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Kang DH, Lee YJ, Ha IH, Song HS, Lee YS. Trends in healthcare utilization by patients with gout: A cross-sectional study using Health Insurance Review and Assessment Service data. Medicine (Baltimore) 2024; 103:e36436. [PMID: 38363901 PMCID: PMC10869061 DOI: 10.1097/md.0000000000036436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/10/2023] [Indexed: 02/18/2024] Open
Abstract
This study aimed to analyze the distribution of gout patients and the utilization of healthcare services in South Korea to provide valuable recommendations to clinicians and policymakers. A cross-sectional study was conducted. Claims data from the Health Insurance Review and Assessment Service spanning 2010 to 2019 were utilized, and a sample of 69,680 patients was included in the study. The incidence of gout was observed to be high in male patients over the age of 40, with most patients receiving outpatient care for gout management. Nonsteroidal anti-inflammatory drugs and urate-lowering agents were the most frequently prescribed medications, with prescriptions for colchicine and febuxostat increasing among urate-lowering agents. Musculoskeletal disorders were found to be the most common comorbidities among gout patients. Although the total costs of gout management increased, there was no significant increase in cost per patient. This study provides insights into the current state of healthcare utilization for gout patients in South Korea and trends in the disease burden and use of medications. The findings have crucial implications for clinicians and policymakers involved in decision-making regarding the management and treatment of gout.
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Affiliation(s)
- Do-Hyun Kang
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Ho Seub Song
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Gachon University, Seongnam, Republic of Korea
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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Shang YX, Wei SF, Yang KP, Liu Y, Wei S, Dong X, Wang XC, Xie ZM, Fang RL, Liang LN, Li XF, Xu L, Chen MZ, Zhang KX, Huang JY, Wang L, Yang YG, Liao HL, Xing GE, Zheng YP, Li XF, Lin JL, Shi CQ, Zeng YP, Mo LD, Sun F, Li XP, Zhang Z, Chen K, He ZC, Liu JP. Efficacy of Qingpeng ointment (a Tibetan medicine) for acute gouty arthritis: a multi-center, randomized, double-blind, placebo-controlled trial. BMC Complement Med Ther 2024; 24:21. [PMID: 38178115 PMCID: PMC10768221 DOI: 10.1186/s12906-023-04328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND This study aims to assess the efficacy and safety of Qingpeng ointment (QPO), a Tibetan medicine for alleviating symptoms in individuals with acute gouty arthritis (AGA). METHODS This study was a randomized, double-blind, placebo-controlled trial that involved individuals with AGA whose joint pain, as measured on a visual analog scale (VAS) from 0 to 10, was equal to or greater than 3. The participants were randomly assigned to either the QPO or the placebo group and received their respective treatments twice daily for seven consecutive days. In case of intolerable pain, the participants were allowed to use diclofenac sodium sustained-release tablets as a rescue medicine. The primary outcomes measured were joint pain and swelling, while the secondary outcomes included joint mobility, redness, serum uric acid levels, C-reactive protein levels, and the amount of remaining rescue medicine. Any adverse events that occurred during the trial were also recorded. RESULTS A total of 203 cases were divided into two groups, with balanced baselines: 102 in the QPO group and 101 in the placebo group. For joint pain, differences between the groups were notable in the VAS scores [1.75 (0, 3.00) versus 2.00 (1.00, 3.50); P = 0.038], changes in VAS [5.00 (3.00, 6.00) versus 4.00 (2.00, 6.00); P = 0.036], and disappearance rate [26.47% compared to 15.84%; P = 0.046] after treatment. Concerning joint swelling, significant between-group differences were observed in the VAS scores [1.00 (0, 2.30) versus 2.00 (0.70, 3.00); P = 0.032] and disappearance rate [33.33% compared to 21.78%; P = 0.046] at treatment completion. The QPO group exhibited a statistically significant mobility improvement compared to the placebo group (P = 0.004). No significant differences were found in other secondary outcomes. Five patients, four from the QPO group and one from the other, encountered mild adverse events, primarily skin irritation. All of these cases were resolved after dosage reduction or discontinuation of the medication. CONCLUSIONS Compared to the placebo, QPO exhibits positive effects on AGA by alleviating pain, reducing swelling, and enhancing joint mobility, without causing significant adverse effects. TRIAL REGISTRATION ISRCTN34355813. Registered on 25/01/2021.
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Affiliation(s)
- Ya-Xi Shang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Shu-Feng Wei
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ke-Peng Yang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuan Liu
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Su Wei
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Xia Dong
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xin-Chang Wang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhi-Min Xie
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ru-Lu Fang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Li-Na Liang
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiu-Feng Li
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Xu
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mu-Zhi Chen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kai-Xian Zhang
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ji-Yong Huang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Le Wang
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - You-Guo Yang
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Hong-Li Liao
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Gui-E Xing
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Ping Zheng
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Fen Li
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Jing-Lian Lin
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Cheng-Qian Shi
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yong-Ping Zeng
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Li-Dan Mo
- Liuzhou People's Hospital, Liuzhou, Guangxi Zhuang Autonomous Region, China
| | - Fan Sun
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Peng Li
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhuo Zhang
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kai Chen
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhao-Chun He
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China.
- The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Norway, Tromsø, Norway.
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Tao M, Liu J, Chen X, Wang Q, He M, Chen W, Wang C, Zhang L. Correlation between serum uric acid and body fat distribution in patients with MAFLD. BMC Endocr Disord 2023; 23:204. [PMID: 37749567 PMCID: PMC10518962 DOI: 10.1186/s12902-023-01447-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Metabolic dysfunction associated with fatty liver disease (MAFLD) is often correlated with obesity and hyperuricemia. The present study aimed to determine the association between serum uric acid (SUA) and central fat distribution in patients with MAFLD. METHODS A total of 485 patients were classified into the following groups: (1) controls without MAFLD and hyperuricemia (HUA), (2) MAFLD with normal SUA, and (3) MAFLD with HUA. DUALSCAN HDS-2000 was used to measure visceral fat (VAT) and subcutaneous fat (SAT). Dual-energy X-ray absorptiometry (DEXA) was used to measure body fat distribution. RESULTS MAFLD patients with HUA had remarkably higher BMI, fasting insulin, OGIRT AUC, ALT, AST, TG, VAT, SAT, Adipo-IR, trunk fat mass, android fat, and total body fat than MAFLD patients with normal SUA (all p < 0.05). The increase in VAT, SAT, CAP, Adipo-IR, upper limbs fat mass, trunk fat mass, and android fat, as well as the percentage of MAFLD, were significantly correlated with the increase in SUA. The percentage of MAFLD patients with HUA increased significantly with increasing VAT or SAT, as determined by the Cochran-Armitage trend test (all p < 0.05). Furthermore, VAT (OR = 1.01 CI: 1.00, 1.03; p < 0.05) and adipo-IR (OR = 1.09 CI: 1.00, 1.19; p < 0.05) were associated with circling SUA in MAFLD after adjusting for sex, age, TG, TC, HOMA-IR, and BMI. CONCLUSION Abdominal fat promotes the co-existence of HUA and MAFLD, while weight loss, especially, decreasing VAT, is of great importance to decrease SUA levels and manage MAFLD.
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Affiliation(s)
- Min Tao
- Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Jing Liu
- Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Xingyu Chen
- Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Qing Wang
- Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Miao He
- Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Wenwen Chen
- Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Cong Wang
- Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China.
| | - Lili Zhang
- Department of Endocrinology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China.
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Bae J, Park KY, Son S, Huh Y, Nam GE. Associations between obesity parameters and hyperuricemia by sex, age, and diabetes mellitus: A nationwide study in Korea. Obes Res Clin Pract 2023; 17:405-410. [PMID: 37739857 DOI: 10.1016/j.orcp.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/21/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE We investigated the associations between obesity parameters and the risk of hyperuricemia among Korean adults by sex, age, and diabetes mellitus status. METHODS This study analyzed data from 17,753 adults from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2018. Multivariable logistic regression analyses were conducted to examine the associations of body mass index (BMI), waist circumference (WC), and general and abdominal obesity with the risk of hyperuricemia (serum uric acid ≥7.0 mg/dL in men and ≥6.0 mg/dL in women). RESULTS Of all the participants, 12.7% (n = 2256) had hyperuricemia. The age-adjusted mean serum uric acid levels increased significantly with increasing BMI and WC (P for trend <0.001). The adjusted odds ratios (ORs) of hyperuricemia increased as BMI and WC increased in both sexes (P for trend <0.001). General (OR 1.98, 95% confidence interval [CI]: 1.69-2.32) and abdominal (OR 2.21, 95% CI: 1.89-2.58) obesity in men and general (OR 3.26, 95% CI: 2.60-4.09) and abdominal (OR 3.43, 95% CI: 2.69-4.37) obesity in women were associated with higher risks of hyperuricemia. These associations were prominent in women. The association between abdominal obesity and hyperuricemia persisted after additional adjustments for BMI in both sexes. Significant interactions were observed in younger adults and individuals without diabetes mellitus. CONCLUSION Increased BMI and WC, and general and abdominal obesity, may be important risk factors for hyperuricemia in both sexes. Women, young adults, and individuals without diabetes mellitus require particular attention to prevent obesity and hyperuricemia.
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Affiliation(s)
- Jaeyeon Bae
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Serhim Son
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Youn Huh
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University, Gyeonggi-do, Republic of Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Han F, Yu C, Hu F, Zhou W, Wang T, Zhu L, Huang X, Bao H, Cheng X. Association between serum uric acid levels and peripheral artery disease in Chinese adults with hypertension. Front Endocrinol (Lausanne) 2023; 14:1197628. [PMID: 37674616 PMCID: PMC10478083 DOI: 10.3389/fendo.2023.1197628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
Background Higher serum uric acid (SUA) can cause gout, which is principally characterized by arthritis due to monosodium urate crystal deposition in the lower extremities. High levels of SUA have been linked to endothelial dysfunction, oxidative stress, and inflammation, all of which are involved in the pathogenesis of peripheral artery disease(PAD). To date, the relationship between SUA levels and PAD is still poorly understood. Method An analysis of 9,839 Chinese adults with essential hypertension from the ongoing China H-type Hypertension Registry Study was conducted in this cross-sectional study. Patients with an ABI ≤0.9 was diagnosed with PAD. Hyperuricemia was defined as SUA levels >420 mol/L in men and >360 mol/L in women. The association between SUA levels and PAD was evaluated using multivariable logistic regression models based on odds ratios (ORs) and their 95% confidence intervals (CIs). Results The enrolled subjects ranged in age from 27 to 93 years, with a mean age of 63.14 ± 8.99 years. The proportion of male patients was 46.22%, and the prevalence of hyperuricemia was 50.72%. In males, hyperuricemia was positively associated with the risk of PAD (adjusted OR per SD increase: 1.72, 95% CI 1.17 to 2.53, P =0.006). Males in the highest SUA tertile were significantly more likely to have PAD (adjusted OR: 2.63, 95% CI 1.42 to 4.86, P = 0.002; P for trend = 0.001). However, this positive relationship was not observed in females (adjusted OR: 1.29, 95% CI 0.77 to 2.17, P = 0.327; P for trend = 0.347). Conclusion According to this cross-sectional study, higher SUA levels were positively associated with PAD in male hypertensive patients, while this positive relationship disappeared in female participants.
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Affiliation(s)
- Fengyu Han
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
| | - Chao Yu
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Feng Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
| | - Wei Zhou
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tao Wang
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Linjuan Zhu
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, Jiangxi, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, Jiangxi, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Amatucci AJ, Padnick-Silver L, LaMoreaux B, Bulbin DH. Comparison Between Early-Onset and Common Gout: A Systematic Literature Review. Rheumatol Ther 2023; 10:809-823. [PMID: 37335432 PMCID: PMC10326179 DOI: 10.1007/s40744-023-00565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Gout is an inflammatory, metabolic disease associated with a high comorbidity burden including cardiovascular disease, hypertension, type 2 diabetes, hyperlipidemia, renal disease, and metabolic syndrome. Approximately 9.2 million Americans have gout, making prognosis and treatment outcome predictors highly important. About 600,000 Americans have early-onset gout (EOG), generally defined as first gout attack at ≤ 40 years of age. However, data on EOG clinical features, comorbidity profile, and treatment response are sparse; this systematic literature review provides insight. METHODS PubMed and American College of Rheumatology (ACR)/European Alliance of the Associations for Rheumatology (EULAR) abstract archives were searched for early-onset gout, "early onset gout," and ("gout" AND "age of onset"). Duplicate, foreign language, single case report, older (before 2016), and irrelevant/data insufficient publications were excluded. The age of diagnosis categorized patients as having common gout (CG, generally > 40 years) or EOG (generally ≤ 40 years). Applicable publications were extensively reviewed/discussed among authors for inclusion/exclusion consensus. RESULTS A total of 283 publications were identified, with 46 (35 articles, 10 abstracts) reviewed and 17 (12 articles, 5 abstracts) ultimately included. Eleven reported clinical characteristics, with 6 EOG-CG retrospective/cross-sectional comparisons. Gout diagnosis preceded cardiometabolic comorbidity and renal comorbidities were less prevalent in EOG than CG patients. EOG patients had more severe disease (more gout flares, polyarticular disease), higher pre-therapy serum urate (SU), and worse oral urate-lowering therapy response. Genetics-focused publications reported higher incidences of dysfunctional urate transporter mutations in EOG patients. CONCLUSIONS This review suggests that EOG is more recalcitrant to urate-lowering therapy, is associated with urate transporter defects, and carries heavy disease burden. Therefore, early rheumatology referral and urate-lowering in a treat-to-target fashion may benefit EOG patients. Interestingly, EOG patients had fewer cardiometabolic comorbidities at diagnosis than CG patients, presenting a potential "window of opportunity" to attenuate cardiometabolic comorbidity development with SU control. Preventing gout-related suffering and health burden is particularly important in these young EOG patients who will live with gout and its sequelae for decades.
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Affiliation(s)
| | | | - Brian LaMoreaux
- Horizon Therapeutics plc, 1 Horizon Way, Deerfield, IL, 60015, USA
| | - David H Bulbin
- Division of Rheumatology, Geisinger Medical Center, Danville, PA, USA
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Cowley S, McCarthy G. Diagnosis and Treatment of Calcium Pyrophosphate Deposition (CPPD) Disease: A Review. Open Access Rheumatol 2023; 15:33-41. [PMID: 36987530 PMCID: PMC10040153 DOI: 10.2147/oarrr.s389664] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Calcium Pyrophosphate Dihydrate (CPPD) crystal-related arthropathies are a common cause of acute and chronic arthritis caused by the deposition of calcium pyrophosphate crystals in joints and soft tissues, resulting in inflammation and joint damage. They present with a wide spectrum of clinical manifestations and often present challenges to diagnosis and management as they commonly affect older co-morbid patients. The challenges are compounded by a lack of a well-defined description of CPPD. However, an international expert-driven process is underway to develop CPPD classification criteria. Treatment is also problematic as unlike gout, there are no agents available that decrease the crystal burden. Treatment options have often been extrapolated from gout treatment pathways without having extensive trials or a solid evidence base. It is hoped the new CPPD classification guidelines will contribute to large multicentre studies, with well-defined patient cohorts, which will facilitate the production of high-quality evidence to guide the management of this condition. Here, we discuss the barriers and facilitators in diagnosing and treating CPPD-related arthropathy.
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Affiliation(s)
- Sharon Cowley
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Geraldine McCarthy
- Department of Rheumatology, Mater Misericordiae University Hospital, Dublin, Ireland
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Li X, Liu S, Jin W, Zhang W, Zheng G. Identification of the Constituents of Ethyl Acetate Fraction from Smilax china L. and Determination of Xanthine Oxidase Inhibitory Properties. Int J Mol Sci 2023; 24:ijms24065158. [PMID: 36982233 PMCID: PMC10049564 DOI: 10.3390/ijms24065158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
The aim of this work was to investigate the xanthine oxidase (XO)-inhibitory activity of ethanol extracts from Smilax china L. and to identify the active compounds in the ethyl acetate (EtOAc) fraction. Extraction of ethanol extracts from Smilax china L. and then ethanol extracts were concentrated, and the polyphenolic compounds were extracted with petroleum ether (PE), chloroform, EtOAc, n-butanol (n-BuOH), and residual ethanol fractions. Their effects on XO activity were then compared separately. The polyphenolic components of the EtOAc fraction were identified by HPLC and HPLC-mass spectrometry (HPLC-MS) analysis. Kinetic analysis demonstrated that all these extracts showed XO-inhibitory properties, and among them the EtOAc fraction had the strongest inhibitory effect (IC50 = 101.04 μg/mL). The inhibitory constant (Ki) of the EtOAc fraction on XO activity was 65.20 μg/mL, showing excellent inhibition on XO in the competitive mode. Sixteen compounds were identified from the EtOAc fraction. The study demonstrates that the EtOAc fraction of Smilax china L. may be a potential functional food to inhibit XO activity.
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Affiliation(s)
- Xin Li
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Shanshan Liu
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Weili Jin
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Wenkai Zhang
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Guodong Zheng
- Jiangxi Key Laboratory of Natural Product and Functional Food, College of Food Science and Engineering, Jiangxi Agricultural University, Nanchang 330045, China
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Verma AK, Hossain MS, Ahmed SF, Hussain N, Ashid M, Upadhyay SK, Vishvakarma NK, Bhojiya AA, Srivastava SK. " In silico identification of ethoxy phthalimide pyrazole derivatives as IL-17A and IL-18 targeted gouty arthritis agents". J Biomol Struct Dyn 2022:1-15. [PMID: 35532103 DOI: 10.1080/07391102.2022.2071338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Two proinflammatory cytokines, IL17A and IL18, are observed to be elevated in the serum of gout patients and they play a crucial role in the development and worsening of inflammation, which has severe effects. In present study, we have combined molecular docking, molecular dynamics studies and MM-PBSA analysis to study the effectiveness of ethoxy phthalimide pyrazole derivatives (series 3a to 3e) as potential inhibitors against cytokines IL17A and IL18 as a druggable targets. The binding energy of the docked series ranges from -13.5 to -10.0 kcal/mol and extensively interacts with the amino acids in the active pocket of IL17A and IL18. Compound 3e had the lowest binding energy with IL17A at -12.6 kcal/mol compared to control allopurinol (3.32 kcal/mol). With IL18, compound 3a seems to have the lowest binding energy of -9.6 kcal/mol compared to control allopurinol (3.18 kcal/mol). In MD simulation studies, compound 3a forms a stable and energetically stabilized complex with the target protein. Depending on properties of the bound IL17A-3a and IL18-3a complexes was compared by means of MM-PBSA analysis. These derivatives can be used as a scaffold to develop promising IL17A and IL18 inhibitors to assess their potential for gouty arthritis and other related diseases.
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Affiliation(s)
- Abhishek Kumar Verma
- Department of Biosciences, Manipal University Jaipur, Dehmi Kalan, Off Jaipur-Ajmer Expressway, Jaipur, Rajasthan, India
| | - Md Shahadat Hossain
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Sk Faisal Ahmed
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Nasir Hussain
- Department of Chemistry, Faculty of Science and Technology, Mewar University, Chittorgarh, Rajasthan, India
| | - Mohammad Ashid
- Department of Chemistry, Faculty of Science and Technology, Mewar University, Chittorgarh, Rajasthan, India
| | - Sudhir K Upadhyay
- Department of Environmental Science, V.B.S. Purvanchal University, Jaunpur, Uttar Pradesh, India
| | | | - Ali Asger Bhojiya
- Department of Science, U.S. Ostwal Science, Arts & Commerce College, Chittorgarh, India
| | - Sandeep Kumar Srivastava
- Department of Biosciences, Manipal University Jaipur, Dehmi Kalan, Off Jaipur-Ajmer Expressway, Jaipur, Rajasthan, India
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10
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Anti-inflammatory and Antioxidant Effect of Poly-gallic Acid (PGAL) in an In Vitro Model of Synovitis Induced by Monosodium Urate Crystals. Inflammation 2022; 45:2066-2077. [PMID: 35505045 DOI: 10.1007/s10753-022-01676-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/24/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022]
Abstract
Gout is a chronic and degenerative disease that affects the joints and soft tissues because of the crystalline deposit of monosodium urate. The interaction between monosodium urate crystals (MSU) and synoviocytes generates oxidative and inflammatory states. These physiological characteristics have promoted the study of poly-gallic acid (PGAL), a poly-oxidized form of gallic acid reported to be effective in in vitro models of inflammation. The effect of PGAL in an in vitro model of oxidation and synovial inflammation induced by MSU was evaluated after 24 h of stimulation through the morphological changes, the determination of oxidative stress (OS), IL-1β, and the phagocytosis of the MSU. A 20% reduction in synovial viability and the generation of vesicles were observed when they were exposed to MSU. When PGAL was used at 100 and 200 µg/ml, cell death was reduced by 30% and 17%, respectively. PGAL both doses reduce the vesicles generated by MSU. OS generation in synoviocytes exposed to 100 µg/ml and 200 µg/ml PGAL decreased by 1.28 and 1.46 arbitrary fluorescence units (AFU), respectively, compared to the OS in synoviocytes exposed to MSU (1.9 AFU). PGAL at 200 µg/ml inhibited IL-1β by 100%, while PGAL at 100 µg/ml inhibited IL-1β by 66%. The intracellular MSU decreased in synoviocytes stimulated with 100 µg/ml PGAL. The PGAL has a cytoprotective effect against damage caused by MSU in synoviocytes and can counteract the oxidative and inflammatory response induced by the crystals probably because it exerts actions at the membrane level that prevent phagocytosis of the crystals.
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11
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Potential Use of Moringa oleifera Twigs Extracts as an Anti-Hyperuricemic and Anti-Microbial Source. Processes (Basel) 2022. [DOI: 10.3390/pr10030563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Moringa oleifera (MO) grows throughout most of the tropics and has several industrial and medicinal uses. Besides the various uses of the plant parts such as its leaves, seed kernels, roots, or stem barks, the twigs (MT) of this plant are usually regarded as excessive parts. Although there have been few studies conducted to determine the value of this plant part, in fact, its potential uses—especially the pharmaceutical effects—of this biomaterial remains an up-to-date topic for scientists to discover due to the lack of interest so far. This study aims to identify the optimized fractions of different solvents for the extraction of antioxidants, for xanthine oxidase inhibition agents, and for anti-microbial activities. The two most active fractions obtained by column chromatography were the Hexane-Ethyl Acetate elution at a 9:1 (E1) and 8:2 (E2) ratio, respectively. With regard to antioxidant activity, E1 and E2 displayed relatively high DPPH radical scavenging capacity (IC50 = 87.7 and 99.0 µg/mL), which was only four times weaker than the control BHT (IC50 = 21.4 µg/mL). The highest inhibition activity against xanthine oxidase was also observed clearly in E1 and E2, which showed relatively low IC50 (54.7 and 42.0 µg/mL, respectively). These levels were inconsiderably higher than that of the positive control (IC50 = 20.8 µg/mL), proving that E1 and E2 exerted relatively strong antioxidant activity in terms of XOD inhibition. Regarding the antimicrobial test, E2 showed the highest inhibition activities against E. coli, K. pneumoiae, L. monocytogenes, B. subtilis, and P. mirabilis. The result indicates that (1) E1 and E2 were the strongest fractions for constraining free radical agents and several bacteria, and thus, (2) Moringa oleifera twigs are also a potential source for the prevention of gout-related symptoms.
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12
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Huang XN, Zhang YM, Wen Y, Jiang Y, Wang CH. Protease-Catalyzed Rational Synthesis of Uric Acid-Lowering Peptides in Non-aqueous Medium. Int J Pept Res Ther 2022. [DOI: 10.1007/s10989-022-10367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Thompson JW, Srinivasan S, Makkuni D. Chronic tophaceous gout mimicking widespread metastasis. BMJ Case Rep 2021; 14:14/5/e236166. [PMID: 34059531 DOI: 10.1136/bcr-2020-236166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gout is a common crystal-induced arthropathy affecting mainly the joints of the appendicular skeleton; however, rarely this condition affects the axial skeleton as well. Spinal gout can cause radiculopathy, cord compression, canal stenosis and discitis. We describe a case of a 71-year-old woman where the initial presentation of destructive arthropathy and spinal masses secondary to axial gout was mistaken for a metastatic malignancy. Despite chronic polyarthropathy and bilateral subcutaneous gouty tophi, spinal gout was not considered a differential diagnosis during initial assessment.The patient was managed conservatively with pharmacological treatment resulting in improvement of her upper limb radiculopathy and systemic joint pain, although little improvement in mobility. Such extensive involvement is rare and the masses can mimic an underlying metastatic disease. Careful history and clinical examination recognising polyarthropathy and subcutaneous tophi can aid the clinician to make the right diagnosis and institute correct treatment. Delay in recognising gout as a differential diagnosis can lead to marked morbidity as illustrated in our case.
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Affiliation(s)
- Joshua W Thompson
- Trauma & Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Sriram Srinivasan
- Trauma & Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Damodar Makkuni
- Rheumatology Department, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
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14
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Wu X, Chen X, Lyu X, Zheng H. Advances in Microbiome Detection Technologies and Application in Antirheumatic Drug Design. Curr Pharm Des 2021; 27:891-899. [PMID: 33308114 DOI: 10.2174/1381612826666201211114609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/25/2020] [Indexed: 11/22/2022]
Abstract
Rheumatic diseases are a kind of chronic inflammatory and autoimmune disease affecting the connection or supporting structures of the human body, such as the most common diseases Ankylosing spondylitis (AS), gout and Systemic lupus erythematosus (SLE). Although the precise etiology and pathogenesis of the different types of rheumatic diseases remain mostly unknown, it is now commonly believed that these diseases are attributed to some complex interactions between genetics and environmental factors, especially the gut microbiome. Altered microbiome showed clinical improvement in disease symptoms and partially restored to normality after prescribing disease-modifying antirheumatic drugs (DMARDs) or other treatment strategies. Recent advances in next-generation sequencing-based microbial profiling technology, especially metagenomics, have identified alteration of the composition and function of the gut microbiota in patients. Clinical and experimental data suggest that dysbiosis may play a pivotal role in the pathogenesis of these diseases. In this paper, we provide a brief review of the advances in the microbial profiling technology and up-to-date resources for accurate taxonomic assignment of metagenomic reads, which is a key step for metagenomics studies. In addition, we review the altered gut microbiota signatures that have been reported so far across various studies, upon which diagnostics classification models can be constructed, and the drug-induced regulation of the host microbiota can be used to control disease progression and symptoms.
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Affiliation(s)
- Xin Wu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, China
| | - Xiang Chen
- Department of Bioinformatics, Hangzhou Nuowei Information Technology, Co., Ltd. Hangzhou, China
| | - Xiaochen Lyu
- Department of Bioinformatics, Hangzhou Nuowei Information Technology, Co., Ltd. Hangzhou, China
| | - Hao Zheng
- Department of Bioinformatics, Hangzhou Nuowei Information Technology, Co., Ltd. Hangzhou, China
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15
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Erickson TD, Assylbekova B, Chong ACM. Multiple Subcutaneous Gouty Tophi Even with Appropriate Medical Treatment: Case Report and Review of Literature. Kans J Med 2021; 14:12-16. [PMID: 33643522 PMCID: PMC7833980 DOI: 10.17161/kjm.vol1414505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Alexander C M Chong
- Sanford Health Department of Graduate Medical Education, Fargo, ND.,University of North Dakota, School of Medicine & Health Sciences, Grand Forks, ND
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16
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Kamel B, Graham GG, Stocker SL, Liu Z, Williams KM, Carland JE, Pile KD, Day RO. A pharmacokinetic-pharmacodynamic study of a single dose of febuxostat in healthy subjects. Br J Clin Pharmacol 2020; 86:2486-2496. [PMID: 32386239 DOI: 10.1111/bcp.14357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS To examine the pharmacokinetic-phamacodynamic (PK-PD) relationships of plasma febuxostat and serum urate and the effect of a single dose of the drug on renal excretion and fractional clearance of urate (FCU). METHODS Blood and urine samples were collected at baseline and up to 145 hours following administration of febuxostat (80 mg) to healthy subjects (n = 9). Plasma febuxostat and serum and urinary urate and creatinine concentrations were determined. Febuxostat pharmacokinetics were estimated using a two-compartment model with first-order absorption. An Emax PK-PD model was fitted to mean febuxostat and urate concentrations. Urinary urate excretion and FCU were calculated pre- and post-dose. RESULTS Maximum mean plasma concentration of febuxostat (2.7 mg L-1 ) was observed 1.2 hours after dosage. Febuxostat initial and terminal half-lives were 2.0 ± 1.0 and 14.0 ± 4.7 hours (mean ± SD), respectively. The majority (81%) of the drug was eliminated in the 9 hours after dosing. Serum urate declined slowly achieving mean nadir (0.20 mmol L-1 ) at 24 hours. The IC50 (plasma febuxostat concentration that inhibits urate production by 50%) was 0.11 ± 0.09 mg L-1 (mean ± SD). Urinary urate excretion changed in parallel with serum urate. There was no systematic or significant change in FCU from baseline. CONCLUSION The PK-PD model could potentially be used to individualise febuxostat treatment and improve clinical outcomes. A single dose of febuxostat does not affect the efficiency of the kidney to excrete urate. Further investigations are required to confirm the present results following multiple dosing with febuxostat.
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Affiliation(s)
- Bishoy Kamel
- The George Institute for Global Health, Australia.,St Vincent's Clinical School, University of New South Wales, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Australia
| | - Garry G Graham
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Australia
| | - Sophie L Stocker
- St Vincent's Clinical School, University of New South Wales, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Zhixin Liu
- Stats Central, University of New South Wales, Kensington, NSW, Australia
| | - Kenneth M Williams
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Australia
| | - Jane E Carland
- St Vincent's Clinical School, University of New South Wales, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Kevin D Pile
- Department of Medicine, Western Sydney University, New South Wales, Australia.,Department of Rheumatology, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Richard O Day
- St Vincent's Clinical School, University of New South Wales, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia
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17
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Changes in Urinary Microalbumin Levels after Correction of Hyperuricemia in Patients with Gout: An Observational Cohort Study. Int J Rheumatol 2020; 2020:8310685. [PMID: 32308689 PMCID: PMC7152934 DOI: 10.1155/2020/8310685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background Gout is commonly associated with metabolic syndrome. Strong association between the serum uric acid level and microalbuminuria has also been observed in various studies. Aim To observe the change in urinary microalbumin after urate-lowering treatment in patients with gout and microalbuminuria. Methodology. A prospective, observational study was conducted at a tertiary-level rheumatic center (NCRD) in Kathmandu, Nepal. Adults diagnosed with gout using the 2015 ACR/EULAR criteria and microalbuminuria were enrolled in the study after obtaining informed consent. Sociodemographic profile and clinical history were recorded at baseline. Serum uric acid levels, spot urinary microalbumin (MAU) excretion, blood sugar, lipid profile, and blood pressure were measured at baseline, 3-month follow-up, and 6-month follow-up. A paired t-test was used to compare the change in mean MAU after treatment. Results A total of 778 patients diagnosed with gout were screened for microalbuminuria. Among them, 114 (14.6%) had urinary microalbumin levels of >30.0 mg/L during presentation. Mean MAU level among those with microalbuminuria was 132.4 ± 124.6 mg/L. Thirty-five patients had concomitant HTN and were put on ARBs (20 mg of telmisartan). All received 40 mg of febuxostat. In patients with ARBs, MAU reduced significantly after 3 months of treatment with ARBs. Reduction in MAU in those without ARBs was seen after the 6-month follow-up, and the change was statistically significant. Conclusions There is significant reduction in MAU after the use of urate-lowering drugs in patients with gout.
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18
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Kao Y, Wang Z, Leng J, Qu Z, Zhuang X, Ma H, Song Q, Liu Z, Sun S, Liu Y. Thoracic gout tophus with abdominal wall protrusion: A case report. Medicine (Baltimore) 2020; 99:e19348. [PMID: 32150074 PMCID: PMC7478684 DOI: 10.1097/md.0000000000019348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE A patient presented the abdominal wall protrusion due to tophaceous gout of the spine. Similar cases were not reported in the literature. This study aimed to report a case of tophaceous gout of the spine with abdominal wall protrusion. PATIENT CONCERNS A 38-year-old male patient had a 10-year history of gout and hyperuricemia. He complained of back pain and abdominal wall protrusion. DIAGNOSES The patient was diagnosed with tophaceous gout of the spine with abdominal wall weakness caused by T11 nerve root compression. INTERVENTIONS A semi-lamina decompression was performed at T11-T12. The pathological examination of the specimen demonstrated tophaceous gout of the spine. OUTCOMES After the surgery, the patient's back pain was completely relieved and the abdominal wall weakness significant improved. LESSONS This case highlighted that axial gout could mimic thoracic disk herniation clinically. The abdominal wall weakness might also be due to single T11 nerve compression by the tophaceous gout of the spine. In patients with a history of gout, axial gout should be considered as one of the differential diagnoses.
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Affiliation(s)
| | | | - Jiali Leng
- Department of Hospice, the First Hospital of Jilin University, No. 1, Xinmin St, Chaoyang District, ChangChun City, Jilin Province
| | | | | | - Hongyun Ma
- Department of Orthopaedics, Qinghai Provincial People's Hospital, Xining City, Qinghai Province
| | | | - Zijing Liu
- Nursing platform of spinal surgery department, the First Hospital of Jilin University, No. 1, Xinmin St, Chaoyang District, ChangChun City, Jilin Province, People's Republic of China
| | | | - Yi Liu
- Department of Spinal Surgery
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19
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Understanding the patient voice in gout: a quantitative study conducted in Europe. BJGP Open 2020; 4:bjgpopen20X101003. [PMID: 32071040 PMCID: PMC7330181 DOI: 10.3399/bjgpopen20x101003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/10/2019] [Indexed: 12/27/2022] Open
Abstract
Background Although commonly diagnosed, gout often remains a poorly managed disease. This is partially due to a lack of awareness of the long-term effect of gout among patients and healthcare professionals. Aim To understand unmet needs for patients and provide insight into achieving better treatment. Design & setting A quantitative online questionnaire collected from 1100 people with gout from 14 countries within Europe. Method Patients were recruited to complete an online survey via healthcare professional (HCP) referral, patient associations, or market research panels. Patients were included if they had been diagnosed with gout by a physician. Prior to commencement, patients were made aware that this study was sponsored by Grünenthal. The responses collected were collated and analyses were performed. Results Patients had an average of 2.9 gout flares within a 12-month period. Although 79% of patients were satisfied with treatment, inadequate gout control was also reported by 71% of patients. Furthermore, 84% experienced moderate-to-severe pain with their most recent flare. Of those who acknowledged treatment dissatisfaction, only 24% discussed other options with their GP. Most patients reported irregular follow-up and serum uric acid (sUA) monitoring. In addition, loss of belief that more can be done was a key barrier for patients. Conclusion Patients reported severe pain and social burden, coupled with low treatment expectation and lack of awareness of target sUA. Education around knowing and reaching sUA target is needed so that patients can receive and GPs can deliver higher quality management.
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20
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Whole-Exome Sequencing Reveals a Rare Missense Variant in SLC16A9 in a Pedigree with Early-Onset Gout. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4321419. [PMID: 32090094 PMCID: PMC7013288 DOI: 10.1155/2020/4321419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/28/2019] [Accepted: 01/10/2020] [Indexed: 02/06/2023]
Abstract
Gout is a common inflammatory arthritis triggered by monosodium urate deposition after longstanding hyperuricemia. In the general community, the disease is largely polygenic in genetic architecture, with many polymorphisms having been identified in gout or urate-associated traits. In a small proportion of cases, rare high penetrant mutations associated with monogenic segregation of the disease in families have been demonstrated to be disease causative. In this study, we recruited a two-generation pedigree with early-onset gout. To elucidate the genetic predisposition, whole-exome sequencing (WES) was performed. After comprehensive variant analyses and cosegregation testing, we identified a missense variant (c.277C>A, p.L93M) in SLC16A9, an extremely rare variant in genetic databases. Moreover, in silico assessments showed strong pathogenicity. This variant cosegregated with the disease phenotype perfectly in the family and is located in a highly conserved functional domain. A few studies supported our results of the association between SLC16A9 and gout and serum urate levels. In conclusion, we provide the first evidence for the association of rare missense in SLC16A9 with early-onset gout. These findings not only expand our current understanding of gout but also may have further implications for the treatment and prevention of gout.
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21
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Association of serum uric acid with visceral, subcutaneous and hepatic fat quantified by magnetic resonance imaging. Sci Rep 2020; 10:442. [PMID: 31949261 PMCID: PMC6965096 DOI: 10.1038/s41598-020-57459-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/28/2019] [Indexed: 12/20/2022] Open
Abstract
Elevated serum uric acid (SUA) is associated with a variety of medical conditions, such as hypertension, diabetes and obesity. Analyses investigating uric acid and obesity were primarily conducted using anthropometric measures like BMI and waist circumference. However, different adipose tissue depots might be differentially affected in uric acid metabolism. We analyzed the relation of SUA with visceral, subcutaneous and hepatic fat as quantified by Magnetic Resonance Imaging in N = 371 individuals from a cross-sectional sample of a population-based cohort. Associations of SUA and fat depots were calculated by regressions adjusted for potential confounders. We found that SUA was correlated with all fat measures (e.g. Pearson’s r between SUA and hepatic fat: 0.50, 95%-CI: 0.42, 0.57). Associations with visceral and hepatic fat, but not with subcutaneous fat, remained evident after adjustment for anthropometric measures (e.g. visceral fat: β = 0.51 l, 95%-CI: 0.30 l, 0.72 l). In conclusion, these results show how different adipose tissue compartments are affected by SUA to varying degrees, thus emphasizing the different physiological roles of these adipose tissues in uric acid metabolism.
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22
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Huang KH, Tai CJ, Tsai YF, Kuan YH, Lee CY. Correlation between Gout and Coronary Heart Disease in Taiwan: A Nationwide Population-Based Cohort Study. ACTA CARDIOLOGICA SINICA 2019; 35:634-640. [PMID: 31879516 DOI: 10.6515/acs.201911_35(6).20190403b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Gout is the most common inflammatory arthritis in adult males. Patients with gout are at a higher risk of coronary heart disease (CHD). This study aimed to investigate the correlation between gout and CHD. Methods This was a retrospective cohort study that used data from the Longitudinal Health Insurance Database of Taiwan. The study subjects were 46,140 patients with new-onset gout during 2003-2010. To avoid selection bias, we used propensity score matching. A Cox proportional hazard model was used to analyze differences in the risk of CHD between patients with and without gout after controlling for related variables. Results The patients with gout had a higher risk of CHD than the patients without gout [adjusted hazards ratio (HR) = 1.34, 95% confidence interval (CI): 1.23-1.45]. The risk of CHD increased with older age. Other related factors for CHD included gender (female vs. male, adjusted HR = 0.86, 95% CI: 0.79-0.93), hypertension (adjusted HR = 1.53, 95% CI: 1.42-1.65), hyperlipidemia (adjusted HR = 1.18, 95% CI: 1.07-1.29), and diabetes mellitus (adjusted HR = 1.24, 95% CI: 1.13-1.36). Conclusions We found correlations between gout and CHD and other influencing factors including hypertension, hyperlipidemia, and diabetes mellitus. We also found that gender and age were associated with CHD.
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Affiliation(s)
- Kuang-Hua Huang
- Department of Health Services Administration, China Medical University
| | - Chih-Jaan Tai
- Department of Health Services Administration, China Medical University.,Department of Otorhinolaryngology, China Medical University Hospital
| | | | - Yu-Hsiang Kuan
- Department of Pharmacology, Chung Shan Medical University.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
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23
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Chuang JP, Lee JC, Leu TH, Hidajah AC, Chang YH, Li CY. Association of gout and colorectal cancer in Taiwan: a nationwide population-based cohort study. BMJ Open 2019; 9:e028892. [PMID: 31601586 PMCID: PMC6797386 DOI: 10.1136/bmjopen-2019-028892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study aimed to determine colorectal cancer (CRC) risks among patients with gout through a follow-up study on a nationwide population-based cohort that included patients with gout and the general population in Taiwan. PARTICIPANT From the Taiwan National Health Insurance Research Database, we identified 28 061 patients who were newly diagnosed with gout between 2000 and 2010 as the study cohort. We randomly selected 84 248 subjects matching in gender, age and baseline year as comparison cohort. The cohorts were followed up until CRC occurrence, withdrawal from the system of National Health Insurance, or Dec. 31, 2013. PRIMARY AND SECONDARY OUTCOME MEASURES Cumulative incidences and incidence rate ratios (IRRs) of CRC between two cohorts were examined. The Cox proportional hazards model was used to evaluate risk factors associated with CRC development. RESULTS During the 13-year follow-up, the incidence rate of CRC development in the gout cohort reached 2.44 per 1000 person-years, which was higher than the 2.13 per 1000 person-years in the control cohort (IRR=1.15; 95% CI 1.04 to 1.26). After adjusting for age, gender, urbanisation status and comorbidities, including hypertension, diabetes and hyperlipidaemia, gout showed no significant association with increased risk of CRC occurrence (adjusted HR=1.03; 95% CI 0.93 to 1.14). CONCLUSIONS Similar risks of CRC incidence were observed in patients with and without gout in Taiwan. Allopurinol and colchicine are commonly used as urate-lowering drug and anti-inflammation medication in Taiwan and had been shown to reduce the risk of CRC incidence. Thus, further pharmaco-epidemiological studies should be carried out to specifically assess the role of allopurinol in the relationship between gout and CRC.
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Affiliation(s)
- Jen-Pin Chuang
- Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan
- Puzi Hospital, Ministry of Health and Welfare, Chia-Yi, Taiwan
| | - Jenq-Chang Lee
- Department of Surgery, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Tzeng-Horng Leu
- Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan, Taiwan
- Department of Pharmacology, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Atik Choirul Hidajah
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Ya-Hui Chang
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
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24
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Wang Y, Lin Z, Zhang B, Jiang Z, Guo F, Yang T. Cichorium intybus L. Extract Suppresses Experimental Gout by Inhibiting the NF-κB and NLRP3 Signaling Pathways. Int J Mol Sci 2019; 20:E4921. [PMID: 31590257 PMCID: PMC6801406 DOI: 10.3390/ijms20194921] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/22/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The production and maturation of interleukin (IL)-1β, regulated by the NF-κB and NLRP3 signaling pathways, lie at the core of gout. This study aimed to evaluate the antigout effect of Cichorium intybus L. (also known as chicory) in vivo and in vitro. METHODS A gout animal model was established with monosodium urate (MSU) crystal injections. Rats were orally administered with chicory extract or colchicine. Levels of ankle edema, inflammatory activity, and IL-1β release were observed. Several essential targets of the NF-κB and NLRP3 signaling pathways were detected. Primary macrophages were isolated to verify the antigout mechanism of chicory extract as well as chicoric acid in vitro. RESULTS Improvements of swelling degree, inflammatory activity, and histopathological lesion in MSU-injected ankles were observed in the treatment with chicory extract. Further, the chicory extract significantly decreased IL-1β release by suppressing the NF-κB and NLRP3 signaling pathways in gout rats. Similar to the in vivo results, IL-1β release was also inhibited by chicory extract and chicoric acid, a specific effective compound in chicory, through the NF-κB and NLRP3 signaling pathways. CONCLUSION This study suggests that chicory extract and chicoric acid may be used as promising therapeutic agents against gout by inhibiting the NF-κB and NLRP3 signaling pathways.
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Affiliation(s)
- Yu Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China.
| | - Zhijian Lin
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China.
| | - Bing Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China.
| | - Zhuoxi Jiang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China.
| | - Fanfan Guo
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China.
| | - Ting Yang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100102, China.
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Russell MD, Yates M, Bechman K, Rutherford AI, Subesinghe S, Lanyon P, Galloway JB. Rising Incidence of Acute Hospital Admissions due to Gout. J Rheumatol 2019; 47:619-623. [DOI: 10.3899/jrheum.190257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 01/10/2023]
Abstract
Objective.To describe trends in acute hospital admissions due to gout in England, with rheumatoid arthritis (RA) as a comparator, alongside prescribing trends for common gout medications.Methods.An ecological study was performed using UK National Health Service (NHS) Digital Hospital Episode Statistics data to calculate the incidence of unplanned admissions with primary diagnoses of gout or RA in adults in England between April 2006 and March 2017. NHS Digital Community Prescription data for allopurinol, febuxostat, and colchicine were considered over a similar period.Results.The incidence of unplanned gout admissions increased by 58.4% over the study period, from 7.9 admissions per 100,000 population in 2006/07 to 12.5 admissions per 100,000 population in 2016/17 (p < 0.0001). Gout admissions increased as a proportion of all hospital admissions, and accounted for 349,768 bed-days cumulatively. Unplanned RA admissions halved over the study period, from 8.6 admissions per 100,000 population in 2006/07 to 4.3 admissions per 100,000 population in 2016/17 (p < 0.0001). Community prescriptions dispensed for allopurinol and colchicine have increased by 71.4% and 165.6%, respectively, since 2006 (p < 0.0001). Febuxostat prescriptions have increased 20-fold since 2010 (p < 0.0001), when prescription data became available.Conclusion.Acute gout admissions in England increased between 2006 and 2017, accompanied by increasing prescription of gout therapies. Acute admissions due to RA halved over the same time period. These data call for aggressive target-driven therapy for this highly treatable disease.
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A conserved role of the insulin-like signaling pathway in diet-dependent uric acid pathologies in Drosophila melanogaster. PLoS Genet 2019; 15:e1008318. [PMID: 31415568 PMCID: PMC6695094 DOI: 10.1371/journal.pgen.1008318] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/17/2019] [Indexed: 12/17/2022] Open
Abstract
Elevated uric acid (UA) is a key risk factor for many disorders, including metabolic syndrome, gout and kidney stones. Despite frequent occurrence of these disorders, the genetic pathways influencing UA metabolism and the association with disease remain poorly understood. In humans, elevated UA levels resulted from the loss of the of the urate oxidase (Uro) gene around 15 million years ago. Therefore, we established a Drosophila melanogaster model with reduced expression of the orthologous Uro gene to study the pathogenesis arising from elevated UA. Reduced Uro expression in Drosophila resulted in elevated UA levels, accumulation of concretions in the excretory system, and shortening of lifespan when reared on diets containing high levels of yeast extract. Furthermore, high levels of dietary purines, but not protein or sugar, were sufficient to produce the same effects of shortened lifespan and concretion formation in the Drosophila model. The insulin-like signaling (ILS) pathway has been shown to respond to changes in nutrient status in several species. We observed that genetic suppression of ILS genes reduced both UA levels and concretion load in flies fed high levels of yeast extract. Further support for the role of the ILS pathway in modulating UA metabolism stems from a human candidate gene study identifying SNPs in the ILS genes AKT2 and FOXO3 being associated with serum UA levels or gout. Additionally, inhibition of the NADPH oxidase (NOX) gene rescued the reduced lifespan and concretion phenotypes in Uro knockdown flies. Thus, components of the ILS pathway and the downstream protein NOX represent potential therapeutic targets for treating UA associated pathologies, including gout and kidney stones, as well as extending human healthspan.
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Li Y, Piranavan P, Sundaresan D, Yood R. Clinical Characteristics of Early-Onset Gout in Outpatient Setting. ACR Open Rheumatol 2019; 1:397-402. [PMID: 31777819 PMCID: PMC6857998 DOI: 10.1002/acr2.11057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/21/2019] [Indexed: 12/12/2022] Open
Abstract
Objective The objective of this study is to investigate the clinical characteristics and treatment of patients with early-onset gout. Methods We retrospectively reviewed 327 adult patients with a first diagnosis of gout from 2008 to 2016 using the database of a multispecialty group practice in New England. Patients were classified into the following groups: age 30 years or younger at first diagnosis (group 1), age 31-40 years (group 2), and age over 40 years (group 3). The clinical characteristics and treatment of gout were compared among the three groups. Results We identified 87 patients in group 1 and 140 patients in group 2. Group 3 included 100 patients randomly chosen from the 7216 patients with a first diagnosis at age over 40 years. Patients within group 1 had significantly higher serum uric acid (sUA) levels at the time of diagnosis and a more prominent family history of gout. Younger patients (groups 1 and 2) had a significantly higher body mass index than patients over 40 years of age (group 3). A substantial number of younger patients also had hypertension or hyperlipidemia. The majority of younger patients met the 2012 American College of Rheumatology (ACR) guidelines for initiating urate-lowering therapy (ULT) on the basis of frequency of gout attacks, whereas the majority of patients over 40 years of age met the guidelines for ULT on the basis of chronic kidney disease. Patients over 40 years of age were more likely to achieve an sUA level less than 6.0 mg/dl. Conclusion Patients with a first diagnosis of gout at age 40 years or younger frequently had cardiovascular risk factors and were less likely to achieve an sUA level less than 6.0 mg/dl compared with patients over 40 years of age who were treated in routine clinical practice. Clinicians should be aware that patients with early-onset gout may be an undertreated population with poor adherence to ULT and increased risk of recurrent gout and cardiovascular diseases.
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Affiliation(s)
- Yan Li
- Saint Vincent Hospital Worcester Massachusetts
| | | | | | - Robert Yood
- Saint Vincent Hospital and Reliant Medical Group Worcester Massachusetts
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Pascart T, Norberciak L, Ea HK, Guggenbuhl P, Lioté F. Patients With Early-Onset Gout and Development of Earlier Severe Joint Involvement and Metabolic Comorbid Conditions: Results From a Cross-Sectional Epidemiologic Survey. Arthritis Care Res (Hoboken) 2019; 71:986-992. [PMID: 30022604 DOI: 10.1002/acr.23706] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/17/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Little is known of the clinical features and comorbidity profile of patients presenting with early-onset gout (EOG), although international guidelines recommend rapid treatment after diagnosis. The objective of this study was to assess specific characteristics and comorbidities of patients with gout who had an early onset. METHODS Patients from a cross-sectional French national cohort who experienced their first gout flare before age 40 years were included in the EOG group and compared to patients with an onset after age 40 years, the common gout group. RESULTS A total of 120 patients were included in the EOG group (mean ± SD age 49.5 ± 11.9 years) and 865 patients in the common gout group (mean ± SD age 64.4 ± 10.1 years). Patients with EOG more often presented with a history of polyarticular flares (P < 0.01), but had similar frequency of flares (P = 0.16), gout arthropathy (P = 0.79), and tophi (P = 0.53). Prevalence of each item comprising metabolic syndrome did not differ between groups. In patients with EOG, all cardiovascular comorbidities were diagnosed after gout onset. Greater age, low high-density lipoprotein, and excessive alcohol intake were associated in multivariate analysis with the common gout group, while a familial history of gout, longer duration of urate-lowering treatment, higher serum uric acid levels, and metabolic syndrome were associated with the EOG group. CONCLUSION Patients with EOG developed slightly more severe joint involvement and earlier metabolic disorders than patients with common gout.
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Affiliation(s)
- Tristan Pascart
- Université de Lille, EA440, and Hôpital Saint-Philibert, F-59160, Lomme, France
| | - Laurène Norberciak
- Université de Lille, EA440, and Hôpital Saint-Philibert, F-59160, Lomme, France
| | - Hang-Korng Ea
- Université Paris Diderot, Sorbonne Paris Cité, F-75205, AP-HP, Hôpital Lariboisière, Viggo Petersen, F-75010, and INSERM, UMR 1132, Paris, France
| | - Pascal Guggenbuhl
- CHU de Rennes, F-35000, Institut Numecan, INSERM U 1241, INRA U 1341, F-35000, and Université de Rennes 1, F-35000, Rennes, France
| | - Frédéric Lioté
- Université Paris Diderot, Sorbonne Paris Cité, F-75205, AP-HP, Hôpital Lariboisière, Viggo Petersen, F-75010, and INSERM, UMR 1132, Paris, France
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Mirmiran R, Bush T, Cerra MM, Grambart S, Kauschinger E, Younger M, Zychowicz M. Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners®: Etiology, Diagnosis, and Treatment Consensus for Gouty Arthritis of the Foot and Ankle. J Foot Ankle Surg 2019; 57:1207-1217. [PMID: 30368431 DOI: 10.1053/j.jfas.2018.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Gout is a condition that commonly affects the foot and ankle, and practitioners who treat these structures should be aware of the methods to diagnose and treat this form of arthritis. Practitioners also need to recognize extra-articular manifestations of the disease. Although the acutely red, hot, swollen joint is a common presentation, chronic tophaceous gout can be associated with pain, nodule formation, and cutaneous compromise. Since the underlying causes that lead to excessive monosodium urate deposition may be treatable, early and accurate diagnosis can be very beneficial and may even prevent articular degeneration.
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Affiliation(s)
- Roya Mirmiran
- Foot and Ankle Surgeon, Department of Surgery, Sutter Medical Group, Sacramento, CA.
| | - Tom Bush
- Associate Professor and Assistant Dean for Practice, University of North Carolina at Chapel Hill Schools of Nursing and Medicine, Chapel Hill, NC
| | - Michele M Cerra
- Director of the Duke NP/PA Rheumatology Fellowship Program & Faculty, Department of Medicine, Duke University School of Medicine, NC
| | - Sean Grambart
- Foot and Ankle Surgeon, Carle Physician Group, Department of Surgery, Champaign, IL
| | - Elaine Kauschinger
- Clinical Assistant Professor, Duke University School of Nursing, Durham, NC
| | - Melissa Younger
- Podiatric Research Fellow, Penn Presbyterian Medical Center, Philadelphia, PA
| | - Michael Zychowicz
- Professor and Director of MSN Program & Lead Faculty in Orthopedic NP Specialty, Duke University School of Nursing, Durham, NC
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Polymorphisms of ABCG2 and SLC22A12 Genes Associated with Gout Risk in Vietnamese Population. ACTA ACUST UNITED AC 2019; 55:medicina55010008. [PMID: 30621105 PMCID: PMC6359270 DOI: 10.3390/medicina55010008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/13/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Abstract
Background and objective: Gout is a common form of inflammatory arthritis caused by the crystallization of uric acid. Previous studies have demonstrated that the genetic predisposition of gout varies in different ethnic populations. However the association study of genetic variants with gout remains unknown in the Vietnamese population. Our study aimed to assess the relationship between polymorphisms in ABCG2 and SLC22A12 and gout susceptibility in Vietnamese. Materials and methods: Genomic DNA was extracted from blood of a total of 170 patients with gout and 351 healthy controls. We genotyped single nucleotide polymorphisms (SNPs): rs72552713, rs12505410 of the ABCG2 gene and rs11231825, rs7932775 of the SLC22A12 gene using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) and then confirmed 10% of randomly selected subjects by Sanger sequencing. Results: Three SNPs (rs72552713 and rs12505410 and rs11231825) were in accordance with Hardy–Weinberg Equilibrium (HWE) (p > 0.05) while rs7932775 was not (p < 0.05). For rs72552713, CT genotype was significantly different between gout patient and control groups (p < 0.001) and the T allele was associated with an increased risk of gout (OR = 21.19; 95% CI: 3.00–918.96; p < 0.001). Serum uric acid and hyperuricemia differed significantly between CC and CT genotype groups (p = 0.004 and 0.008, respectively). For rs11231825, a protective effect against gout risk was identified in the presence of the C allele when compared with the T allele (OR = 0.712; 95% CI: 0.526–0.964 p = 0.0302). In contrast, no significant difference of allele frequencies between gout patients and controls was detected for rs12505410 (p > 0.05). However, significant differences in serum uric acid and systolic blood pressure were obtained among gout patients. Conclusion: Our results suggest that ABCG2 rs72552713 and SLC22A12 rs11231825 are likely associated with gout in the Vietnamese population in which T allele may be a risk factor for gout susceptibility.
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Atypical Gout Manifestations in General Practice–Family Medicine: Own Clinical Observations and Literature Data. Fam Med 2018. [DOI: 10.30841/2307-5112.6.2018.168384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Mirmiran R, Bush T, Cerra MM, Grambart S, Kauschinger E, Younger M, Zychowicz M. Joint Clinical Consensus Statement of the American College of Foot and Ankle Surgeons® and the American Association of Nurse Practitioners™: Etiology, Diagnosis, and Treatment Consensus for Gouty Arthritis of the Foot and Ankle. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mele C, Tagliaferri MA, Saraceno G, Mai S, Vietti R, Zavattaro M, Aimaretti G, Scacchi M, Marzullo P. Serum uric acid potentially links metabolic health to measures of fuel use in lean and obese individuals. Nutr Metab Cardiovasc Dis 2018; 28:1029-1035. [PMID: 30139687 DOI: 10.1016/j.numecd.2018.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/04/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Uric acid (UA) is a byproduct of the high-energy purine metabolism and is conventionally regarded as a marker of cardio-metabolic impairment. Its potential relationship with energy homeostasis is unknown to date. METHODS AND RESULTS In a cross-sectional study on 121 otherwise healthy obese and 99 sex- and-age-matched lean subjects, UA levels were analyzed in relation to metabolic health, inflammatory markers, respiratory quotient (RQ) and resting energy expenditure (REE) as assessed by indirect calorimetry, fat mass (%FM) and fat-free mass (FFM) as determined by bioimpedance analysis. As expected, obese and lean subjects differed in BMI, glucolipid homeostasis, leptin and insulin levels, inflammatory markers, %FM and FFM (p < 0.001 for all). Likewise, UA levels (p < 0.001) and rates of hyperuricaemia (40.5% vs 3.0%, p < 0.0001) were also higher in obese than lean controls. Further, indirect calorimetry confirmed that obesity increased REE and decreased RQ significantly (p < 0.001). Beyond the expected metabolic correlates, in individual and merged groups UA levels were associated negatively with RQ and positively with REE (p < 0.0001 for both). In multivariable regression analysis, significant independent predictors of UA were BMI and sex. When BMI was replaced by measures of body composition, %FM and FFM emerged as significant predictors of serum UA (p < 0.0001). CONCLUSIONS A potential link relates serum UA to measures of resting energy expenditure and their determinants.
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Affiliation(s)
- C Mele
- Division of General Medicine, Ospedale S. Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824, Piancavallo di Oggebbio (VB), Italy; Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - M A Tagliaferri
- Division of General Medicine, Ospedale S. Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824, Piancavallo di Oggebbio (VB), Italy
| | - G Saraceno
- Division of General Medicine, Ospedale S. Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824, Piancavallo di Oggebbio (VB), Italy
| | - S Mai
- Laboratory of Metabolic Research, Ospedale S. Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824, Piancavallo di Oggebbio (VB), Italy
| | - R Vietti
- Laboratory of Metabolic Research, Ospedale S. Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824, Piancavallo di Oggebbio (VB), Italy
| | - M Zavattaro
- Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - G Aimaretti
- Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - M Scacchi
- Division of General Medicine, Ospedale S. Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824, Piancavallo di Oggebbio (VB), Italy
| | - P Marzullo
- Division of General Medicine, Ospedale S. Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824, Piancavallo di Oggebbio (VB), Italy; Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy.
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Singh JA, Cleveland JD. Gout and the risk of age-related macular degeneration in the elderly. PLoS One 2018; 13:e0199562. [PMID: 30001351 PMCID: PMC6042699 DOI: 10.1371/journal.pone.0199562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/08/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To assess whether gout is associated with incident age-related macular degeneration (AMD) Methods We used the 5% Medicare claims data from 2006–12 for all beneficiaries who were enrolled in Medicare fee-for-service (Parts A, B) and not enrolled in a Medicare Advantage Plan, and resided in the U.S. People were censored at the occurrence of new diagnosis of AMD, death or the end of study (12/31/2012), whichever occurred first. We used multivariable-adjusted Cox regression analyses to assess the association of gout with incident AMD, adjusted for demographics, comorbidity, and use of medications for cardiovascular disease and gout. Hazard ratios and 95% confidence intervals were calculated. Results In this observational cohort study, of the 1,684,314 eligible people, 116,097 developed incident AMD (6.9%). Incidence rates of AMD per 1,000 person-years were 20.1 for people with gout and 11.7 for people without gout. In multivariable-adjusted analyses, a diagnosis of gout was significantly associated with a higher risk of incident AMD with a hazard ratio of 1.39 (95% CI, 1.35, 1.43). This association was confirmed in sensitivity analyses that substituted Charlson-Romano comorbidity index continuous score with either a categorical Charlson-Romano comorbidity index score or individual Charlson-Romano index comorbidities plus hypertension, hyperlipidemia and coronary artery disease. Other covariates significantly associated with higher hazards of incident AMD were older age, female gender, White race/ethnicity, and higher Charlson-Romano comorbidity index score. Conclusions We noted a novel association of gout with AMD in the elderly. Future studies should investigate the pathways that mediate this association.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, Alabama, United States of America.,Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America.,Department of Epidemiology at the UAB School of Public Health, Birmingham, Alabama, United States of America
| | - John D Cleveland
- Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America
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Assessing the causal association between smoking behavior and risk of gout using a Mendelian randomization study. Clin Rheumatol 2018; 37:3099-3105. [PMID: 30003442 DOI: 10.1007/s10067-018-4210-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/09/2018] [Indexed: 01/20/2023]
Abstract
This study aimed to examine whether smoking behavior is causally related to gout. Summary statistics of publicly available data from genome-wide association studies (GWAS) of smoking behavior (n = 85,997) served as the exposure dataset, while meta-analysis results of 14 studies including 2115 cases and 67,259 controls of European descent served as the outcome dataset. The data were subjected to two-sample Mendelian randomization (MR) analysis using the inverse-variance weighted (IVW), weighted median, and MR-Egger regression methods. Five single-nucleotide polymorphisms (SNPs) from GWAS of smoking behavior were selected as instrumental variables (IVs) to improve inference: CHRNA3 (rs1051730), PDE1C (rs215614), CYP2A6 (rs4105144), CHRNB3 (rs6474412), and CYP2B6 (rs7260329). The IVW data did not support a causal association between smoking behavior and gout (beta = - 0.035, SE = 0.036, p = 0.333). MR-Egger regression indicated that directional pleiotropy did not bias the result (intercept = 0.021; p = 0.560). MR-Egger analysis revealed no causal association between smoking behavior and gout (beta = - 0.074, SE = 0.070, p = 0.366). The weighted median approach did not support a causal association between smoking behavior and gout (beta = - 0.043, SE = 0.040, p = 0.279). Cochran's Q test indicated no evidence of heterogeneity between IV estimates based on individual variants. The results of "leave one out" analysis demonstrated that no single SNP drove the IVW point estimate. MR estimates using IVW, weighted median, and MR-Egger analysis were consistent and did not support a causal inverse association between smoking behavior and gout.
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Differentiating the acute phase of gout from the intercritical phase with ultrasound and quantitative shear wave elastography. Eur Radiol 2018; 28:5316-5327. [PMID: 29869177 DOI: 10.1007/s00330-018-5529-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/27/2018] [Accepted: 05/07/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the value of ultrasound (US) in differentiating the acute phase of gout from the intercritical phase, particularly using shear wave elastography (SWE). METHODS 57 gout patients were prospectively enrolled and divided into acute phase and intercritical phase groups. The patients underwent US and SWE examinations for the first metatarsophalangeal joints with the same protocol. Maximum synovial thickness was measured. US features were reviewed by two radiologists independently. The maximum (Emax) and mean (Emean) elastic moduli of synovium were calculated. Diagnostic performances of US, SWE and combined US and SWE were evaluated. RESULTS US findings demonstrated that the colour Doppler flow signal grade in the acute phase was higher than that in the intercritical phase (p = 0.001), whereas no differences were found for B-mode US features between the two groups (all p > 0.05). For SWE, Emax and Emean were significantly higher in the intercritical phase than in the acute phase (both p < 0.001). The areas under the receiver operating characteristic curve (AUROCs) were 0.494-0.553 for B-mode US, 0.735 for colour Doppler US (CDUS), 0.887 for Emax and 0.882 for Emean. The combination of CDUS and SWE increased the AUROC, sensitivity and accuracy significantly in comparison with CDUS alone (all p < 0.001). However, the combined set did not show stronger diagnostic performance in comparison with SWE alone. CONCLUSION SWE increases the diagnostic performance in differentiating the acute phase of gout from the intercritical phase in comparison with conventional US. KEY POINTS • Colour Doppler flow signal grade is higher in acute phase of gout than in intercritical phase. • SWE demonstrates that synovium stiffness is higher in intercritical phase of gout than in acute phase. • SWE increases diagnostic performance in differentiating acute phase of gout from intercritical phase in comparison with conventional US.
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Klein RW, Kabadi S, Cinfio FN, Bly CA, Taylor DC, Szymanski KA. Budget impact of adding lesinurad for second-line treatment of gout: a US health plan perspective. J Comp Eff Res 2018; 7:807-816. [PMID: 29792516 DOI: 10.2217/cer-2017-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aim: To estimate budget impact of adopting lesinurad as add-on to allopurinol for urate-lowering therapy in gout. Methods: A budget impact model was developed for a US payer perspective, using a Markov model to estimate costs, survival and discontinuation in a one-million-member health plan. The population included patients failing first-line gout therapy, followed for 5 years. Results: Incremental costs of adding lesinurad versus no lesinurad were US$241,907 and US$1,098,220 in first and fifth years, respectively. Cumulative 5-year incremental cost was US$3,633,440. Estimated incremental mean cost per treated patient with gout per year was US$112. The mean per-member per-month cost increased by US$0.06. Conclusion: Initiating lesinurad would result in an incremental per-member per-month cost of US$0.06 over 5 years.
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Affiliation(s)
- Robert W Klein
- Medical Decision Modeling, Inc., 3500 DePauw Blvd #1037, Indianapolis, IN 46268, USA
| | - Shaum Kabadi
- AstraZeneca LP, 101 Orchard Ridge Drive, Gaithersburg, MD 20878, USA
| | - Frank N Cinfio
- Medical Decision Modeling, Inc., 201 N. Illinois #1175, Indianapolis, IN 46204, USA
| | - Christopher A Bly
- Medical Decision Modeling, Inc., 201 N. Illinois #1175, Indianapolis, IN 46204, USA
| | - Douglas Ca Taylor
- Ironwood Pharmaceuticals, 301 Binney Street, Cambridge, MA 02142, USA
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Muraki S, Moriki K, Shigematsu S, Fukae M, Kakara M, Yamashita D, Hirota T, Takane H, Shimada M, Hirakawa M, Ieiri I. Population Pharmacodynamic Analysis of Uric Acid-Lowering Effects of Febuxostat Based on Electronic Medical Records in Two Hospitals. J Clin Pharmacol 2017; 58:304-313. [PMID: 29045766 DOI: 10.1002/jcph.1023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/05/2017] [Indexed: 12/22/2022]
Abstract
The aim of this study was to develop a population pharmacodynamic (PPD) model to describe uric acid (UA)-lowering effects in patients treated with febuxostat based on electronic medical records in 2 independent hospitals (university and city hospitals). Interhospital differences in the PPD model were also evaluated. We conducted the following 2 approaches to build the PPD models. A PPD model was developed separately using individual hospital data, and structural models and covariates between the two hospitals were compared (approach A). Another PPD model was developed using all available data from both hospitals, and differences between the 2 hospitals were evaluated by performing a covariate analysis on all PPD parameters (approach B). PPD analyses were performed by NONMEM using data from 358 patients. In both approaches, one indirect response model was established. In approach A, 2 diuretics (loops and thiazides) and renal function tests (Scr or BUN) were selected as covariates for the UA baseline level (serum UA levels just before the febuxostat treatment), whereas 2 diuretics and BUN were selected in approach B. A covariate analysis indicated that loops and thiazides increased UA baseline levels by 7%-14% and 6%-11%, respectively. In approach B, "hospital" was identified as a significant covariate for the UA baseline level; the baseline level was 7% higher in the city hospital. A PPD analysis may provide a precise description of the time course of the UA-lowering effects of febuxostat and quantitatively detect an interhospital difference in the UA baseline level.
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Affiliation(s)
- Shota Muraki
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniaki Moriki
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan.,Department of Hospital Pharmacy, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Saki Shigematsu
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Masato Fukae
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Kakara
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Daiki Yamashita
- Hospital Pharmacy, Fukuoka Tokushukai Medical Center, Fukuoka, Japan
| | - Takeshi Hirota
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Takane
- Department of Hospital Pharmacy, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Miki Shimada
- Department of Hospital Pharmacy, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Masaaki Hirakawa
- Hospital Pharmacy, Fukuoka Tokushukai Medical Center, Fukuoka, Japan
| | - Ichiro Ieiri
- Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
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Wang H, Peng Y, Zhang T, Lan Q, Zhao H, Wang W, Zhao Y, Wang X, Pang J, Wang S, Zheng J. Metabolic Epoxidation Is a Critical Step for the Development of Benzbromarone-Induced Hepatotoxicity. Drug Metab Dispos 2017; 45:1354-1363. [PMID: 29021351 DOI: 10.1124/dmd.117.077818] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/06/2017] [Indexed: 12/16/2022] Open
Abstract
Benzbromarone (BBR) is effective in the treatment of gout; however, clinical findings have shown it can also cause fatal hepatic failure. Our early studies demonstrated that CYP3A catalyzed the biotransformation of BBR to epoxide intermediate(s) that reacted with sulfur nucleophiles of protein to form protein covalent binding both in vitro and in vivo. The present study attempted to define the correlation between metabolic epoxidation and hepatotoxicity of BBR by manipulating the structure of BBR. We rationally designed and synthesized three halogenated BBR derivatives, fluorinated BBR (6-F-BBR), chlorinated BBR (6-Cl-BBR), and brominated BBR (6-Br-BBR), to decrease the potential for cytochrome P450-mediated metabolic activation. Both in vitro and in vivo uricosuric activity assays showed that 6-F-BBR achieved favorable uricosuric effect, while 6-Cl-BBR and 6-Br-BBR showed weak uricosuric efficacy. Additionally, 6-F-BBR elicited much lower hepatotoxicity in mice. Fluorination of BBR offered advantage to metabolic stability in liver microsomes, almost completely blocked the formation of epoxide metabolite(s) and protein covalent binding, and attenuated hepatic and plasma glutathione depletion. Moreover, the structural manipulation did not alter the efficacy of BBR. This work provided solid evidence that the formation of the epoxide(s) is a key step in the development of BBR-induced hepatotoxicity.
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Affiliation(s)
- Hui Wang
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Ying Peng
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Tingjian Zhang
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Qunsheng Lan
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Huimin Zhao
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Wenbao Wang
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Yufei Zhao
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Xu Wang
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Jianxin Pang
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Shaojie Wang
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
| | - Jiang Zheng
- Wuya College of Innovation (H.W., Y.P., H.Z., Y.Z., X.W., J.Z.) and Key Laboratory of Structure-Based Drug Design and Discovery (Ministry of Education) (W.W., S.W.), School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, Liaoning, P.R. China; School of Pharmacy, China Medical University, Shenyang, Liaoning, P.R. China (T.Z.); Guangdong Provincial Key Laboratory of Drug Screening and School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, Guangdong, P.R. China (Q.L., J.P.); and State Key Laboratory of Functions and Applications of Medicinal Plants and Key Laboratory of Pharmaceutics of Guizhou Province, Guizhou Medical University, Guiyang, Guizhou, P.R. China (J.Z.)
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Karimzadeh H, Sirous M, Sadati SN, Bashshash M, Mottaghi P, Ommani B, Karimifar M. Prevalence of Chondrocalcinosis in Patients above 50 Years and the Relationship with Osteoarthritis. Adv Biomed Res 2017; 6:98. [PMID: 28828349 PMCID: PMC5549543 DOI: 10.4103/2277-9175.211835] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Some studies showed a relation between chondrocalcinosis and osteoarthritis (OA). Hence, considering the importance of chondrocalcinosis diagnosis andnecessity for its integration with OA, the current study aims at investigating prevalence of chondrocalcinosis in patients above 50 years admitted to Isfahan Al-Zahra Medical Center and its relationship with OA. MATERIALS AND METHODS In a cross-sectional study, 600 patients who referred to the radiology units of Al-Zahra Hospital for radiography of different joints were studied during 2013-2014. The patients images were studied for chondrocalcinosis and OA by a radiologist and also examined clinically and results of imaging by an expert rheumatologist. The prevalence of chondrocalcinosis and it relation with OA was determined by Statistical Package for Social Sciences software and using of Chi-square and t-test. RESULTS 23 patients under study had chondrocalcinosis (3.83%). patients with chondrocalcinosis had higher age average, and they were in age group of 70 years and older, but no significant difference was observed regarding the prevalence of the disease in both genders. Chondrocalcinosis prevalence in terms of body mass index showed significant differences (P = 0.001). All patients with chondrocalcinosis had a history of joint disease and prevalence of chondrocalcinosis in terms of joint disease history showed a significant difference (P < 0.001). CONCLUSION Prevalence of chondrocalcinosis is relatively high in the Iranian population of 70 years and older. Hence, more investigation considering to the diagnosis of chondrocalcinosis among patients with OA is very important.
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Affiliation(s)
- Hadi Karimzadeh
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Sirous
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mahdiyyeh Bashshash
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Mottaghi
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Ommani
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansoor Karimifar
- Department of Rheumatology, Isfahan University of Medical Sciences, Isfahan, Iran
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Callear J, Blakey G, Callear A, Sloan L. Gout in primary care: Can we improve patient outcomes? BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:bmjquality_uu210130.w4918. [PMID: 28469909 PMCID: PMC5411725 DOI: 10.1136/bmjquality.u210130.w4918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/08/2016] [Indexed: 12/22/2022]
Abstract
In the United Kingdom, gout represents one of the most common inflammatory arthropathies predominantly managed in the primary care setting. Gout is a red flag indicator for cardiovascular disease and comorbidity. Despite this, there are no incentivised treatment protocols and suboptimal management in the primary care setting is common. A computer based retrospective search at a large inner city GP practice between January 2014-December 2014 inclusive, identified 115 patients with gout. Baseline measurements revealed multiple gout related consultations, poor medication compliance, high uric acid levels and deficiencies in uric acid monitoring. A series of improvement cycles were conducted. A telephone questionnaire conducted in January 2015, identified that patient education was suboptimal. The following improvement cycles aimed to educate patients, improve uric acid monitoring and support medication compliance. It was ultimately hoped that these measures would reduce gout flares and GP practice attendance. The improvement cycles contributed towards reduction in uric acid levels from 0.37 to 0.3 (p=0.14), 20% reduction in patients experiencing one or more gout flares and 77% reduction in GP related consultations between March 2015-March 2016 compared to baseline. The proportion of patients fully compliant with taking their urate lowering therapies improved from 63% to 91% (p=0.0001). A follow up series of PDSA cycles were performed between July-December 2016. The purpose of these cycles was to assess the sustainability of the improved medication compliance demonstrated by the improvement cycles. Three months following the completion of the improvement cycles, full medication compliance dropped from 91% to 70% (p=0.0001). The introduction of a paper calendar saw sustained and maintained improvement in medication compliance to 100% (p=0.0001) at the end of the study period. The improvement and PDSA cycles have demonstrated that simple interventions can be a sustainable way of improving disease control and patient outcomes.
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Cui L, Meng L, Wang G, Yuan X, Li Z, Mu R, Wu S. Prevalence and risk factors of hyperuricemia: results of the Kailuan cohort study. Mod Rheumatol 2017; 27:1066-1071. [PMID: 28395604 DOI: 10.1080/14397595.2017.1300117] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of this study is to determine the serum uric acid (SUA) level and the prevalence of hyperuricemia (HUA) in Chinese population. METHODS We conducted a cross-sectional study among 100,226 employees (79.9% male) of the Kailuan Group using physical examination data in 2006-2007. HUA was defined as SUA >356.9 μmol/L (6.0 mg/dL) for women and SUA >416.4 μmol/L (7.0 mg/dL) for men. We investigated crude and age adjusted HUA prevalence and compared characteristics of subjects with and without HUA in men and women using multivariate logistic regression. RESULTS SUA levels were 244.9 ± 71.5 μmol/L in women and 302.0 ± 83.5 μmol/L in men. About 8290 (8.27%) subjects were diagnosed with HUA. Age-adjusted prevalence of HUA was 8.02% in the total sample (6.87% in women and 8.57% in men). The SUA level and HUA prevalence showed U-shaped or J-shaped associations with age. Multivariate logistic regression revealed age, waist circumference, total cholesterol, triglyceride, hypertension and non-alcoholic fatty liver disease history, prolonged sitting, alcohol consumption, and oral diuretics were independent risk factors of HUA, while long sleep duration was protective against HUA. CONCLUSIONS The prevalence of HUA is 6.87% and 8.57% in Chinese women and men. HUA is likely related with life style and metabolic disorders.
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Affiliation(s)
- Liufu Cui
- a Department of Rheumatology and Immunology , Kailuan General Hospital , Tangshan , Hebei Province , China
| | - Lingmin Meng
- b Key Laboratory of Neurological and Biological Function of Hebei Province, Kailuan General Hospital , Tangshan , Hebei Province , China
| | - Guanying Wang
- c Department of Rheumatology and Immunology , Peking University People's Hospital , Beijing , China
| | - Xiaodong Yuan
- d Department of Neurology , Kailuan General Hospital , Tangshan , Hebei Province , China
| | - Zhanguo Li
- c Department of Rheumatology and Immunology , Peking University People's Hospital , Beijing , China
| | - Rong Mu
- c Department of Rheumatology and Immunology , Peking University People's Hospital , Beijing , China
| | - Shouling Wu
- e Department of Cardiology , Kailuan General Hospital , Tangshan , Hebei Province , China
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Mahbub MH, Yamaguchi N, Takahashi H, Hase R, Amano H, Kobayashi-Miura M, Kanda H, Fujita Y, Yamamoto H, Yamamoto M, Kikuchi S, Ikeda A, Kageyama N, Nakamura M, Ishimaru Y, Sunagawa H, Tanabe T. Alteration in plasma free amino acid levels and its association with gout. Environ Health Prev Med 2017; 22:7. [PMID: 29165113 PMCID: PMC5664792 DOI: 10.1186/s12199-017-0609-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/04/2017] [Indexed: 01/09/2023] Open
Abstract
Background Studies on the association of plasma-free amino acids with gout are very limited and produced conflicting results. Therefore, we sought to explore and characterize the plasma-free amino acid (PFAA) profile in patients with gout and evaluate its association with the latter. Methods Data from a total of 819 subjects (including 34 patients with gout) undergoing an annual health examination program in Shimane, Japan were considered for this study. Venous blood samples were collected from the subjects and concentrations of 19 plasma amino acids were determined by high-performance liquid chromatography–electrospray ionization–mass spectrometry. Student’s t-test was applied for comparison of variables between patient and control groups. The relationships between the presence or absence of gout and individual amino acids were investigated by logistic regression analysis controlling for the effects of potential demographic confounders. Results Among 19 amino acids, the levels of 10 amino acids (alanine, glycine, isoleucine, leucine, methionine, phenylalanine, proline, serine, tryptophan, valine) differed significantly (P < .001 to .05) between the patient and control groups. Univariate logistic regression analysis revealed that plasma levels of alanine, isoleucine, leucine, phenylalanine, tryptophan and valine had significant positive associations (P < .005 to .05) whereas glycine and serine had significant inverse association (P < .05) with gout. Conclusions The observed significant changes in PFAA profiles may have important implications for improving our understanding of pathophysiology, diagnosis and prevention of gout. The findings of this study need further confirmation in future large-scale studies involving a larger number of patients with gout.
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Affiliation(s)
- M H Mahbub
- Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Natsu Yamaguchi
- Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hidekazu Takahashi
- Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Ryosuke Hase
- Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroki Amano
- Division of Health Administration and Promotion, Graduate School of Medicine, Tottori University, Yonago, Japan
| | | | - Hideyuki Kanda
- Department of Environmental Medicine and Public Health, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yasuyuki Fujita
- Department of Environmental Medicine and Public Health, Shimane University Faculty of Medicine, Izumo, Japan
| | | | - Mai Yamamoto
- Institute for Innovation, Ajinomoto Co. Inc, Kawasaki, Japan
| | - Shinya Kikuchi
- Institute for Innovation, Ajinomoto Co. Inc, Kawasaki, Japan
| | - Atsuko Ikeda
- Institute for Innovation, Ajinomoto Co. Inc, Kawasaki, Japan
| | - Naoko Kageyama
- Institute for Innovation, Ajinomoto Co. Inc, Kawasaki, Japan
| | - Mina Nakamura
- Institute for Innovation, Ajinomoto Co. Inc, Kawasaki, Japan
| | - Yasutaka Ishimaru
- Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hiroshi Sunagawa
- Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Tsuyoshi Tanabe
- Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
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Crystal arthritides - gout and calcium pyrophosphate arthritis : Part 2: clinical features, diagnosis and differential diagnostics. Z Gerontol Geriatr 2017; 51:579-584. [PMID: 28233118 DOI: 10.1007/s00391-017-1198-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/17/2017] [Indexed: 12/18/2022]
Abstract
Gout develops in four stages beginning with an asymptomatic increase in blood levels of uric acid. An acute gout attack is an expression of an underlying inflammatory process, which in the course of time is self-limiting. Without therapy monosodium urate crystals remain in the synovial fluid and synovial membrane and trigger more acute attacks. In the course of the disease monosodium urate crystals form deposits (tophi) leading in severe forms to irreversible joint deformities with loss of functionality. In 20% of cases gout leads to involvement of the kidneys. Overproduction of uric acid can cause nephrolithiasis. These stones can be composed of uric acid or calcium phosphate. Another form of kidney disease caused by gout is uric acid nephropathy. This is a form of abacterial chronic inflammatory response with deposition of sodium urate crystals in the medullary interstitium. Acute obstructive nephropathy is relatively rare and characterized by renal failure due to uric acid precipitation in the tubules because of rapid cell lysis that occurs, for example, with chemotherapy. There is a causal interdependence between the occurrence of hyperuricemia and hypertension. Uric acid activates the renin-angiotensin-aldosterone (RAA) system and inhibits nitric oxide (NO) with the possible consequence of a rise in systemic vascular resistance or arteriolar vasculopathy; however, uric acid is also an apparently independent risk factor for atherosclerosis. In contrast to young patients, the diagnosis of an acute gout attack in the elderly can be a challenge for the physician. Polyarticular manifestations and obscure symptoms can make it difficult to differentiate it from rheumatoid arthritis and calcium pyrophosphate deposition disease (CPPD). Aspiration of synovial fluid with visualization of urate crystals using compensated polarized light microscopy is the gold standard for diagnosis of acute gout. Moreover, analysis of synovial fluid enables a distinction from septic arthritis by Gram staining and bacterial culture. Soft tissue ultrasonography is useful to detect affected synovial tissue and monosodium urate crystals within the synovial fluid. Involvement of bone occurs relatively late in the disease so that x‑ray images are not useful in the early stages but might be helpful in differential diagnostics. Dual energy computed tomography (CT) and magnetic resonance imaging (MRI) can be used for certain indications.
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Huang Z, Hong Q, Zhang X, Xiao W, Wang L, Cui S, Feng Z, Lv Y, Cai G, Chen X, Wu D. Aldose reductase mediates endothelial cell dysfunction induced by high uric acid concentrations. Cell Commun Signal 2017; 15:3. [PMID: 28057038 PMCID: PMC5217275 DOI: 10.1186/s12964-016-0158-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 12/20/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Uric acid (UA) is an antioxidant found in human serum. However, high UA levels may also have pro-oxidant functions. According to previous research, aldose reductase (AR) plays a vital role in the oxidative stress-related complications of diabetes. We sought to determine the mechanism by which UA becomes deleterious at high concentrations as well as the effect of AR in this process. METHOD and vWF levels were measured in vivo. RESULTS production in hyperuricemic mice and protected endothelial cell function. CONCLUSIONS could protect endothelial function and maintain the antioxidant activities of UA. These findings provide new insight into the role of UA in chronic kidney disease.
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Affiliation(s)
- Zhiyong Huang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China.,Department of Nephrology, The 175th Hospital of PLA, Zhangzhou Fujian, 36300, People's Republic of China
| | - Quan Hong
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Xueguang Zhang
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Wenzhen Xiao
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Liyuan Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Shaoyuan Cui
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Zhe Feng
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Yang Lv
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Guangyan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China
| | - Di Wu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, 100853, People's Republic of China.
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Honda S, Masuda T. Identification of Pyrogallol in the Ethyl Acetate-Soluble Part of Coffee as the Main Contributor to Its Xanthine Oxidase Inhibitory Activity. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2016; 64:7743-7749. [PMID: 27680749 DOI: 10.1021/acs.jafc.6b03339] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this study, ethyl acetate-soluble parts of hot-water extracts from roasted coffee beans were found to demonstrate potent xanthine oxidase (XO) inhibition. The XO inhibitory activities and chlorogenic lactone contents (chlorogenic lactones have previously been identified as XO inhibitors in roast coffee) were measured for ethyl acetate-soluble parts prepared from coffee beans roasted to three different degrees. Although chlorogenic lactone contents decreased with higher degrees of roasting, the XO inhibitory activity did not decrease. These data led us to investigate new potent inhibitors present in these ethyl acetate-soluble extracts. Repeated assay-guided purifications afforded a highly potent XO inhibitor, which was eluted before chlorogenic lactones via medium-pressure chromatography using an octadecylsilica gel column. The obtained inhibitor was identified as pyrogallol (1,2,3-trihydroxybenzene), which had an IC50 of 0.73 μmol L-1, much stronger than that of other related polyphenolic compounds. Quantitative analysis of pyrogallol and chlorogenic lactones revealed that pyrogallol (at concentrations of 33.9 ± 4.2 nmol mL-1 in light roast coffee and 39.4 ± 3.9 nmol mL-1 in dark roast coffee) was the main XO inhibitor in hot-water extracts of roasted coffee beans (i.e., drinking coffee).
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Affiliation(s)
- Sari Honda
- Graduate School of Human Life Science, Osaka City University , Osaka 558-8585, Japan
| | - Toshiya Masuda
- Graduate School of Human Life Science, Osaka City University , Osaka 558-8585, Japan
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The management of gout in different clinical specialties in Turkey: a patient-based survey. Clin Rheumatol 2016; 35:3019-3024. [PMID: 27722972 DOI: 10.1007/s10067-016-3423-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 08/07/2016] [Accepted: 09/17/2016] [Indexed: 10/20/2022]
Abstract
Although gout is potentially curable, the management of this disease is often suboptimal. In this study, we investigated the treatment of gout in Turkey and also compared the management approaches to gout in different clinical specialties. Three hundred and nineteen consecutive patients (mean age 58.60 ± 12.8 years; 44 females, 275 males) were included in this multicenter study. A standardized form was generated to collect data about the patient's first admission to health care, the specialty of the doctor first diagnosed the gout, the treatment options for gout including attack management, patient referral, chronic treatment including medical treatment, and life style modifications. Forty patients were referred to another center without any treatment (12.8 %), and referral rate is most common among the primary care physicians (28.8 %). Colchicine was more commonly used for attack prophylaxis than allopurinol. Ninety-two patients had never been treated with allopurinol (28.8 %). Allopurinol prescription was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. Recommendation of diet and life style modifications was less common among the primary care physicians and orthopedists, and highest among the rheumatologists. The rates of life style modification recommendation and long-term allopurinol prescription were 83.7 and 77.6 %, respectively, among the rheumatologists. Both acute and chronic management of gout is suboptimal in Turkey especially among the primary care physicians and orthopedists. Moreover, chronic treatment is even suboptimal among rheumatologists.
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48
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Gout characteristics associate with depression, but not anxiety, in primary care: Baseline findings from a prospective cohort study. Joint Bone Spine 2016; 83:553-8. [DOI: 10.1016/j.jbspin.2015.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/19/2015] [Indexed: 11/20/2022]
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49
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Soldatos T, Pezeshk P, Ezzati F, Karp DR, Taurog JD, Chhabra A. Cross-sectional imaging of adult crystal and inflammatory arthropathies. Skeletal Radiol 2016; 45:1173-91. [PMID: 27209200 DOI: 10.1007/s00256-016-2402-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 02/02/2023]
Abstract
This article highlights the key aspects and current perspectives of the role of cross-sectional imaging in adult crystal and inflammatory arthropathies in adults, briefly discussing CT, and particularly focusing on MRI and US imaging as it supplements the conventional radiography. The role of conventional and advanced MR imaging techniques and imaging findings in this domain is discussed and illustrated with case examples. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article contains images and data, which were collected from patients as a part of a retrospective IRB from the institutional teaching files and informed consent was waived.
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Affiliation(s)
| | - Parham Pezeshk
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | - Fatemeh Ezzati
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David R Karp
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joel D Taurog
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA. .,Musculoskeletal Radiology, Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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50
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Dong D, Ozdemir S, Mong Bee Y, Toh SA, Bilger M, Finkelstein E. Measuring High-Risk Patients' Preferences for Pharmacogenetic Testing to Reduce Severe Adverse Drug Reaction: A Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:767-775. [PMID: 27712704 DOI: 10.1016/j.jval.2016.03.1837] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/11/2016] [Accepted: 03/10/2016] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To investigate patient preferences and willingness to pay (WTP) for a genetic test that can reduce the risk of life-threatening adverse drug reactions (ADRs). We hypothesize that test features (risk of developing the adverse reaction with and without testing, test cost, and treatment cost) and the choice context (physician recommendation and the most common choice made by peer patients) will influence choices. METHODS A discrete choice experiment was conducted in which 189 patients at high risk for gout were asked to choose between treatment options that varied along key attributes. A latent class logit model was used to analyze the choice data and test the hypotheses. RESULTS We identified two classes of patients: the risk-averse class and the cost-conscious class. The WTP to reduce the risk of life-threatening ADRs from 1 out of 600 to 1 out of 1 million was SGD1215 in the risk-averse class. In contrast, in the cost-conscious class, the WTP was insensitive to the extent of risk reduction. Overall, the predicted take-up rate for the test is 65% at a price of SGD400. If the test was recommended by a physician or was chosen by most of the patients, the take-up rate for the test would increase by 8.5 and 1.5 percentage points, respectively. CONCLUSIONS There is a potentially large demand for genetic tests that could reduce the risk of life-threatening ADRs. Physician recommendations and providing information on the choices of others are powerful influences on demand, even more so than moderate price reductions.
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Affiliation(s)
- Di Dong
- Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore; Global Health Research Center, Duke Kunshan University, Kunshan, China.
| | - Semra Ozdemir
- Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Sue-Anne Toh
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marcel Bilger
- Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Eric Finkelstein
- Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore; Duke Global Health Institute, Duke University, Durham, NC, USA
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