering the link between inflammatory rheumatic diseases and male reproductive health: a perspective on male infertility and sexual dysfunction

Inflammatory rheumatic diseases (IRDs) refer to a range of persistent disorders that have a major influence on several physiological systems. Although there is much evidence connecting IRDs to sexual dysfunction and fertility problems, research specifically focusing on male infertility in relation to these diseases is sparse. This review addresses the complicated connection between IRDs and male infertility, emphasising the physiological, psychological, and pharmacological aspects that influence reproductive health outcomes in men with rheumatic conditions. We explore the effects of IRDs and their treatments on many facets of male reproductive well-being, encompassing sexual functionality, semen characteristics, and hormonal balance. Additionally, we present a comprehensive analysis of the present knowledge on the impact of several categories of anti-rheumatic drugs on male reproductive function. Although there is an increasing awareness of the need of addressing reproductive concerns in individuals IRDs, there is a noticeable lack of research especially dedicated to male infertility. Moving forward, more comprehensive research is needed to determine the prevalence, risk factors, and mechanisms driving reproductive difficulties in males with IRDs. We can better assist the reproductive health requirements of male IRD patients by expanding our understanding of male infertility in the setting of rheumatic disorders and implementing holistic methods to care.

Role of uric acid in neurodegenerative diseases, focusing on Alzheimer and Parkinson disease: A new perspective

Neurodegenerative diseases (NDs) such as Alzheimer disease (AD) and Parkinson disease (PD) are group of diseases affecting the central nervous system (CNS) characterized by progressive neurodegenerations and cognitive impairment. Findings from different studies highlighted the beneficial and detrimental effects of serum uric acid on the development and progression of NDs. Therefore, this mini-review aims to discuss the beneficial and detrimental effects of uric on NDs. The neuroprotective effect of uric acid is mainly related to the antioxidant effect of uric acid which alleviates oxidative stress-induced neurodegeneration in AD and PD. However, long-term effect of hyperuricemia prompts for the development and progression of cognitive impairment. Hyperuricemia is associated with cognitive impairment and dementia, and gout increases dementia risk. In addition, hyperuricemia can cause cerebral vascular injury which is a risk factor for vascular dementia and cognitive impairment. Taken together, the relationship between uric acid and NDs risk remains conflicting. Hence, preclinical and clinical studies are indicated in this regard.

Is cardiac function associated with the clinical course of disease in patients with gout? A prospective study

OBJECTIVE

To analyze the function of the left heart in patients with different courses of gout, the independent influencing factors for left heart functional changes, and interactions between left atrial and left ventricular functions.

METHODS

Patients with gout (n = 171) were selected; 87 patients with a disease course <10 years were included in Group I, and 84 patients with a disease course ≥10 years were included in Group II. Ninety-four healthy volunteers comprised the control group.

RESULTS

The intergroup differences in cardiac strain parameters were statistically significant (p < .05). Moreover, the differences gradually declined with disease progression. Multivariate logistic regression analysis showed that uric acid was an independent predictor of decreased left ventricular global longitudinal strain (LVGLS). Moreover, LVGLS had a positive effect on the left atrial systolic rate (LASr) and the left atrial systolic contraction time (LASct) but no interaction with the left atrial systolic contraction duration (LAScd).

CONCLUSION

The course of the disease significantly affected the function of the left heart in gout patients, and uric acid was observed to be an independent predictor of decreased LVGLS in gout patients.

The relationship between metabolites and gout: a Mendelian randomization study

BACKGROUND

Gout is closely tied to metabolism, yet there is limited evidence on how metabolites may cause or prevent the condition.

METHODS

This study utilized a two-sample Mendelian randomization (MR) analysis to evaluate the causal relationship between 1,400 serum metabolites and gout. We primarily employed the inverse variance-weighted (IVW) method to estimate causal effects, supplemented by MR-Egger regression, weighted median, simple mode, and weighted mode for comprehensive evaluations. Additionally, we conducted tests for pleiotropy and heterogeneity.

RESULTS

After a rigorous selection process, we identified eight known metabolites and four unknown metabolites associated with gout. Among the eight known metabolites, Glucuronide of piperine metabolite C17H21NO3 and the Phosphate to mannose ratio were positively associated with an increased risk of gout. Conversely, levels of 5 alpha-androstan-3 beta, 17 alpha-diol disulfate, Pantoate, N-carbamoylalanine, Sphingomyelin (d18:0/20:0, d16:0/22:0), Hydroxypalmitoyl sphingomyelin (d18:1/16:0(OH)), and Mannose were linked to a decreased risk of gout.

CONCLUSION

This study identified eight metabolites from 1,400 blood samples significantly linked to gout risk. Integrating genomics and metabolomics offers valuable insights for gout screening and prevention, indicating that specific blood metabolites can help identify individuals at higher risk.