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Johnson RJ, Mandell BF, Schlessinger N, Mount DB, Botson JK, Abdellatif AA, Rhoades R, Singh JA. Controversies and practical management of patients with gout and chronic kidney disease. Kidney Int 2024:S0085-2538(24)00473-3. [PMID: 39033815 DOI: 10.1016/j.kint.2024.05.033] [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: 02/20/2024] [Revised: 04/05/2024] [Accepted: 05/28/2024] [Indexed: 07/23/2024]
Abstract
Uric acid is a toxin retained with advancing kidney disease. Clinical manifestations of hyperuricemia include gout and systemic inflammation that are associated with increased risk for cardiovascular mortality. As many as one third of all patients with chronic kidney disease (CKD) have a history of gout, yet <25% of these patients are effectively treated to target serum urate levels of ≤6 mg/dL. A major reason for ineffective management of gout and hyperuricemia is the complexity in managing these patients, with some medications contraindicated, others requiring special dosing, potential drug interactions, and other factors. Consequently, many nephrologists do not primarily manage gout despite it being a common complication of CKD, leaving management to the primary physician or rheumatologist. We believe that kidney specialists should consider gout as a major complication of CKD and actively manage it in their patients. Here, we present insights from nephrologists and rheumatologists on a team approach to gout management that includes the nephrologist.
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Affiliation(s)
- Richard J Johnson
- Division of Renal Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Brian F Mandell
- Department of Rheumatologic and Immunologic Disease, Cleveland Clinic Lerner College of Medicine of Case Western University
| | - Naomi Schlessinger
- Division of Rheumatology, Spencer Fox Eccles School of Medicine, University of Utah
| | - David B Mount
- Renal Divisions, Brigham and Women's Hospital and VA Boston Healthcare System, Harvard Medical School, Boston
| | | | | | | | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham.
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2
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Stamp LK, Horsley C, Te Karu L, Dalbeth N, Barclay M. Colchicine: the good, the bad, the ugly and how to minimize the risks. Rheumatology (Oxford) 2024; 63:936-944. [PMID: 38019947 PMCID: PMC10986813 DOI: 10.1093/rheumatology/kead625] [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: 09/07/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Colchicine has an important role in managing various conditions, including gout, familial Mediterranean fever, amyloidosis, Behçet's syndrome, recurrent pericarditis and calcium pyrophosphate deposition disease. The adverse effect profile of colchicine is well understood. However, due to its narrow therapeutic index, colchicine has been associated with overdose and fatalities. When ingested in toxic amounts, the mainstay of management is supportive care. Strategies to minimize the risk of colchicine poisoning can focus on three broad causes: unauthorized access, intentional overdose and inappropriate dosing. Culturally safe and appropriate education about storage and appropriate use of colchicine is essential to minimize the risk of overdose.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Carl Horsley
- Critical Care Complex, Middlemore Hospital, Auckland, New Zealand
| | - Leanne Te Karu
- Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Murray Barclay
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
- Department of Clinical Pharmacology, Te Whatu Ora, Waitaha Canterbury, New Zealand
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3
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Alunno A, Carubbi F, Ferri C. Colchicine and cardiovascular prevention. Eur J Intern Med 2024; 121:30-34. [PMID: 38171936 DOI: 10.1016/j.ejim.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/09/2023] [Accepted: 12/29/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Alessia Alunno
- University of L'Aquila, Department of Clinical Medicine, Life, Health and Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Francesco Carubbi
- University of L'Aquila, Department of Clinical Medicine, Life, Health and Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
| | - Claudio Ferri
- University of L'Aquila, Department of Clinical Medicine, Life, Health and Environmental Sciences, Internal Medicine and Nephrology Division, San Salvatore Hospital, L'Aquila, Italy
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Bausson J, Keller N, Von Hunolstein JJ, Sacrez M, Michel B, Gourieux B, Fourtage M, Felten R. Safety and efficacy of colchicine in crystal-induced arthritis flare in 54 patients with severe chronic kidney disease. RMD Open 2024; 10:e003872. [PMID: 38296804 PMCID: PMC10831468 DOI: 10.1136/rmdopen-2023-003872] [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: 11/02/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Colchicine, commonly used in gout flare, is contraindicated in severe chronic kidney disease (CKD) (estimated glomerular filtration rate <30 mL/min). However, in this context, there are few alternatives, and colchicine use persists. We evaluated the tolerance of colchicine and its efficacy in patients with severe CKD. PATIENTS AND METHODS All prescriptions of colchicine for managing crystal-induced arthritis flare (gout or calcium pyrophosphate deposition (CPPD) disease) in a hospitalised patient with severe CKD were screened from September 2020 to September 2021. After patient consent and treatment information, clinical and biological safety and efficacy data were prospectively collected from day 1 (D1) to D11. RESULTS We included 54 patients (median age 75 years (IQR 67-83)) with 62 colchicine prescriptions (cases). Twelve (22%) patients were on dialysis. The main reason for hospitalisation was heart failure (31.5%), acute renal failure (22.2%), infection (18.5%) or an acute joint episode (9.3%). In total, 59.3% of patients had diabetes. The prescriptions concerned 58 cases of gout flares, 1 case of CPPD and 3 cases of both. Initial colchicine dosages were ≤0.5 mg/day in 47/62 (75.8%) cases; no dosage exceeded 1 mg/day (median duration of 6 days (IQR 3-11)). Colchicine was well tolerated in 47/61 (77%) cases. No serious adverse event was reported. Colchicine was considered completely effective by the medical team in 48/58 (83%) of cases. CONCLUSION The use of colchicine, at reduced doses, was mostly effective to treat crystal-induced arthritis flare in 54 patients with severe CKD and was well tolerated, without any serious adverse events.
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Affiliation(s)
- Johanna Bausson
- Service de Pharmacie-Stérilisation, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Nicolas Keller
- Service de Néphrologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | | | - Matthieu Sacrez
- Service de Pharmacie-Stérilisation, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Bruno Michel
- Service de Pharmacie-Stérilisation, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Bénédicte Gourieux
- Service de Pharmacie-Stérilisation, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Marion Fourtage
- Service de Pharmacie-Stérilisation, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Renaud Felten
- Service de Rhumatologie de Hautepierre, RESO, Centre de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest, Hôpitaux universitaires de Strasbourg, Strasbourg, France
- Centre d'Investigation Clinique, Inserm 1434, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Département Universitaire de Pharmacologie, Addictologie, Toxicologie et Thérapeutique (DUPATT), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Wang J, Hao P, Sun X, Ward R, Tang T, Chen X, Liu Y, Luo G, Yang Y, Xiang C, An S, Xu TR. New animal model of chronic gout reproduces pathological features of the disease in humans. RMD Open 2023; 9:e003499. [PMID: 37973536 PMCID: PMC10660916 DOI: 10.1136/rmdopen-2023-003499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES Gout, as the most prevalent form of inflammatory arthritis, necessitates the use of animal models to investigate the molecular mechanisms involved in its development. Therefore, our objective was to develop a novel chronic mouse model of gout that more closely mimics the progression of gout in humans. METHODS A novel chronic mouse model of gout was established by a simple method, which does not require high technical proficiency, predominantly involves daily intraperitoneal injections of potassium oxonate for approximately 4 months, combined with a high fat-diet and injections of acetic acid into the hind paws to facilitate the formation of monosodium urate (MSU). Arthritis scores and paw oedema were assessed, behavioural tests were conducted, and histopathological and imaging evaluations of the arthritic paw joints were performed. RESULTS After 4 months of induction, mice in the model group exhibited noticeable increases in arthritis severity, joint and cartilage damage, as well as bone erosion. Gomori's methenamine silver stain revealed the presence of MSU crystal deposition or tophi in the paw joints or ankle joints of up to 37.9% of the model mice (11 out of 29 mice). Moreover, treatment with benzbromarone effectively prevented the further development of gout or tophi formation in model mice. CONCLUSIONS Our model more accurately replicates the pathological features of gouty arthritis compared with gout induced by MSU crystal injections. Therefore, it is particularly suitable for further investigations into the pathogenesis of gout and also serves as a valuable platform for screening potential antigout agents.
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Affiliation(s)
- Jiwei Wang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Peiqi Hao
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xianrun Sun
- Department of Orthopedic Surgery, Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Richard Ward
- Centre for Translational Pharmacology, Institute of Molecular Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Tao Tang
- Medical School, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xi Chen
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yihong Liu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Guancong Luo
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yang Yang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Cheng Xiang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Su An
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Tian-Rui Xu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
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Kannuthurai V, Gaffo A. Management of Patients with Gout and Kidney Disease: A Review of Available Therapies and Common Missteps. KIDNEY360 2023; 4:e1332-e1340. [PMID: 37526648 PMCID: PMC10550007 DOI: 10.34067/kid.0000000000000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
Gout, a common form of inflammatory arthritis, is characterized by deposition of monosodium urate crystals in articular and periarticular tissues. Repeated flares of gout cause joint damage as well as significant health care utilization and decreased quality of life. Patients with CKD have a higher prevalence of gout. Treating Patients with CKD and gout is challenging because of the lack of quality data to guide management in this specific population. This often leads to suboptimal treatment of patients with gout and impaired renal function because concerns regarding the efficacy and safety of available gout therapies in this population often result in significant interphysician variability in treatment regimens and dosages. Acute gout flares are treated with various agents, including nonsteroidal anti-inflammatory drugs, colchicine, glucocorticoids, and-more recently-IL-1 inhibitors. These medications can also be used as prophylaxis if urate-lowering therapy (ULT) is initiated. While these drugs can be used in patients with gout and CKD, there are often factors that complicate treatment, such as the numerous medication interactions involving colchicine and the effect of glucocorticoids on common comorbidities, such as diabetes and hypertension. ULT is recommended to treat recurrent flares, tophaceous deposits, and patients with moderate-to-severe CKD with a serum urate goal of <6 mg/dl recommended to prevent flares. While many misconceptions exist around the risks of using urate-lowering agents in patients with CKD, there is some evidence that these medications can be used safely in Patients with renal impairment. Additional questions exist as to whether gout treatment is indicated for Patients on RRT. Furthermore, there are conflicting data on whether ULT can affect renal function and cardiovascular disease in patients. All of these factors contribute to the unique challenges physicians face when treating patients with gout and CKD.
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Affiliation(s)
- Vijay Kannuthurai
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Angelo Gaffo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Birmingham VA Medical Center, Birmingham, Alabama
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7
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Stamp LK, Gaffo A. What future do biological therapies have in the treatment of gout? Expert Opin Biol Ther 2023; 23:1151-1154. [PMID: 37860846 DOI: 10.1080/14712598.2023.2273936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Angelo Gaffo
- Division of Rheumatology and Clinical Immunology, University of Alabama, Birmingham, USA
- Birmingham VA Medical Center, Birmingham, USA
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8
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Anders HJ, Li Q, Steiger S. Asymptomatic hyperuricaemia in chronic kidney disease: mechanisms and clinical implications. Clin Kidney J 2023; 16:928-938. [PMID: 37261000 PMCID: PMC10229286 DOI: 10.1093/ckj/sfad006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 10/19/2023] Open
Abstract
Asymptomatic hyperuricaemia (HU) is considered a pathogenic factor in multiple disease contexts, but a causative role is only proven for the crystalline form of uric acid in gouty arthritis and urate nephropathy. Epidemiological studies document a robust association of HU with hypertension, cardiovascular disease (CVD) and CKD progression, but CKD-related impaired uric acid (UA) clearance and the use of diuretics that further impair UA clearance likely accounts for these associations. Interpreting the available trial evidence is further complicated by referring to xanthine oxidase inhibitors as urate-lowering treatment, although these drugs inhibit other substrates, so attributing their effects only to HU is problematic. In this review we provide new mechanistic insights into the biological effects of soluble and crystalline UA and discuss clinical evidence on the role of asymptomatic HU in CKD, CVD and sterile inflammation. We identify research areas with gaps in experimental and clinical evidence, specifically on infectious complications that represent the second common cause of death in CKD patients, referred to as secondary immunodeficiency related to kidney disease. In addition, we address potential therapeutic approaches on how and when to treat asymptomatic HU in patients with kidney disease and where further interventional studies are required.
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Affiliation(s)
- Hans-Joachim Anders
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Qiubo Li
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Stefanie Steiger
- Division of Nephrology, Department of Medicine IV, Hospital of the Ludwig-Maximilians University, Munich, Germany
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9
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Pirmohammadi Y, Asnaashari S, Nazemiyeh H, Hamedeyazdan S. Bioactivity assays and phytochemical analysis upon Alcea glabrata; focusing on xanthine oxidase inhibitory and antimalarial properties. Toxicon 2023; 229:107140. [PMID: 37119859 DOI: 10.1016/j.toxicon.2023.107140] [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: 03/06/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/01/2023]
Abstract
Alcea glabrata from the family Malvaceae, was selected for evaluating its xanthine oxidase inhibitory, anti-malarial, and antioxidant activities. In addition, some phytochemical analysis upon different extracts of A. glabrata were performed. Aerial parts of the collected A. glabrata plant material were dried and solvent extracted via soxhlet apparatus using different solvents. Various chromatographic techniques were used for extra fractionation of the achieved extracts. Xanthine oxidase (XO) inhibitory, antimalarial and antioxidant activity assays upon different A. glabrata extracts and fractions were carried out and reported in terms of IC50s. Total phenolic and flavonoid contents of the A. glabrata methanol extract (MeOH) were determined using the 2,2-Di Phenyl-1-Picryl Hydrazyl (DPPH) assay, aluminum chloride colorimetric, and Folin-Ciocalteu reagents, respectively. In addition, A. glabrata essential oil was obtained through hydrodistillation by a Clevenger apparatus. Analysis and identification of essential oil compounds were carried out through gas chromatography mass spectrometry (GC-MS) analysis. MeOH extract showed the highest XO inhibitory activity with the IC50 of 0.37 ± 0.12 μg/mL antioxidant activity with the RC50 of 0.24 ± 0.06 μg/mL. While, chloroform extract revealed the strongest antimalarial activity with the IC50 of 0.4 ± 0.05 μg/mL. The total flavonoid and phenolic contents of the A. glabrata methanol extract were 39.8 mg quercetin equivalent and 6.1 g gallic acid equivalent per 100 g of dry plant material, respectively. GC-MS analysis showed that the monoterpenes were prevailing in A. glabrata essential oil where the major constituents: octacosane (30.7%), eugenol (12.3%), and anethole (12.0%). Concerning the results of this study, A. glabrata extracts and its ingredients could be considered as a novel promising herbal medicine in the design and also treatment of new drugs for the relief of gout and malaria diseases.
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Affiliation(s)
- Yalda Pirmohammadi
- Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Solmaz Asnaashari
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Nazemiyeh
- Research Center for Pharmaceutical Nanotechnology, Tabriz University of Sciences, Tabriz, Iran
| | - Sanaz Hamedeyazdan
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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10
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Harty T, O'Shaughnessy M, Harney S. Therapeutics in rheumatology and the kidney. Rheumatology (Oxford) 2023; 62:1009-1020. [PMID: 35951751 DOI: 10.1093/rheumatology/keac460] [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: 03/21/2022] [Revised: 07/08/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
The field of rheumatology has advanced significantly in recent years to provide rheumatologists with an extensive array of medications to combat rheumatic joint conditions. In contrast to an older era, when NSAIDs and other nephrotoxic agents were the mainstay of treatment, modern DMARDs vary considerably in their nephrotoxic potential and their use is not always precluded in populations with pre-existing chronic kidney disease (CKD). This review will explore in detail the safety and efficacy profiles of medications used to treat rheumatologic disease, specifically in the setting of CKD. Specifically, we discuss both traditional agents used, i.e. NSAIDs, CSs and conventional synthetic DMARDs, as well as novel biologic DMARDs and targeted synthetic DMARDs. Anti-gout prescribing in CKD is also reviewed. We aim to provide practical guidance to rheumatologists, nephrologists and general physicians when prescribing these medications in the setting of CKD.
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Affiliation(s)
| | | | - Sinead Harney
- School of Medicine, University College Cork.,Department of Rheumatology, Cork University Hospital, Cork, Ireland
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11
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Lee ZC, Santosa A, Khor AYK, Sriranganathan MK. The Singapore Experience With Uncontrolled Gout: Unmet Needs in the Management of Patients. Cureus 2023; 15:e36682. [PMID: 36987445 PMCID: PMC10039979 DOI: 10.7759/cureus.36682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Gout is the most common type of inflammatory arthritis, and its impact on cardiovascular health and quality of life is often underestimated. The prevalence and incidence of gout are increasing globally. Further, ischemic heart disease (IHD) and chronic kidney disease (CKD) are prevalent in gout patients. Some unmet needs for gout management include physicians' low initiation rate of urate-lowering therapy (ULT) and poor treatment adherence in patients with gout. There is also a lack of randomized controlled trials that establish safe doses of acute and long-term treatment for gout, particularly in patients with IHD and stage 4 CKD and above (including end-stage renal failure). Furthermore, there is also a lack of studies showing optimal serum uric acid (SUA) target and validated clinical outcome measures, including disease activity and remission criteria for gout tailored to treat-to-target approaches and the high cost of newer gout medications. The causal relationship between asymptomatic hyperuricemia or gout with comorbidities such as IHD and CKD has yet to be fully elucidated. There is a pressing need for collaborative international efforts to address the overall suboptimal management of gout.
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12
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Jeria-Navarro S, Gomez-Gomez A, Park HS, Calvo-Aranda E, Corominas H, Pou MA, Diaz-Torne C. Effectiveness and safety of anakinra in gouty arthritis: A case series and review of the literature. Front Med (Lausanne) 2023; 9:1089993. [PMID: 36714095 PMCID: PMC9877612 DOI: 10.3389/fmed.2022.1089993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Background Gout is the most common type of inflammatory arthritis. Nonsteroidal anti-inflammatory drugs, corticosteroids, and colchicine are the first-line agents, although they are contraindicated in many patients. Blockade of IL-1 with anakinra can be an alternative. Objective To present a case series of 10 difficult-to-treat gout patients treated with anakinra and perform a scoping review of the effectiveness and safety of anakinra in gout patients. Methods A total of 1,519 citations were screened. The reviewers ran a two-stage screening process by title/abstract and full-text reading. Thirty-eight articles finally met the selection criteria and were included for data extraction and synthesis. Experience in difficult-to treat and complex clinical scenarios, such as active infection, hemodialysis, and transplantation, were specifically described. Results The study sample comprised 551 patients, from whom 648 flares were finally analyzed. The mean age was 57.9 years, and 82.9% were men. The clinical presentation was polyarticular in 47.5% and tophaceous in 66.9%. Sixty-five patients with an active infection, 41 transplanted patients and 14 in haemodyalisis treated with anakinra are described. More than half of the patients had >1 associated comorbidity. Anakinra was effective both for flares (94%) and for long-term treatment (91%) and well tolerated. In the case of flares, 34 (6.7%) adverse effects were registered. Adverse events were more prevalent in long-term treatment. Conclusion Anakinra was effective and safe for management of gout flares in difficult-to-treat patients. It has been used in multiple complex scenarios, such as active infections, dialysis, transplantation, chronic kidney disease, and polyarticular gout. Anakinra has also proven effective as long-term treatment, although there are more concerns about its safety.
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Affiliation(s)
- Sicylle Jeria-Navarro
- Rheumatology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alejandro Gomez-Gomez
- Rheumatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain,Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain
| | - Hye Sang Park
- Rheumatology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Enrique Calvo-Aranda
- Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain,Rheumatology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Hector Corominas
- Rheumatology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Cesar Diaz-Torne
- Rheumatology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain,Crystal-induced Arthritis Study Group, Spanish Society of Rheumatology (GEACSER), Madrid, Spain,*Correspondence: Cesar Diaz-Torne ✉
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13
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Park EH, Choi ST, Song JS. Current state and prospects of gout treatment in Korea. Korean J Intern Med 2022; 37:719-731. [PMID: 35811361 PMCID: PMC9271716 DOI: 10.3904/kjim.2022.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022] Open
Abstract
Effective management of gout includes the following: appropriate control of gout flares; lifestyle modifications; management of comorbidities; and long-term urate-lowering therapy (ULT) to prevent subsequent gout flares, structural joint damage, and shortening of life expectancy. In addition to traditional treatments for gout, novel therapies have been introduced in recent years. Indeed, new recommendations for the management of gout have been proposed by various international societies. Although effective and safe medications to treat gout have been available, management of the disease has continued to be suboptimal, with poor patient adherence to ULT and failure to reach serum urate target. This review outlines recent progress in gout management, mainly based on the latest published guidelines, and specifically provides an update on efficient strategies for implementing treatment, efficacy and safety of specific medications for gout, and cardiovascular outcomes of ULT. In particular, we reviewed gout management approaches that can be applied to a Korean population.
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Affiliation(s)
- Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sang Tae Choi
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jung Soo Song
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
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Cai JR, Chen XW, He YJ, Wu B, Zhang M, Wu LH. Washed microbiota transplantation reduces serum uric acid levels in patients with hyperuricaemia. World J Clin Cases 2022; 10:3401-3413. [PMID: 35611199 PMCID: PMC9048544 DOI: 10.12998/wjcc.v10.i11.3401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/08/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous studies have found that hyperuricaemia (HUA) is closely related to intestinal flora imbalance.
AIM The current study investigated the effects and safety of washed microbiota transplantation (WMT) on serum uric acid (SUA) levels in different populations.
METHODS A total of 144 patients who received WMT from July 2016 to April 2020 in the First Affiliated Hospital of Guangdong Pharmaceutical University and had SUA data before treatment were selected. Changes in SUA levels before and after treatment were retrospectively reviewed based on short-term and mid-term effects of WMT regimens. SUA levels measured in the last test within 3 mo after the first WMT represented the short-term effect, and SUA levels measured in the last test within 3-6 mo after the first WMT represented the mid-term effect. The patients were divided into an HUA group (SUA > 416 μM) and a normal uric acid (NUA) group (SUA ≥ 202 μM to ≤ 416 μM) based on pretreatment SUA levels.
RESULTS Average short-term SUA levels in the HUA group decreased after WMT (481.00 ± 99.85 vs 546.81 ± 109.64 μM, n = 32, P < 0.05) in 25/32 patients and returned to normal in 10/32 patients. The short-term level of SUA reduction after treatment moderately correlated with SUA levels before treatment (r = 0.549, R² = 0.300, P < 0.05). Average SUA levels decreased after the first and second courses of WMT (469.74 ± 97.68 vs 540.00 ± 107.16 μM, n = 35, and 465.57 ± 88.88 vs 513.19 ± 78.14 μM, n = 21, P < 0.05). Short-term and mid-term SUA levels after WMT and SUA levels after the first, second and third courses of WMT were similar to the levels before WMT in the NUA group (P > 0.05). Only 1/144 patients developed mild diarrhea after WMT.
CONCLUSION WMT reduces short-term SUA levels in patients with HUA with mild side effects but has no obvious effect on SUA levels in patients with NUA.
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Affiliation(s)
- Jin-Rong Cai
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510030, Guangdong Province, China
| | - Xin-Wen Chen
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510030, Guangdong Province, China
| | - Yu-Jian He
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510030, Guangdong Province, China
| | - Bin Wu
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510030, Guangdong Province, China
| | - Min Zhang
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou 510220, Guangdong Province, China
| | - Li-Hao Wu
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510030, Guangdong Province, China
- Research Center, Engineering Techniques of Microbiota-Targeted Therapies of Guangdong Province, Guangzhou 510030, Guangdong Province, China
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Xi S, ZhiguoShao, Li L, Gui Z, Liu P, Jiang Q, Yu Y, Zhou W, Zhou Z, Zhang S, Peng XC, Su B. Tongbixiao Pills Improve Gout by Reducing Uric Acid Levels and Inhibiting Inflammation. Dose Response 2022; 20:15593258221090340. [PMID: 35431698 PMCID: PMC9005743 DOI: 10.1177/15593258221090340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gout is a chronic disease. Gout symptoms are often experienced in the middle of the night. The onset of gout in the middle of the night is closely related to abnormal liver and gallbladder meridian. The purpose of this study was to investigate the clinical efficacy and possible mechanism of action of Tongbixiao pills in the treatment of hyperuricemia and gouty arthritis. The Tongbixiao pills we used included several traditional Chinese medicines, most of which tonify the spleen; strengthen the liver; benefit the kidney; and reduce heat, dampness, and blood stasis. In this randomized clinical study of 105 patients, we found that Tongbixiao pills can reduce uric acid levels in hyperuricemia patients. Additionally, the efficacy was similar to that of allopurinol and the level of uric acid did not increase significantly at eight weeks after withdrawal. In the absence of notable adverse reactions, Tongbixiao pills can also increase uric acid excretion, reduce serum creatinine and lipid levels, and reduce inflammation and relieve gout symptoms. In addition, we used SD rats to simulate gout and arthritis and divided them into five groups: normal group, model group, low-dose group, medium-dose group, and high-dose group. The inflammatory indices of the 40 SD rats were observed. After seven days, ankle swelling in rats in the treatment group was significantly reduced. The indices of uric acid, creatinine, and urea nitrogen in the treatment group were significantly lower than those in the model group, which proved that Tongbixiao pills could inhibit hyperuricemia in rats, thus treating gout. This study demonstrates that Tongbixiao pills can treat gout, provide more treatment options for gouty arthritis, and improve the quality of life of patients.
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Affiliation(s)
- Shijun Xi
- Department of Pathophysiology, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
- Laboratory of Oncology, Center for Molecular Medicine, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
| | - ZhiguoShao
- Jingzhou Hospital of Traditional Chinese Medicine, Yangtze University Third Clinical Medical College, Jingzhou, Hubei, China
| | - Lu Li
- Jingzhou Second People’s Hospital, Jingzhou, Hubei, China
| | - Zhuang Gui
- Jingzhou Hospital of Traditional Chinese Medicine, Yangtze University Third Clinical Medical College, Jingzhou, Hubei, China
| | - Peng Liu
- Jingzhou Hospital of Traditional Chinese Medicine, Yangtze University Third Clinical Medical College, Jingzhou, Hubei, China
| | - Qi Jiang
- Jingzhou Hospital of Traditional Chinese Medicine, Yangtze University Third Clinical Medical College, Jingzhou, Hubei, China
| | - Yuan Yu
- Jingzhou Hospital of Traditional Chinese Medicine, Yangtze University Third Clinical Medical College, Jingzhou, Hubei, China
| | - Wen Zhou
- Department of Pathophysiology, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
- Laboratory of Oncology, Center for Molecular Medicine, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
| | - Ziqi Zhou
- Department of Pathophysiology, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
- Laboratory of Oncology, Center for Molecular Medicine, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
| | - Shuo Zhang
- Department of Pathophysiology, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
- Laboratory of Oncology, Center for Molecular Medicine, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
| | - Xiao Chun Peng
- Department of Pathophysiology, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
- Laboratory of Oncology, Center for Molecular Medicine, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
| | - Bo Su
- Department of Pathology, School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou, Hubei, China
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16
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OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:4314-4323. [DOI: 10.1093/rheumatology/keac077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/04/2022] [Indexed: 11/13/2022] Open
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17
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Absalón-Aguilar A, Rull-Gabayet M, Pérez-Fragoso A, Mejía-Domínguez NR, Núñez-Álvarez C, Kershenobich-Stalnikowitz D, Sifuentes-Osornio J, Ponce-de-León A, González-Lara F, Martín-Nares E, Montesinos-Ramírez S, Ramírez-Alemón M, Ramírez-Rangel P, Márquez MF, Plata-Corona JC, Juárez-Vega G, Gómez-Martín D, Torres-Ruiz J. Colchicine Is Safe Though Ineffective in the Treatment of Severe COVID-19: a Randomized Clinical Trial (COLCHIVID). J Gen Intern Med 2022; 37:4-14. [PMID: 34755269 PMCID: PMC8577644 DOI: 10.1007/s11606-021-07203-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colchicine is an available, safe, and effective anti-inflammatory drug and has been suggested as a COVID-19 treatment, but its usefulness in hospitalized severe COVID-19 patients has not been thoroughly demonstrated. OBJECTIVE To address the safety and efficacy of colchicine in hospitalized patients with severe COVID-19. DESIGN We conducted a triple-blind parallel non-stratified placebo-controlled clinical trial. PARTICIPANTS We recruited 116 hospitalized patients with severe COVID-19 in Mexico. INTERVENTIONS Patients were randomized to receive 1.5 mg of colchicine or placebo at the time of the recruitment in the study (baseline) and 0.5 mg BID PO to complete 10 days of treatment. MAIN MEASURES The primary composite outcome was the progression to critical disease or death. Besides, we evaluated immunological features at baseline and after recovery or disease progression in 20 patients. KEY RESULTS Fifty-six patients were allocated to colchicine and 60 patients received placebo. The study was suspended after the second interim analysis demonstrated colchicine had no effect on the primary outcome (OR 0.83, 95%CI 0.35-1.93, P = 0.67), nor in the days of ICU and hospital stays. Adverse events were similar between groups (OR 1.63, 95% CI 0.66-3.88, P = 0.37). After colchicine treatment, patients had higher BUN and lower serum levels of IL-8, IL-12p70, and IL-17A. CONCLUSIONS Colchicine is safe but not effective in the treatment of severe COVID-19. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04367168.
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Affiliation(s)
- Abdiel Absalón-Aguilar
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
| | - Marina Rull-Gabayet
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
| | - Alfredo Pérez-Fragoso
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
| | - Nancy R. Mejía-Domínguez
- Bioinformatics, Biostatistics and Computational Biology Unit, Red de apoyo a la investigación Coordinación de Investigación Científica, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos Núñez-Álvarez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
| | | | - José Sifuentes-Osornio
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fernanda González-Lara
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eduardo Martín-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
| | - Sharon Montesinos-Ramírez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
| | - Martha Ramírez-Alemón
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
| | - Pamela Ramírez-Rangel
- Department of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Manlio F. Márquez
- Department of Clinical Investigation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Guillermo Juárez-Vega
- Flow Cytometry Unit, Red de Apoyo a La Investigacion, Coordinacion de Investigacion Cientifica, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Diana Gómez-Martín
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
- Flow Cytometry Unit, Red de Apoyo a La Investigacion, Coordinacion de Investigacion Cientifica, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Jiram Torres-Ruiz
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Sección XVI, Tlalpan, Mexico City, Mexico
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18
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Mei Y, Dong B, Geng Z, Xu L. Excess Uric Acid Induces Gouty Nephropathy Through Crystal Formation: A Review of Recent Insights. Front Endocrinol (Lausanne) 2022; 13:911968. [PMID: 35909538 PMCID: PMC9329685 DOI: 10.3389/fendo.2022.911968] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/21/2022] [Indexed: 12/18/2022] Open
Abstract
Uric acid (UA) is the final product of purine metabolism in the human body, and impaired purine metabolism can increase the uric acid in serum, finally resulting in hyperuricemia (HUA). Current evidences suggest that urates might have antioxidant properties under certain circumstances, but most evidences suggest that urates promote inflammation. Hyperuricemia leads to the formation of urate crystals, which might be recognized as a red flag by the immune system. Such a response stimulates macrophage activation, leads to the activation of NOD-like receptor protein 3 (NLRP3) inflammasome vesicles, and ultimately the production and liberation of interleukin-1b (IL-1b) and interleukin-18 (IL-18), which can mediate inflammation, apoptosis and necroinflammation and cause an inflammatory cascade response. The kidney is one of the most commonly affected organs in HUA, which promotes the development of chronic kidney disease (CKD) by damaging endothelial cells, activating the renin-angiotensin system (RAS), and promoting inflammatory responses. Pharmacological interventions and lifestyle modifications are the primary means for controlling gout and lowering UA. The febuxostat is safe for CKD patients in the UA lowering therapy. Although dialysis can reduce UA levels, the application of drug is also necessary for dialysis patients. This article reviews the synthesis and metabolism of UA, etiology of HUA, the relationship between HUA and kidney disease, the treatment of gout and gouty nephropathy (GN).
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19
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Abstract
The purpose of gout treatment is to alleviate symptoms of flares, prevent flares from recurring by lowering serum urate, and minimize structural joint damage and functional impairment. In recent years, several new medications to treat gout have been developed, and novel agents continue to be investigated, in addition to several long-established treatments. Although a number of effective therapies are available, optimal management and outcomes are frequently not achieved due to physician under prescribing of urate-lowering therapy (ULT) and poor adherence with therapy when it is prescribed. This article reviews recent developments in the management of gout with reference to recently published clinical guidelines, outlines some important questions regarding the safety and efficacy of particular agents, and remaining gaps in our knowledge about the most effective strategies for using currently available treatments.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Hamish Farquhar
- Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
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20
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Stamp LK, Farquhar H, Pisaniello HL, Vargas-Santos AB, Fisher M, Mount DB, Choi HK, Terkeltaub R, Hill CL, Gaffo AL. Management of gout in chronic kidney disease: a G-CAN Consensus Statement on the research priorities. Nat Rev Rheumatol 2021; 17:633-641. [PMID: 34331037 PMCID: PMC8458096 DOI: 10.1038/s41584-021-00657-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/08/2022]
Abstract
Gout and chronic kidney disease (CKD) frequently coexist, but quality evidence to guide gout management in people with CKD is lacking. Use of urate-lowering therapy (ULT) in the context of advanced CKD varies greatly, and professional bodies have issued conflicting recommendations regarding the treatment of gout in people with concomitant CKD. As a result, confusion exists among medical professionals about the appropriate management of people with gout and CKD. This Consensus Statement from the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) discusses the evidence and/or lack thereof for the management of gout in people with CKD and identifies key areas for research to address the challenges faced in the management of gout and CKD. These discussions, which address areas for research both in general as well as related to specific medications used to treat gout flares or as ULT, are supported by separately published G-CAN systematic literature reviews. This Consensus Statement is not intended as a guideline for the management of gout in CKD; rather, it analyses the available literature on the safety and efficacy of drugs used in gout management to identify important gaps in knowledge and associated areas for research.
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Affiliation(s)
| | | | - Huai Leng Pisaniello
- Discipline of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ana B Vargas-Santos
- Department of Internal Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Mark Fisher
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
- Prima CARE, Fall River, MA, USA
| | - David B Mount
- Renal Divisions, Brigham and Women's Hospital, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Hyon K Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Terkeltaub
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Catherine L Hill
- Discipline of Medicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Angelo L Gaffo
- University of Alabama at Birmingham, Birmingham, AL, USA
- Birmingham VA Medical Center, Birmingham, AL, USA
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