allopurinol and Arthritis--Gouty

The purpose of this study was to explore the effects of nanoparticles on gouty arthritis, and to provide evidence for the preclinical application of nanoparticles in gouty arthritis and ideas for nanomedicine improvement for nanoparticle researchers.. Five databases including the Cochrane Library, PubMed, Scopus, Web of Science, and Embase were searched for eligible studies until April 2022. The quality of the selected studies was assessed by SYRCLE's risk of bias (RoB) tool, and the random-effects model was used to calculate the overall effect sizes of weighted mean differences (WMD).. Ten studies met the inclusion criteria. Results showed that nanoparticles were effective in reducing uric acid levels (WMD: -4.91; 95% confidence interval (CI): - 5.41 to - 4.41; p < 0.001), but were not better than allopurinol (WMD: -0.20; 95% CI: - 0.42 to 0.02; p = 0.099). It was worth noting that the nanoparticles were safer than allopurinol. Subgroup analyses indicated that nanoparticle encapsulated substance, animal species, nanoparticle dosage, animal quantity, and animal gender were all sources of heterogeneity.. The nanoparticles are safe medications for gouty arthritis which can effectively reduce uric acid levels in rodents. Although the results are still uncertain, it is expected to have certain clinical application value. The nanoparticles may be the preclinical medications for gouty arthritis in the future.

Topics: Allopurinol; Animals; Arthritis, Gouty; Nanoparticles; Uric Acid

Gout, the most common inflammatory arthritis worldwide, is an auto-inflammatory metabolic disease that leads to monosodium urate crystal deposition. Hyperuricaemia is a significant risk factor for the development of gout; however, hyperuricaemia alone is not sufficient to induce gout.Gout flares have circadian rhythms. Gout flares vary during the day and have strong seasonality, with flares being more common in the spring. The reasons for the predominance of flares in the spring are unclear since serum urate (SU) levels show seasonal variation; however, SU levels are highest in the summer.Immune function varies significantly throughout the year, with enhanced immune responses increasing during the winter. In addition, chronic disruption of circadian rhythms is associated with metabolic syndrome and diseases driven by metabolism. The most telling example relates to Xanthine oxidase (XOD/XDH). The analysis of XOD/XDH established its circadian regulation and demonstrated that inhibition of the activity of XOD is characterised by distinct, crossregulating diurnal/seasonal patterns of activity.The gastrointestinal microbiota of gout patients is highly distinct from healthy individuals. In a small series of gout patients, Bacteroides caccae and Bacteroides xylanisolvens were found to be enriched. Bacteroidales levels were highest during the spring and summer, and loading values were highest in the spring.Our review discusses gout's circadian rhythm and seasonality, possible influences of the microbiome on gout due to our new knowledge that Bacteroidales levels were highest during spring when gout is most common, and potential opportunities for treatment based on our current understanding of this interaction.

Topics: Arthritis, Gouty; Gout; Gout Suppressants; Humans; Hyperuricemia; Microbiota; Symptom Flare Up; Uric Acid; Xanthine Oxidase

Hyperuricaemia is characterised by a high level of urate in the blood. The crystallisation of urate is considered a critical risk factor for the development of gout. Allopurinol and febuxostat have been commonly used medications to decrease the circulating urate levels. However, the use of these drugs is associated with undesired side effects. Therefore, the development of a new active, safety anti-hyperuricaemic and anti-inflammatory drug could be useful in gout therapy and is highly justified. Natural products have become a source of new pharmaceuticals due to their strong efficacy with less side effects, which relies on the comprising of complex bioactive compounds. There are a growing number of studies purporting decreasing serum urate with traditional medicines. This article was aimed to review these studies and identify which extracts promote urate reduction, along with their different mechanisms.

Topics: Animals; Anti-Inflammatory Agents; Arthritis, Gouty; Asteraceae; Biological Products; Double-Blind Method; Gout; Humans; Hyperuricemia; Inflammation; Mice; Placebos; Plant Extracts; Randomized Controlled Trials as Topic; Risk Factors; Tabebuia; Uric Acid; Xanthine Oxidase

Inflammation induced by urate deposition in joints causes gout. Healthy individuals maintain serum levels of urate by balancing urate production/excretion, whereas a production/excretion imbalance increases urate levels. Hyperuricemia is diagnosed when the serum urate level is continuously above 7 mg/dl as the solubility limit, and urate accumulates in the kidneys and joints. Because hyperuricemia increases the risk of gout, therapies aim to eliminate urate deposition to prevent gouty arthritis and kidney injury.. This review discusses the mechanism underlying hyperuricemia with respect to urate production and urate transport, along with urate-lowering therapeutics, including urate synthesis inhibitors, uricolytic enzymes, and uricosuric agents. The authors asses published data on relevant commercial therapy development projects and clinical trials.. Available treatment options for hyperuricemia are limited. Allopurinol, a urate synthesis inhibitor, is generally administered at a reduced dosage to patients with renal impairment. Some URAT1 inhibitors have an unfavorable side effect profile. A promising strategy for treatment is the use of uricosuric agents that inhibit transporters (e.g. URAT1, URATv1/GLUT9, OAT10) which reabsorb urate from the urine.

Topics: Allopurinol; Arthritis, Gouty; Drug Discovery; Gout; Gout Suppressants; Humans; Hyperuricemia; Uric Acid

To determine if urate-lowering treatment (ULT) in gout can reduce cardiovascular (CV) outcomes.. Randomized trials were searched for treatment with ULT in gout. Eligible trials had to report CV safety of a ULT. Potential medications included allopurinol, febuxostat, pegloticase, rasburicase, probenecid, benzbromarone, sulphinpyrazone, losartan, fenofibrate and sodium-glucose linked transporter 2 inhibitors.. A total of 3084 citations were found, with 642 duplicates. After the primary screen, 35 studies were selected for review. Several trials did not report CV events. Six were not randomized controlled trials (RCTs). Four studies reported no events in either intervention arm while the other four had 40 events in the febuxostat group ( n = 3631) and 5 in allopurinol group ( n = 1154). Overall, the pooled analysis did not show a significant difference between the two [febuxostat vs allopurinol: relative risk (RR) 1.69 (95% CI 0.54, 5.34), P = 0.37]. CV events did not decrease over time. Comparing shorter studies (<52 weeks) to longer ones did not reveal any statistical differences. However, in long-term studies with febuxostat vs allopurinol, results were nearly significant, with more CVE occurring with febuxostat treatment. Comparing any ULT to placebo (eight studies, n = 2221 patients) did not demonstrate a significant difference in non-Anti-Platelet Trialists' Collaboration events [any ULT vs placebo: RR 1.47 (95% CI 0.49, 4.40), P = 0.49] or all-cause mortality [any ULT vs placebo: RR 1.45 (95% CI 0.35, 5.77), P = 0.60].. RCT data do not suggest differences in CV events among ULTs in gout. Trials had few events despite high-risk patients being enrolled and may have been too short to show CV reduction by controlling inflammatory attacks and lowering uric acid.

Topics: Adult; Allopurinol; Arthritis, Gouty; Cardiovascular Diseases; Chronic Disease; Febuxostat; Female; Gout; Gout Suppressants; Humans; Male; Middle Aged; Polyethylene Glycols; Prognosis; Randomized Controlled Trials as Topic; Treatment Outcome; Urate Oxidase

Gouty arthritis is one of the most common rheumatic diseases. The clinical burden of gouty arthritis has historically been well recognized; however, gout is often misdiagnosed and mismanaged. The prevalence of gout is rising and is likely attributed to several factors including increased incidence of comorbidities, lifestyle factors, and increased use of causative medications. With the increasing prevalence, there have been several innovations and evidence-based updates related to the diagnosis and management of gout. Acute gouty arthritis should be treated with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents. Xanthine oxidase inhibitor therapy remains the consensus first-line treatment option for the prevention of recurrent gout. Add-on therapies that reduce serum urate concentration include traditional uricosuric agents and a novel uric acid reabsorption inhibitor. Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months. In this review, we discuss the epidemiology and risk factors for gouty arthritis and evaluate diagnostic strategies and therapeutic regimens for the management of gout, including a new drug approval.

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Gout; Humans; Hyperuricemia; Uric Acid; Xanthine Oxidase

Topics: Allopurinol; Arthritis, Gouty; Chronic Disease; Diet Therapy; Female; Gout; Health Care Costs; Humans; Incidence; Male; Needs Assessment; Patient Care Planning; Prognosis; Risk Assessment

Gout, the most common of the crystal arthritides is a result of disturbed uric acid metabolism and precipitation of urate crystals in extra cellular space of joints, periarticular tissue, bones and other organs. In the West, gout affects around 1% of adult men over 45 years of age. The estimated incidence being 0.6 to 2.1 per 1000 per year, with a prevalence of 9.5 to 13.5 per 1000 persons of all ages.1 The incidence of gout has been on rise globally; potentially attributable to recent shifts in diet, lifestyle, medical care, and increased longevity.2 Gout is three to four times more common in males than in pre-menopausal females; incidence in women increases after menopause and after the age of 60, approaches that in men.3 This update aims to highlight recent developments in understanding pathogenesis of gout along with current management strategies.

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Arthritis, Gouty; Colchicine; Diet, Healthy; Febuxostat; Fluid Therapy; Gout Suppressants; Humans; Hyperuricemia; Inflammation; Interleukin 1 Receptor Antagonist Protein; Polyethylene Glycols; Smoking Cessation; Urate Oxidase; Uric Acid; Uricosuric Agents; Xanthine Oxidase

Gouty arthritis and hyperuricemia have ailed humans for centuries. Recent advances in understanding of the mechanism(s) of their development have changed our perception of the disease process. Despite these gains, the treatment options available are limited. The FDA approval of febuxostat for the treatment of hyperuricemia in gout has been a significant step forward. Since its approval in 2009, febuxostat has proven to be safe and efficacious although concerns remain regarding its long-term effects and superiority to other uricosuric agents, such as allopurinol.. A comprehensive literature review of PubMed and Ovid examining clinical trials and post-marketing studies yielded congruent findings on efficacy and safety in elderly populations and those with mild-to-moderate renal/hepatic impairment. A lack of literature and clinical studies was found with regard to comparison of febuxostat to FDA-approved high-dose allopurinol (> 300 mg), the safety of febuxostat in the treatment of severe renal/hepatic impairment and the benefit in the treatment of secondary cases of hyperuricemia.. Febuxostat is effective in the treatment of mild-to-moderate renal/hepatic impairment with dramatic effects on the serum urate level. It can be used safely in patients with hypersensitivity reactions to allopurinol. Further research is needed to determine the long-term benefits and risks.

Topics: Animals; Arthritis, Gouty; Enzyme Inhibitors; Febuxostat; Gout Suppressants; Hepatic Insufficiency; Humans; Hyperuricemia; Liver; Thiazoles; Xanthine Oxidase

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Age Distribution; Aged; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Disease Progression; Early Diagnosis; Female; Gout; Gout Suppressants; Humans; Incidence; Male; Middle Aged; Needs Assessment; Practice Guidelines as Topic; Prognosis; Risk Assessment; Severity of Illness Index; Sex Distribution; Treatment Outcome; United States; Uric Acid

As many as half of all patients with gouty arthritis have some degree of renal impairment. The goal of this systematic review is to provide physicians with a comprehensive examination of available data on the risks and benefits of gouty arthritis treatment options when used in patients with chronic kidney disease (CKD).. We conducted a systematic literature review to determine what information is available to guide treatment decisions in this patient population. PubMed was searched for English-language articles indexed through July 2011 containing the terms "gout" or "hyperuricemia" and synonyms for renal impairment in combination with drug names. Publications were deemed relevant if they reported results from clinical studies, case reports, or prescribing practices of the drug of interest in patients with gouty arthritis and CKD.. Nonsteroidal anti-inflammatory drugs and colchicine are oftentimes not considered appropriate in patients with CKD. Corticosteroids may be an effective alternative in this population; however, their efficacy has not been confirmed in randomized controlled trials and these agents can cause serious side effects. Allopurinol can be used for the prophylactic management of chronic hyperuricemia in patients with CKD, but the recommended decreased dosage may limit efficacy and serious hypersensitivity reactions may preclude its use. Febuxostat and pegloticase are new treatment options for chronic urate-lowering prophylaxis; however, the safety of these drugs in patients with advanced CKD has not yet been reported.. There is currently an unmet need for additional treatment options for the management of gouty arthritis in patients with CKD.

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Comorbidity; Contraindications; Febuxostat; Glucocorticoids; Gout Suppressants; Humans; Hyperuricemia; Polyethylene Glycols; Probenecid; PubMed; Renal Insufficiency, Chronic; Secondary Prevention; Thiazoles; Urate Oxidase

Topics: Absorptiometry, Photon; Aged; Allopurinol; Arthritis, Gouty; Chondrocalcinosis; Cross-Sectional Studies; Enzymes, Immobilized; Evidence-Based Medicine; Febuxostat; Female; Gout Suppressants; Humans; Hyperuricemia; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Odds Ratio; Polyethylene Glycols; Risk Factors; Thiazoles; Ultrasonography; Urate Oxidase

Gouty arthritis is a form of acute joint inflammation provoked by joint deposition of urate crystals. Although this acute pathology resolves after a few days, the marked degree of inflammation in the joint and--possibly more important to the patient--the excruciating pain it causes require proper therapeutic management. Often deemed a "poor sibling" of chronic joint pathologies such as rheumatoid arthritis and psoriatic arthritis, the increasing incidence of gout makes it a more palatable disease for novel drug discovery programs. This fact, associated with novel insights into the molecular mechanisms activated by the urate crystal deposition, is at the basis of new therapeutics under clinical development for gout, a valid example being the effective targeting of the proinflammatory cytokine interleukin-1. Here we briefly review the current status of antigout drug development and propose another target; our focus is on melanocortin receptor agonists as novel therapeutics for gout and inflammatory arthritides, a prototype of which, the adrenocorticotropic hormone, is already used in clinical settings.

Topics: Allopurinol; Animals; Arthritis, Gouty; Colchicine; Crystallization; Disease Models, Animal; Gout Suppressants; Humans; Injections, Intra-Articular; Melanocortins; Mice; Receptors, Melanocortin; Uric Acid

Compared to other chronic inflammatory diseases, gout appears to based on a rather "simple" pathophysiology and therefore the amount of teaching time in medical school and during internship is rather limited. On the other hand, several problems in short- and long-term management still need to be solved - combined with the problem of an increased incidence in elderly people. However, there is significant advance in the knowledge of its pathophysiology including the fact that gout is more than a pure "crystal arthopathy" but rather within the spectrum of chronic inflammatory immunologic diseases. This includes cytokines such as interleukin-1 and intracellular signaling via the inflammasome. For treatment, the novel and effective xanthine oxidase inhibitor febuxostat has been added to the therapeutic armamentarium. Guidelines of EULAR and BSR support the physician in the long-term management of the numerous gout patients.

Topics: Allopurinol; Arthritis, Gouty; Benzbromarone; Combined Modality Therapy; Cytokines; Europe; Febuxostat; Gout; Gout Suppressants; Guideline Adherence; Humans; Inflammasomes; Interleukin-1; Long-Term Care; Probenecid; Signal Transduction; Thiazoles; Uric Acid

Many patients with acute gout (11%-49%) have normal serum uric acid (SUA) levels.

Topics: Acute Disease; Allopurinol; Arthritis, Gouty; Biomarkers; Gout; Gout Suppressants; Humans; Hyperuricemia; Practice Guidelines as Topic; Uric Acid

The majority of patients with gout are cared for by primary care physicians. Although both the physician and patient may easily recognize the acute arthritis of gout, errors in selecting the most appropriate medication and proper dose are common. The clinical stages of gout include asymptomatic hyperuricemia, intermittent gouty arthritis, and chronic tophaceous gout. Treatment of gout is usually considered after the first attack of arthritis, typically podagra. The aims of treatment are to alleviate the pain and inflammation associated with acute attacks, prevent future attacks, and decrease uric acid levels. Confusion frequently arises because certain medications such as colchicine may have dual purposes: to treat an acute attack and to suppress future attacks. The purpose of this management update is to provide practical advice about prescribing the proper medication considering both treatment goals and patient comorbidities.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Aged; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Chronic Disease; Colchicine; Drug Therapy, Combination; Family Practice; Female; Gout; Gout Suppressants; Humans; Male; Middle Aged; Pain Measurement; Prognosis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Uric Acid

Since the original recognition of these conditions in 1961, a great deal has been learned about the pathogenesis, clinical manifestations, and appropriate treatment of gout and pseudogout, and the role of crystals in osteoarthritis has been further defined. The variable manifestations of crystal-induced arthritis in elderly populations has led to a greater need for proper diagnosis and treatment strategies for these increasingly common forms of arthritis.

Topics: Aged; Allopurinol; Arthritis; Arthritis, Gouty; Calcium Pyrophosphate; Chondrocalcinosis; Comorbidity; Diagnosis, Differential; Glucocorticoids; Gout; Gout Suppressants; Humans; Hyperuricemia; Osteoarthritis; Renal Insufficiency; Uric Acid

Newer approaches to the treatment of gout have included modifications and further attention to aspects of current therapies, and development of interesting new therapies. Colchicine prophylaxis appears to be needed longer than previously recognized after introduction of a urate-lowering agent. Diet has received attention, though most dietary effects are small. New agents under investigation include pegylated formulations of uricase and a new potent xanthine oxidase inhibitor, febuxostat. Some cardiovascular drugs have been shown to be uricosuric.

Topics: Anti-Inflammatory Agents; Arthritis, Gouty; Febuxostat; Humans; Thiazoles; Urate Oxidase; Uricosuric Agents; Xanthine Oxidase

Gouty arthritis, a common source of pain and disability, is the most common form of inflammatory arthritis affecting older people. The authors review the epidemiology and pathogenesis of hyperuricemia and gout, as well as the clinical forms of gouty arthritis. Gout is part of a clinical spectrum of conditions (obesity, diabetes mellitus, hyperlipidemia, coronary artery disease) and need for better patient education on management of these associated conditions is emphasized. The general algorithm of gout management is presented. Clinical particularities of gout presentation in older patients (increased incidence in women, polyarticular onset with hand involvement, earlier development of tophi, association with use of diuretics) are reviewed. Barriers against an optimal control of gout include lack of patient education, presence of comorbid conditions, particularly renal impairment, use of multiple drugs such as diuretics, and cognitive decline. Gout management in older adults remains unsatisfactory.

Topics: Aged; Allopurinol; Arthritis, Gouty; Female; Geriatrics; Gout Suppressants; Humans; Hyperuricemia; Incidence; Male; Prevalence; Sex Distribution; United States

Gout and calcium pyrophosphate deposition disease are two common causes of inflammatory joint disease. Despite differences underlying their pathogenesis, their clinical presentation and treatment share some common features. Optimal treatment for both requires prompt resolution of acute synovitis, reduction of chronic joint damage and management of associated conditions. Available therapeutic interventions and future strategies are reviewed in this article.

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Allopurinol; Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Chondrocalcinosis; Colchicine; Drug Combinations; Enzyme Inhibitors; Febuxostat; Gout; Gout Suppressants; Humans; Multicenter Studies as Topic; Probenecid; Randomized Controlled Trials as Topic; Thiazoles; Uric Acid; Uricosuric Agents; Xanthine Oxidase

Gout is a group of diseases characterized by arthritis and results from a disturbance of urate metabolism with the deposition of monosodium urate crystals in the joints and soft tissues. Often, but not invariably, the serum urate levels are elevated as a result of overproduction or underexcretion of uric acid. Clinical manifestations include acute and chronic arthritis, tophaceous deposits, interstitial renal disease, and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joints, tissues, or body fluids. Acute episodes are treated with colchicine, NSAIDs, or steroids. Long-term management includes treatment with uricosuric agents or xanthine oxidase inhibitors.

Topics: Adult; Age Factors; Arthritis, Gouty; Arthritis, Rheumatoid; Colchicine; Diagnosis, Differential; Female; Gout; Gout Suppressants; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteoarthritis; Prevalence; Sex Factors; Tomography, X-Ray Computed; Uricosuric Agents; Xanthine Oxidase

To review the current understanding of the causes and the management of gout.. Publications on all peer-review literature from MEDLINE from 1965 to January 2004.. Selected and evaluated by the author.. Extracted and evaluated by the author.. The underlying metabolic disorder in gout is hyperuricaemia. Most patients with hyperuricaemia remain asymptomatic throughout their lifetime. The phase of asymptomatic hyperuricaemia ends with the first attack of gouty arthritis or urolithiasis. The risk of gout and stone formation is increased with the degree and duration of hyperuricaemia. Drugs available for the treatment of acute gouty arthritis, such as non-steroidal anti-inflammatory drugs, selective cyclo-oxygenase 2 inhibitors, systemic corticosteroids, or colchicine, are effective. For periods between attacks, prophylactic therapy, such as low-dose colchicine, is effective. In those with recurrent attacks of more than two to three times yearly, a uric acid-lowering agent as a long-term therapy should be considered to avoid recurrence and the development of tophaceous gout.. Effective management of gout can be achieved through better understanding of the causes of the condition, preventive measures as well as drug treatment.

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Cyclooxygenase Inhibitors; Diet Therapy; Female; Gout; Gout Suppressants; Heart Failure; Humans; Hyperuricemia; Kidney Failure, Chronic; Male; Purines; Xanthine Oxidase

Topics: Adrenal Cortex Hormones; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Diagnosis, Differential; Gout Suppressants; Humans; Male; Middle Aged; Practice Guidelines as Topic; Uric Acid

Gouty arthritis is the culmination of a number of physiologic mechanisms that ultimately result in deposition of uric acid within joints and soft tissues. Decreased uric acid clearance through the kidney is the most common cause of gout. Tophaceous gout occurs in less than 10% of patients. Acute episodes are treated with NSAIDs or colchicine. Low-dose therapy with these agents can also prevent recurrent attacks. Most patients with gout need long-term treatment with either uricosuric agents or xanthine oxidase inhibitors.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Glucocorticoids; Humans; Uricosuric Agents; Xanthine Oxidase

For the management of acute gouty arthritis, non-steroidal anti-inflammatory drugs (NSAIDs) are the drugs of choice. In recent years, the use of colchicine has declined because of its frequent adverse reactions, and its reduced efficacy when administered more than 24 hours after onset of an acute attack. Intra-articular corticosteroid therapy (e.g. methylprednisolone acetate) is indicated for the treatment of acute mono or oligoarticular gouty arthritis in aged patients, and in those with co-morbid conditions contraindicating therapy with either NSAIDs or colchicine. Oral corticosteroids (e.g. prednisone), and both parenteral corticotrophin (ACTH) and corticosteroids (e.g. intramuscular triamcinolone acetonide) are valuable, relatively safe alternate treatment modalities in those with polyarticular attacks. For the treatment of hyperuricaemia and chronic gouty arthritis, allopurinol is the preferred urate-lowering drug. Its toxicity in elderly individuals, those with renal impairment, and in cyclosporine-treated transplant patients can be minimised by adjusting the initial dose according to the patient's creatinine clearance. In those experiencing cutaneous reactions to allopurinol, cautious desensitisation to the drug can be achieved using a schedule of gradually increasing doses. The therapeutic usefulness of uricosuric drugs is limited by the presence of renal impairment, occurrence of intolerable side-effects, or concomitant intake of salicylates. They are particularly indicated in patients allergic to allopurinol and in those with massive tophi requiring combined therapy with both allopurinol and a uricosuric.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Aged; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Arthritis, Gouty; Chronic Disease; Clinical Trials as Topic; Female; Gout; Gout Suppressants; Humans; Injections, Intra-Articular; Male; Middle Aged; Singapore; Treatment Outcome

Two classes of urate lowering agents, i.e. uricosuric agents and allopurinol, are available for the treatment of hyperuricemia. To prevent the formation of urinary urate stones and possible damage to liver function, it is recommended to use uricosuric agents in those patients with underexcretion of urate, and allopurinol in those with overproduction. Urinary uric acid/creatinine ratio is a convenient index to determine these phenotypes. These agents should be started to prescribe from the minimal dose to prevent the gouty arthritis which is easily evoked in the first several months after the introduction of these agents. An uric acid level between 5.0 and 6.4 mg/dl had minimal occurence of gouty attack during the first six months of the drug therapy.

Topics: Allopurinol; Arthritis, Gouty; Creatinine; Gout Suppressants; Humans; Uric Acid; Uricosuric Agents

The serum levels of uric acid, hypoxanthine and xanthine tended to increase with the decrease of renal function. This mechanism was thought to be the decreased excretion of these materials from the kidney. More than ninety percent of the patients with renal insufficiency (Ccr < or = 30 ml/min) showed hyperuricemia. In general, the gouty arthritis was reported to be uncommon in the patients with secondary hyperuricemia due to renal insufficiency. However, the frequency of gouty arthritis was reported to be high in the patients with polycystic disease and lead nephropathy. The therapeutic standard for secondary hyperuricemia with renal insufficiency was not established. Allopurinol is the drug of choice for controlling hyperuricemia due to renal insufficiency in many cases. In renal insufficiency, the drug must be used cautiously and in reduced dosage because increased serum concentration of oxipurinol, active metabolite of allopurinol, may induce severe side effect.

Topics: Allopurinol; Arthritis, Gouty; Humans; Kidney Diseases; Purine Nucleotides; Uric Acid

The most definitive method of diagnosis for acute gouty arthritis is aspiration of the affected joint and examination of the fluid for the characteristic needle-shaped monosodium urate crystals. Treatment is aimed at promptly stopping the attack and reversing complications. Colchicine and various nonsteroidal anti-inflammatory drugs are effective for both treatment and prophylaxis. Antihyperuricemic therapy may be indicated in patients who have had several attacks in a year.

Topics: Acute Disease; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Glucocorticoids; Humans; Recurrence; Uricosuric Agents

Topics: Adrenal Cortex Hormones; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Diet; Gout; Humans; Uric Acid; Uricosuric Agents

Topics: Acute Disease; Adult; Allopurinol; Arthritis, Gouty; Biomarkers; C-Reactive Protein; Febuxostat; Female; Foot Joints; Gout Suppressants; Humans; Male; Middle Aged; Statistics, Nonparametric; Tomography, X-Ray Computed; Uric Acid

This study assessed the efficacy and safety of canakinumab, a fully human anti-interleukin 1β monoclonal antibody, for prophylaxis against acute gouty arthritis flares in patients initiating urate-lowering treatment.. In this double-blind, double-dummy, dose-ranging study, 432 patients with gouty arthritis initiating allopurinol treatment were randomised 1:1:1:1:1:1:2 to receive: a single dose of canakinumab, 25, 50, 100, 200, or 300 mg subcutaneously; 4×4-weekly doses of canakinumab (50+50+25+25 mg subcutaneously); or daily colchicine 0.5 mg orally for 16 weeks. Patients recorded details of flares in diaries. The study aimed to determine the canakinumab dose having equivalent efficacy to colchicine 0.5 mg at 16 weeks.. A dose-response for canakinumab was not apparent with any of the four predefined dose-response models. The estimated canakinumab dose with equivalent efficacy to colchicine was below the range of doses tested. At 16 weeks, there was a 62% to 72% reduction in the mean number of flares per patient for canakinumab doses ≥50 mg versus colchicine based on a negative binomial model (rate ratio: 0.28-0.38, p≤0.0083), and the percentage of patients experiencing ≥1 flare was significantly lower for all canakinumab doses (15% to 27%) versus colchicine (44%, p<0.05). There was a 64% to 72% reduction in the risk of experiencing ≥1 flare for canakinumab doses ≥50 mg versus colchicine at 16 weeks (hazard ratio (HR): 0.28-0.36, p≤0.05). The incidence of adverse events was similar across treatment groups.. Single canakinumab doses ≥50 mg or four 4-weekly doses provided superior prophylaxis against flares compared with daily colchicine 0.5 mg.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Allopurinol; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Arthritis, Gouty; C-Reactive Protein; Colchicine; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Gout Suppressants; Humans; Interleukin-1beta; Male; Middle Aged; Treatment Outcome; Young Adult

To compare clinical therapeutic effect of surrounded needling therapy and medication on acute gouty arthritis.. Sixty cases of acute gouty arthritis were randomly divided into a surrounded needling therapy group and a western medicine group, 30 cases in each group. The surrounded needling therapy group was treated with shallow needling on local affected area as main and 4-5 distant acupoints as adjuvant, once each day; the western medicine group was treated with oral administration of Indomethacin and Allopurinol, thrice each day. They were treated for 15 days. The clinical therapeutic effects, the changes of serum uric acid content and the adverse reaction were observed in the two groups.. The total effective rate was 93.3% in the surrounded needling therapy group and 80.0% in the western medicine group, with a significant difference between the two groups (P < 0.01); the serum uric acid contents before and after treatment were (516.85 +/- 48.63) micromol/L and (293.77 +/- 68.45) micromol/L in the surrounded needling therapy group, and (509.66 +/- 51.11) micromol/L and (333.66 +/- 89.22) mciromol/L in the western medicine group, respectively, with significant differences before and after treatment in the two groups (both P < 0.05), and with a significant difference in the serum uric acid content after treatment between the two groups (P < 0.01). The surrounded needling therapy group had no adverse reaction, and the adverse reaction rate of the western medicine group was 46.7%, with a significant difference between the two groups (P < 0.01).. Surrounded needling therapy is superior to the western medicine in the therapeutic effect on acute gouty arthritis, and it is a safe and effective method for acute gouty arthritis.

Topics: Acupuncture Points; Acupuncture Therapy; Acute Disease; Adult; Aged; Allopurinol; Arthritis, Gouty; Humans; Indomethacin; Male; Middle Aged; Treatment Outcome; Uric Acid

To evaluate the clinical therapeutic effect of the combination therapy of traditional Chinese and Western medicines in treating gouty arthritis based on the stage of disease, and to explore a safe, effective and reasonable therapeutic regimen for prevention and treatment of gouty arthritis.. One hundred and sixty-six cases of gouty arthritis were divided into three groups randomly, 58 cases in traditional Chinese drug (TCD)-treated group, 56 cases in Western medicine (WM)-treated group and 52 cases in TCD plus WM-treated group. They were all treated for 12 weeks. In the acute stage, patients in TCD-treated group were treated with Huzhang Gout Granule and Jinhuang Ointment, and patients in WM-treated group were treated with diclofenac sodium dual release enteric-coated capsules. In the intermission, patients in TCD-treated group were given Yinlian Gout Granule, and patients in WM-treated group were given benzbromarone or allopurinol. Patients in TCD plus WM-treated group were given both TCD and WM. Clinical symptom score and blood uric acid (BUA) level were measured. The effect initiating time, relapse rate, efficacy rate and the incidence rate of adverse effects were also studied.. There were no significant differences in the efficacy rate and effect initiating time among the three groups in the acute stage. The clinical symptom score and BUA level were obviously reduced in three groups. In the intermission, BUA level in the WM-treated group and TCD plus WM-treated group were obviously reduced. Although there was a drop tendency in the BUA level in TCD-treated group, there was no statistical difference. The relapse rates in TCD-, WM- and TCD plus WM-treated groups were 12.07%, 26.79% and 9.62%, respectively. There was statistical difference in relapse rates among the three groups (P<0.05). The relapse rate was decreased in TCD plus WM-treated group as compared with those in TCD-treated and WM-treated groups. The average clinical symptom scores during recurrence in the three groups were (10.00+/-3.61), (12.38+/-1.85) and (10.75+/-1.89), respectively. The incidence of adverse effects in TCD-treated group (3.45%) was lower than the other two groups (21.43% and 15.38%).. The combination therapy of traditional Chinese and Western medicines based on the stage of disease can control the symptoms of gouty arthritis in the acute stage, improve joint function, and can control the BUA level during the intermission, prevent recurrence and relieve the adverse effects.

Topics: Adolescent; Adult; Aged; Allopurinol; Arthritis, Gouty; Benzbromarone; Diclofenac; Drug Therapy, Combination; Drugs, Chinese Herbal; Female; Gout Suppressants; Humans; Male; Middle Aged; Phytotherapy; Treatment Outcome; Young Adult

To search for a new method for treatment of acute gouty arthritis.. One hundred cases of acute gouty arthritis were randomly divided into an observation group and a control group. The observation group were treated with local blocking and electroacupuncture at Yinbai (SP 1), Taichong (LR 3), Sanyinjiao (SP 6), Zusanli (ST 36), Fenglong (ST 40), Yinlingquan (SP 9) and Ashi points, and the control group were treated with oral administration of 25 mg Indomethacin, thrice each day, and 100 mg Allopurinol, thrice daily. The therapeutic effects and changes of pain score, serum uric acid were observed in the two groups.. The effective rate was 96.4% in the observation group and 84.1% in the control group, the former being better than the later (P < 0.05). Before and after treatment, pain scores were 3.48 +/- 1.05 and 0.94 +/- 10.85, 3.45 +/- 1.07 and 2.11 +/- 0.91, and serum uric acid contents were (539.16 +/- 34.49) micromol/L and (376.30 +/- 52.85) micromol/L, and (552.29 +/- 46.15) micromol/L and (425.79 +/- 48.69) micromol/L in the two group, respectively. After treatment, pain score and serum uric acid content very significantly decreased in the two groups (both P < 0.01) and the observation group in the analgesic effect and the effect in decreasing serum uric acid content was better than the control group (both P < 0.01).. Electroacupuncture combined with local blocking is an effective method for treatment of acute gouty arthritis and it can decrease blood uric acid level.

Topics: Acupuncture Points; Acute Disease; Adult; Aged; Allopurinol; Arthritis, Gouty; Combined Modality Therapy; Electroacupuncture; Female; Humans; Indomethacin; Male; Middle Aged

To assess the short-term urate-lowering effect of fenofibrate in men on long-term allopurinol therapy for hyperuricaemia and gout.. Ten male patients (38-74 yr) with a history of chronic tophaceous or recurrent acute gout with hyperuricaemia and on established allopurinol at 300-900 mg/day for > or =3 months were studied in an open-crossover study of fenofibrate therapy. Allopurinol at the established dose was continued throughout the study. Clinical and biochemical assessments (serum urate and creatinine, 24-h urinary excretion of urate and creatinine, liver function tests, creatine kinase and fasting serum lipids) were undertaken at: (i) baseline, (ii) after 3 weeks of once-daily therapy with micronized fenofibrate (Lipantil Micro) at 200 mg and (iii) 3 weeks after fenofibrate was withdrawn.. Fenofibrate was associated with a 19% reduction in serum urate after 3 weeks of treatment (mean+/-S.E. 0.37+/-0.04 vs 0.30+/-0.02 mM/l; P=0.004). The effect was reversed after a 3-week fenofibrate withdrawal period (0.30+/-0.02 vs 0.38+/-0.03 mM/l). There was a rise in uric acid clearance with fenofibrate treatment of 36% (7.2+/-0.9 vs 11.4+/-1.6 ml/min, normal range 6-11; P=0.006) without a significant change in creatinine clearance. Both total cholesterol and serum triglycerides were also reduced. No patient developed acute gout whilst taking fenofibrate.. Fenofibrate has a rapid and reversible urate-lowering effect in patients with hyperuricaemia and gout on established allopurinol prophylaxis. Fenofibrate may be a potential new treatment for hyperuricaemia and the prevention of gout, particularly in patients with coexisting hyperlipidaemia or those resistant to conventional therapy for hyperuricaemia.

Topics: Acute Disease; Adult; Aged; Alkaline Phosphatase; Allopurinol; Arthritis, Gouty; Chronic Disease; Cross-Over Studies; Drug Therapy, Combination; Fenofibrate; Gout; Gout Suppressants; Humans; Hyperuricemia; Hypolipidemic Agents; Lipids; Male; Middle Aged; Recurrence; Uric Acid

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. Communicated by Ramaswamy H. Sarma.

Topics: Allopurinol; Antineoplastic Agents; Arthritis, Gouty; Cytokines; Humans; Interleukin-17; Interleukin-18; Molecular Docking Simulation; Molecular Dynamics Simulation; Phthalimides; Pyrazoles

The occurrence of gout attacks at the start of uric acid lowering treatment worsens compliance. We aimed to determine the appropriate dose of febuxostat to reduce the occurrence of gout attacks during the initial treatment period.. We retrospectively analyzed the data of patients diagnosed with gout who underwent treatment at Jeju National University Hospital between May 2018 and May 2020.. Two-hundred and twenty-seven patients were included, with a mean age of 53.2 ± 16.4 years, and 219 (96.5%) were male. The patients were divided into two groups according to the starting dose of febuxostat (20 mg vs. 40 mg). There were no significant differences in mean age, disease duration, colchicine, estimated glomerular filtration rate (eGFR), initial uric acid levels, and presence of subcutaneous tophi between the two groups. Gout attacks occurred more frequently in the 20 mg group than in the 40 mg group during the first 3 months of treatment (32.0% vs. 14.3%, p = 0.002), particularly during the first month (21.3% vs. 7.5%, p = 0.005). Multivariate logistic regression analysis was conducted adjusting for the effects of disease duration, the presence of subcutaneous tophi, eGFR, and initial uric acid levels. A febuxostat starting dose of 40 mg (odds ratio, 0.464; 95% confidence interval [CI], 0.246 to 0.862; p = 0.015) and anti-inflammatory prophylaxis (odds ratio, 0.359; 95% CI, 0.158 to 0.813; p = 0.014) were found to be independent factors associated with a gout attack.. Starting uric acid lowering treatment with febuxostat 40 mg rather than 20 mg may reduce the incidence of gout attacks in the early period of treatment in Korean patients with gout.

Topics: Adult; Aged; Allopurinol; Arthritis, Gouty; Febuxostat; Female; Gout; Gout Suppressants; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Uric Acid

In gout, hyperuricemia promotes urate crystal deposition, which stimulates the NLRP3 inflammasome and interleukin-1β (IL-1β)-mediated arthritis. Incident gout without background hyperuricemia is rarely reported. To identify hyperuricemia-independent mechanisms driving gout incidence and progression, we characterized erosive urate crystalline inflammatory arthritis in a young female patient with normouricemia diagnosed as having sufficient and weighted classification criteria for gout according to the American College of Rheumatology (ACR)/EULAR gout classification criteria (the proband).. We conducted whole-genome sequencing, quantitative proteomics, whole-blood RNA-sequencing analysis using serum samples from the proband. We used a mouse model of IL-1β-induced knee synovitis to characterize proband candidate genes, biomarkers, and pathogenic mechanisms of gout.. Lubricin level was attenuated in human proband serum and associated with elevated acute-phase reactants and inflammatory whole-blood transcripts and transcriptional pathways. The proband had predicted damaging gene variants of NLRP3 and of inter-α trypsin inhibitor heavy chain 3, an inhibitor of lubricin-degrading cathepsin G. Changes in the proband's serum protein interactome network supported enhanced lubricin degradation, with cathepsin G activity increased relative to its inhibitors, SERPINB6 and thrombospondin 1. Activation of Toll-like receptor 2 (TLR-2) suppressed levels of lubricin mRNA and lubricin release in cultured human synovial fibroblasts (P < 0.01). Lubricin blunted urate crystal precipitation and IL-1β induction of xanthine oxidase and urate in cultured macrophages (P < 0.001). In lubricin-deficient mice, injection of IL-1β in knees increased xanthine oxidase-positive synovial resident M1 macrophages (P < 0.05).. Our findings linked normouricemic erosive gout to attenuated lubricin, with impaired control of cathepsin G activity, compounded by deleterious NLRP3 variants. Lubricin suppressed monosodium urate crystallization and blunted IL-1β-induced increases in xanthine oxidase and urate in macrophages. The collective activities of articular lubricin that could limit incident and erosive gouty arthritis independently of hyperuricemia are subject to disruption by inflammation, activated cathepsin G, and synovial fibroblast TLR-2 signaling.

Topics: Animals; Arthritis, Gouty; Cathepsin G; Female; Gout; Humans; Hyperuricemia; Inflammation; Interleukin-1beta; Mice; NLR Family, Pyrin Domain-Containing 3 Protein; Toll-Like Receptor 2; Uric Acid; Xanthine Oxidase

The incidence of hyperuricemia and gout has been increasing year by year, and it is showing a younger trend. However, the first-line drugs currently used for hyperuricemia and gouty arthritis have serious side effects that limit their clinical application. Amomum villosum Lour. has been widely used in China for thousands of years as a traditional medical and edible plant, and previous screening showed that the ethanol extract of Amomum villosum Lour. could effectively inhibit the activity of xanthine oxidase. Based on this discovery, this paper had achieved in-depth mechanism research. The results showed that the ethanol extract of Amomum villosum Lour. could treat hyperuricemia by reducing the production of uric acid via inhibition of xanthine oxidase and increasing the excretion of uric acid via regulation of urate transporters. Meanwhile, the extract also showed a certain protective effect on hepatic and renal damage caused by hyperuricemia. With the formation of extensive uric acid, gouty arthritis will be induced by the deposition of monosodium urate in the joint. The extract could also relieve the inflammation by reducing the expression of inflammatory cytokines. In conclusion, the extract deserves focused research and development as a potential medicine, health care product or supplemented food for the prevention and treatment of hyperuricemia and gouty arthritis.

Topics: Arthritis, Gouty; Ethanol; Humans; Hyperuricemia; Plant Extracts; Uric Acid; Xanthine Oxidase

Recent studies presented the crucial role of montelukast (MON, a leukotriene receptor antagonist) against gouty arthritis and its protective effect on drug-induced liver and kidney injury. Allopurinol (ALO, a selective xanthine oxidase inhibitor) is also used for treatment of hyperuricemia, however, it induces hepatotoxicity and acute kidney injury. Therefore, this study introduces the first analytical/biochemical/histopathological assay for MON-ALO co-therapy and aims to: inspect the hepatic and renal impacts of ALO, MON and their combination in rats via biochemical and histopathological examinations, propose and validate a facile HPTLC method for concurrent estimation of ALO-MON binary mixture in human plasma, and employ this method to attain the targeted drugs in real rat plasma. First, the cited drugs in human plasma were simultaneously separated utilizing silica gel G 60 F

Topics: Allopurinol; Animals; Arthritis, Gouty; Humans; Kidney; Liver; Male; Rats; Rats, Wistar; Reproducibility of Results

Gut microbiota plays a significant role in the development and treatment of gouty arthritis. Simiao decoction has been shown to alleviate gouty arthritis by inhibiting inflammation, regulating NLRP3 inflammasome, and altering gut microbiota. However, there is no evidence to prove whether gut microbiota directly mediates the therapeutic efficiency of Simiao decoction in treating gout arthritis.. In this study, fecal microbiota transplantation (FMT) was used to transfer the gut microbiota of gout arthritis mice treated with Simiao decoction or allopurinol to blank gout arthritis mice, in order to investigate whether FMT had therapeutic effects on gout arthritis.. Both Simiao decoction and allopurinol effectively reduced the levels of serum uric acid, liver XOD activity, foot thickness, serum IL-1β, and G-CSF in gout arthritis mice. However, Simiao decoction also had additional benefits, including raising the pain threshold, reducing serum TNF-α and IL-6, alleviating gut inflammation, and repairing intestinal pathology, which were not observed with allopurinol treatment. Moreover, Simiao decoction had a greater impact on gut microbiota than allopurinol, as it was able to restore the abundance of phylum Proteobacteria and genus Helicobacter. After transplantation into gout arthritis mice, gut microbiota altered by Simiao decoction exhibited similar therapeutic effects to those of Simiao decoction, but gut microbiota altered by allopurinol showed no therapeutic effect.. These findings demonstrates that Simiao decoction can alleviate gout arthritis symptoms by regulating gut microbiota.

Topics: Allopurinol; Animals; Arthritis, Gouty; Gastrointestinal Microbiome; Inflammation; Mice; Uric Acid

Silver oxide nanoparticles (AgO-NPs) antioxidant, anti-cancer, anti-microbial, and tissue repair properties. Gouty arthritis is the inflammation of tissues and joints caused by the deposition of monosodium urate crystals. In this experiment, we investigated the anti-hyperuricemic effectiveness of different concentrations of AgO-NPs in mice. The present study aimed to investigate the effect of administration of AgO-NPs in monosodium urate (MSU)-induced gouty mice for the very first time. Monosodium urate (MSU) crystals were administered intraperitoneal for gout induction, followed by 5, 10, and 20 µg/mL doses of AgO-NPs for 2 weeks. The positive control was provided with the commercially available drug allopurinol to compare the effects of AgO-NPs and allopurinol. The main purpose of the study was to investigate the effectiveness of the nanoparticles in comparison with commercially available drugs. AgO-NPs have been shown to improve the condition of gouty arthritis by reducing significantly (P ˂ 0.001) increased levels of ALT, AST, and total bilirubin. The total protein estimation results showed significant improvement at concentration of 20 µg/mL of AgO-NPs. The lipid profile results showed that high concentration (20 µg/mL) of AgO-NPs decrease the lipid content significantly as compared to control. It was concluded from this study that the antioxidant, anti-inflammatory, and antilipidemic properties of AgO-NPs may improve the hyperuricemic condition in gouty arthritis mice.

Topics: Allopurinol; Animals; Antioxidants; Arthritis, Gouty; Hyperuricemia; Lipids; Metal Nanoparticles; Mice; Nanoparticles; Oxides; Silver Compounds; Uric Acid

This is a case report of a 68-year-old male with severe tophaceous gouty arthritis, diabetes, kidney impairment and ischaemic heart disease. The patient had repeated attacks of acute gout during a 20-year period and excessive tophaceous depositions. Walking was severely hampered by feet deformity and pain. No urate-lowering therapy was initiated despite contacts to several medical specialties. After the diagnosis was established, the patient was finally treated with allopurinol with an obvious beneficial effect on his symptoms and the size of the tophaceous depositions.

Topics: Aged; Allopurinol; Arthritis, Gouty; Delivery of Health Care; Gout Suppressants; Humans; Male; Renal Insufficiency

Gouty arthritis is generally induced by the accumulation of monosodium urate (MSU) crystals in the joints due to elevated serum uric acid levels, potentially leading to serious pathological disorders such as nephrolithiasis, renal failure, and acute gouty arthritis. In this study, we aimed to validate the anti-gout effects of carvacrol, a phenolic monoterpene.. Male Sprague-Dawley rats were divided into normal saline, disease group by injecting potassium mono-oxonate (PO) at a dose of 250 mg/kg, and three treatment groups, either with carvacrol 20 mg/kg or 50 mg/kg and 10 mg/kg allopurinol. The blood and tissue samples were subsequently collected and analyzed using different biochemical and histopathological techniques.. Our results revealed a significant increase in the serum levels of oxidative stress-related markers, namely, uric acid and C-reactive protein (CRP), and NLRP3 inflammasome-dependent inflammatory mediators, including nuclear factor kappa B (NF-κB) and tumor necrosis factor-alpha (TNF-α). Carvacrol administration for seven consecutive days exhibited significant anti-hyperuricemic and anti-inflammatory effects in a dose-dependent manner. Notably, the 50 mg/kg carvacrol treatment was observed to produce results similar to the allopurinol treatment. Furthermore, the renal safety of carvacrol was confirmed by the renal function test.. Carvacrol potentially alleviates hyperuricemia-induced oxidative stress and inflammation by regulating the ROS/NRLP3/NF-κB pathway, thereby exerting protective effects against joint degeneration.

Topics: Allopurinol; Animals; Arthritis, Gouty; Cymenes; Hyperuricemia; Inflammation; Male; NF-kappa B; NLR Family, Pyrin Domain-Containing 3 Protein; Oxidative Stress; Rats; Rats, Sprague-Dawley; Uric Acid

The present study investigated the mechanism of total flavonoids from Ampelopsis grossedentata(AGTF) against gouty arthritis(GA) by network pharmacology and experimental validation. The main active ingredients and targets of AGTF, as well as disease targets, were screened out using relevant databases and literature data. The "protein-protein interaction"(PPI) network and "drug-ingredient-target-pathway" network were constructed, and the potential targets and mechanism of AGTF against GA were predicted. The hyperuricemia(HUA) combined with GA model was induced in rats. The gait behaviors of rats were scored, and ankle swelling degree was observed. The uric acid(UA) level and xanthine oxidase(XOD) activity in the rat serum were detected, and the levels of interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α) were measured. The protein expression of toll-like receptor 4(TLR4), myeloid differentiation factor 88(MyD88), and nuclear factor-kappa B(NF-κB) in the synovial tissues of the rat ankle joint was determined by immunohistochemistry. Ten active ingredients of AGTF and 73 candidate targets of AGTF against GA were screened out by network pharmacology. Eighty-six signaling pathways were enriched, including TNF signaling pathway, NF-κB signaling pathway, TLR signaling pathway, Nod-like receptor signaling pathway, and purine metabolism signaling pathway, which were closely related to AGTF against GA. Animal experimental results showed that AGTF could effectively improve the abnormal gait behaviors of GA rats, relieve ankle inflammation, and reduce ankle joint swelling. In addition, AGTF could significantly reduce UA level, inhibit XOD activity, decrease TNF-α, IL-6, and IL-1β content, and down-regulate the expression of TLR4, MyD88, and NF-κB in ankle synovial tissues(P<0.05, P<0.01). The results of network pharmacology and experimental validation are consistent, indicating that AGTF exerts its therapeutic effect on GA by regulating UA metabolism, improving abnormal UA level, reducing the release of inflammatory factors, and regulating immunity and the TLR4/MyD88/NF-κB inflammatory pathway.

Topics: Ampelopsis; Animals; Arthritis, Gouty; Flavonoids; Interleukin-1beta; Interleukin-6; Myeloid Differentiation Factor 88; NF-kappa B; NLR Proteins; Rats; Toll-Like Receptor 4; Tumor Necrosis Factor-alpha; Uric Acid; Xanthine Oxidase

Acute inflammation and hyperuricemia are associated with gouty arthritis. As an edible and therapeutic mushroom,

Topics: Animals; Anti-Inflammatory Agents; Antioxidants; Arthritis, Gouty; Edema; Hyperuricemia; Interleukin-8; Ligands; Matrix Metalloproteinase 9; Mice; Rats; Rodentia; Tumor Necrosis Factor-alpha; Uric Acid; Xanthine Oxidase

Hyperuricemia (HUA) is an important risk factor for gout, renal dysfunction and cardiovascular diseases. The whole plant of Persicaria capitata (Buch.-Ham. ex D. Don) H. Gross, namely Persicaria capitata herba, is a well-known ethnic herb with potent therapeutic effects on urinary tract infections and urinary calculus, yet previous reports have only focused on its effect on urinary tract infections.. To evaluate the therapeutic potential of P. capitata herba against gout by investigating its antihyperuricemia and antigouty arthritis effects and possible mechanisms.. The ethanol extract (EP) and water extract (WP) of P. capitata herba were prepared by extracting dried and ground whole plants of P. capitata with 75% ethanol and water, respectively, followed by removal of solvents and characterization by UHPLC-Q-TOF/MS. The antihyperuricemia and antigouty arthritis effects of the two extracts were evaluated in a potassium oxonate- and hypoxanthine-induced hyperuricemia mouse model and a monosodium urate crystal (MSUC)-induced acute gouty arthritis mouse model, respectively. The mechanisms were investigated by testing their effects on the expression of correlated proteins (by Western blot) and mRNAs (by RT-PCR).. UHPLC-HRMS fingerprinting and two chemical markers (i.e., quercetin and quercitrin) determination were used for the characterization of the WP and EP extracts. Both WP and EP extracts showed pronounced antihyperuricemia activities, with a remarkable decline in serum uric acid and a marked increase in urine uric acid in hyperuricemic mice. Unlike the clinical xanthine oxidase (XOD) inhibitor allopurinol, WP and EP did not show any distinct renal toxicities. The underlying antihyperuricemia mechanism involves the inhibition of the activity and expression of XOD and the downregulation of the mRNA and protein expression of glucose transporter 9 (GLUT9) and urate transporter 1 (URAT1). The extracts of P. capitata herba also demonstrated remarkable anti-inflammatory activity in MSUC-induced acute gouty arthritis mice. The mechanism might involve inhibitory effects on the expression of proinflammatory factors.. The extracts of P. capitata herba possessed pronounced antihyperuricemia and antigouty arthritis effects and were, therefore, promising natural medicines for hyperuricemia-related disorders and gouty arthritis. The use of P. capitata herba for the treatment of urinary calculus may be, at least to some degree, related to its potential as an antihyperuricemia and antigouty arthritis drug.

Topics: Animals; Arthritis, Gouty; Hyperuricemia; Mice; Oxonic Acid; Plant Extracts; Uric Acid; Xanthine Oxidase

BACKGROUND Gout is a metabolic disease characterized by deposition of monosodium urate (MSU) crystals called tophi. The typical location of tophi is in the joint and will chronically damage the joint. However, there is a rare atypical dermatologic manifestation of tophi that occur extensively in the skin. CASE REPORT A 46-year-old male presented with acute pain in multiple joints. He had a history of gouty arthritis with recurrence attacks, in the past 2 years ago. Over time, he had gradual eruption of multiple tophi and multiple yellowish nodules under his skin which sometimes would ulcerate. Laboratory value showed creatinine 2.3 mg/dL and uric acid 11.5 mg/dL. Ultrasound of the kidney showed nephrocalcinosis appearance. Urate crystal was identified in skin biopsy of the nodules. We diagnosed the patient with chronic tophaceous gout with extensive cutaneous involvement. Given the renal impairment, we gave methylprednisolone 3 doses of 8 mg for 5 days then tapered off, colchicine 0.5 mg every other day and allopurinol 1 dose of 100 mg. The patient had dramatic improvement of his pain and is now being followed up regularly. CONCLUSIONS We describe a rare and severe extensive cutaneous manifestation in a chronic tophaceous gout patient.

Topics: Allopurinol; Arthritis, Gouty; Biomarkers; Colchicine; Glucocorticoids; Gout Suppressants; Humans; Male; Methylprednisolone; Middle Aged; Renal Insufficiency; Skin Diseases

Topics: Animals; Anti-Inflammatory Agents; Arthritis, Gouty; Carbon; Drugs, Chinese Herbal; Hyperuricemia; Inflammation; Male; Mice; Microscopy, Electron, Transmission; Plant Extracts; Rats; Rats, Sprague-Dawley; RAW 264.7 Cells; Uric Acid; Xanthine Oxidase

Topics: Allopurinol; Antirheumatic Agents; Arthritis, Gouty; Arthritis, Psoriatic; Diagnosis, Differential; Finger Joint; Finger Phalanges; Gout Suppressants; Humans; Interleukin 1 Receptor Antagonist Protein; Male; Middle Aged; Radiography

Topics: Allopurinol; Arthritis; Arthritis, Gouty; Biopsy; Gout Suppressants; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Skin; Treatment Outcome; Ultrasonography

Topics: Anacardiaceae; Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Chalcone; Dose-Response Relationship, Drug; Edema; Enzyme Inhibitors; Flavanones; Hyperuricemia; Inflammation; Male; Mice; Mice, Inbred Strains; Molecular Structure; Oxonic Acid; Structure-Activity Relationship; Uric Acid; Xanthine Oxidase

Dual-energy CT (DECT) detects and quantifies monosodium urate (MSU) crystal deposition with high precision. This DECT study assessed crystal deposition in patients with gout treated with stable-dose allopurinol, and investigated potential clinical determinants for crystal deposition.. Patients with gout treated with allopurinol ≥300 mg daily for at least 3 months were prospectively recruited from the USA and New Zealand, using monitored enrolment to include approximately 25% patients with palpable tophi and approximately 50% with serum urate (sUA) levels <6.0 mg/dL (<357µmol/L). MSU crystal deposition was measured in the hands/wrists, feet/ankles/Achilles and knees bilaterally. The presence and total volume of crystals were assessed by DECT and analysed according to sUA levels and gout characteristics.. A substantial proportion of patients without palpable tophi have MSU crystal deposition, despite receiving allopurinol doses ≥300 mg/day for a considerable duration. Patients with higher sUA and clinical features of severe disease have a higher frequency and greater volume of MSU crystal deposition.

Topics: Adult; Aged; Allopurinol; Arthritis, Gouty; Female; Gout Suppressants; Humans; Male; Middle Aged; New Zealand; Prevalence; Prospective Studies; Severity of Illness Index; Tomography, X-Ray Computed; United States; Uric Acid

Gnaphalium affine D. Don is a folk medicine of China believed to be efficacious in the treatment of many ailments, including hyperuricemia and gout.. Based on a previous study, we isolated two flavones, luteolin and luteolin-4'-O-glucoside, from G. affine. Our aim was to assess the potential beneficial effects of treatment and mechanisms of these two flavones on hyperuricemia and acute gouty arthritis.. The model of potassium oxonate (PO)-induced hyperuricemia and monosodium urate (MSU) crystal-induced inflammation in mice has been established. We evaluated serum uric acid (Sur), xanthine oxidase (XO) activity, protein expression of urate transporter 1 (mURAT1) and glucose transporter 9 (mGLUT9) in renal and kidney protection in a hyperuricemia model. In addition, paw swelling and levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in serum were assessed in MSU crystal-induced mice.. Luteolin and luteolin-4'-O-glucoside showed a potent clinical effect in treating hyperuricemia and gout. We observed that the two flavones possess potent effect in hyperuricemia mice by decreasing the level of mURAT1 and inhibiting XO activity, which contribute to enhancing uric acid (UA) excretion and improving hyperuricemia-induced renal dysfunction. In addition, luteolin and luteolin-4'-O-glucoside also alleviated paw swelling and inflammation induced by MSU crystals. Further investigation implied that luteolin and luteolin-4'-O-glucoside improved the symptoms of inflammation by decreasing the levels of IL-1β and TNF-α.. The present study suggests that luteolin and luteolin-4'-O-glucoside could be developed as therapeutics for treating hyperuricemia and gouty arthritis.

Topics: Animals; Arthritis, Gouty; Disease Models, Animal; Drugs, Chinese Herbal; Edema; Glucose Transport Proteins, Facilitative; Glucosides; Gnaphalium; Hyperuricemia; Interleukin-1beta; Kidney; Luteolin; Male; Mice, Inbred ICR; Organic Anion Transporters; Uric Acid; Xanthine Oxidase

The Gnaphalium affine D. Don is used in China as a folk medicine to treat gout, anti-inflammatory, antitussive and expectorant activities. The aim of this study was to evaluate the potential of the extract of G. affine to treat hyperuricemia and acute gouty arthritis in animal model.. G. affine extract was evaluated in an experimental model with potassium oxonate (PO) induced hyperuricemia in mice which was used to evaluate anti-hyperuricemia activity and xanthine oxidase (XO) inhibition. Therapies for acute gouty arthritis was also investigated on monosodium urate (MSU) crystal induced paw edema model.. G. affine extract showed expressive results on active in reducing serum uric acid (Sur) through effect renal mGLUT9 and mURAT1 mainly and inhibit XO activity in vivo. The extract of G. affine also showed significant anti-inflammatory activity and reduced the paw swelling on MSU crystal-induced paw edema model. Meanwhile, eight major compounds were identified by HPLC-ESI-QTOF-MS/MS.. The extract of G. affine showed significant effect on evaluated models and therefore may be active agents for the treatment of hyperuricemia and acute gouty arthritis.

Topics: Animals; Anti-Inflammatory Agents; Arthritis, Gouty; Chromatography, High Pressure Liquid; Disease Models, Animal; Edema; Gnaphalium; Hyperuricemia; Male; Mice; Mice, Inbred ICR; Oxonic Acid; Plant Extracts; Tandem Mass Spectrometry; Uric Acid; Xanthine Oxidase

Topics: Allopurinol; Arthritis, Gouty; Colchicine; Disease Progression; Hand; Humans; Joint Deformities, Acquired; Male; Middle Aged; Prognosis; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Failure

The species Sparattosperma leucanthum (Vell.) K. Schum is used in Brazilian folk medicine to treat rheumatism, throat ulcers, stomatitis, syphilis, bladder stones and as blood cleanser. The aim of this study was to evaluate the potential, in vitro and in vivo, of the extracts of leaves from Sparattosperma leucanthum to treat hyperuricemia and inflammation in the gouty arthritis model.. Ethyl acetate extract (SLE), methanolic extract (SLM) and aqueous extract (SLW) were evaluated in vitro on XO inhibitory activity and in vivo in an experimental model with oxonate-induced hyperuricemia in mice which was used to evaluate anti-hyperuricemic activity and liver xanthine oxidase (XOD) inhibition. Anti-inflammatory activity was also investigated on MSU crystal-induced paw edema model.. Sparattosperma leucanthum crude extracts showed expressive results on urate-lowering activity in blood. SLW at the dose of 125 mg/kg has proved to be active in reducing hyperuricemia and was capable to inhibit the hepatic xanthine oxidase enzyme (XOD). SLM showed anti-hyperuricemic activity on all doses tested; however, this extract showed activity on the XOD only at the dose of 500 mg/kg. SLE, at the three evaluated doses, has proved to be active in reducing hyperuricemia in vivo and was able to inhibit XO activity in vitro at the concentration of 100 µg/mL. This extract was also able to inhibit XOD activity in vivo at the doses of 250 mg/kg and 500 mg/kg. SLE (125 and 250 mg/kg) and SLW (500 mg/kg) showed significant anti-inflammatory activity on monosodium urate crystal-induced paw edema model.. The ethyl acetate, methanolic and aqueous extracts of Sparattosperma leucanthum showed significant results on evaluated models and therefore may be important agents for the treatment of gouty arthritis and hyperuricemia.

Topics: Animals; Anti-Inflammatory Agents; Arthritis, Gouty; Bignoniaceae; Gout Suppressants; Hyperuricemia; Liver; Male; Mice; Oxonic Acid; Phytotherapy; Plant Extracts; Plant Leaves; Uric Acid; Xanthine Oxidase

Gout is a painful arthritic condition that affects many people worldwide. The disease has been associated with hyperuricaemia and life style risk factors such as obesity, alcohol intake, meat and seafood consumption. We present a case of a 67-year-old male with a history of gout, who attended the clinic with a painful 1st metatarsophalangeal joint, which had progressively worsened in pain, mobility and deformity in the last 20 years. Although lifestyle changes had been advised by the GP some years earlier such as a low purine based diet, management had only consisted of NSAID's, which had not significantly improved symptoms. Surgical excision of chalky white material from around the 1st metatarsophalangeal joint rendered the patient symptom free with increased mobility after 6 weeks. Histopathology confirmed the excised tissue as gouty tophus. Following this, the patient was placed on allopurinol, a xanthine oxidase inhibitor to prevent recurrent attacks. This case study highlights the importance of early recognition and prophylactic management in gout sufferers. In joints where the disease process is well-established surgical excision of the gouty tophus may help mitigate further disease progression, and restore quality of life to individuals.

Topics: Aged; Allopurinol; Arthritis, Gouty; Gout Suppressants; Humans; Male; Metatarsophalangeal Joint

To estimate the time course of changes in the clinical manifestations of gout and their risk factors during a long-term follow-up.. A total of 160 male patients with gout were examined and followed up for a mean of 6.9 ± 2.0 years. Their clinical assessment included determination of the type of arthritis over time, the frequency of arthritis attacks during one year prior to the examination, the presence and number of subcutaneous tophi, inflamed joints, comorbid or co-occurring diseases (CD), allopurinol adherence, dietary compliance, frequency of taking non-steroidal anti-inflammatory drugs (NSAIDs), diuretics, and alcohol. The serum levels of uric acid (UA), glucose, total cholesterol, and glomerular filtration rate were estimated.. The number of patients taking allopurinol increased from 19% to 64% (p < 0.0001), its average daily dose was 167.6 ± 94.6 mg. The serum level of UA decreased; 16% of the patients achieved its target level. The number of patients with chronic arthritis was not significantly changed. Their serum level of UA was unchanged; the detection rate of subcutaneous tophi and CD rose. During one year, arthritis attacks were absent in 13% of the patients; 90% of them took allopurinol. In these patients, serum UA levels and body mass index significantly declined and the rate of CD was unchanged. None of 18 patients who had their diet and no allopurinol achieved the target level of UA.. Among the gouty patients, 36% refrain from the use of allopurinol, only 23% out of them require that its dose be adjusted to achieve the target level of UA. Dietary compliance is insufficient to reach the target level of UA. Chronic arthritis is associated with the increased incidence of CD.. Цель исследования. Оценка динамики клинических проявлений подагры и факторов, влияющих на них, при длительном наблюдении. Материалы и методы. Обследовали 160 больных подагрой мужчин, средний период наблюдения за которыми составил 6,9±2 года. Клиническая оценка включала определение в динамике варианта артрита, частоты приступов артрита за предшествующий осмотру год, наличия и количества подкожных тофусов, воспаленных суставов, коморбидных, или сочетанных, заболеваний (СЗ), соблюдение схемы приема аллопуринола, диеты, частоты приема нестероидных противовоспалительных препаратов, диуретиков, алкоголя. Определяли в сыворотке крови уровни мочевой кислоты (МК), глюкозы, общего холестерина, рассчитывали скорость клубочковой фильтрации. Результаты. Число больных, принимавших аллопуринол, увеличилось с 19 до 64% (р<0,0001), средняя суточная доза составила 167,6±94,6 мг. Уровень МК в сыворотке крови снизился, целевой уровень достигнут у 16% больных. Число больных хроническим артритом достоверно не изменилось. Уровень МК в сыворотке крови у них не изменился, увеличилась частота выявления подкожных тофусов, СЗ. Приступы артрита в течение года отсутствовали у 13% больных, 90% из них принимали аллопуринол. У этих больных достоверно снизились уровень МК в сыворотке крови и индекс массы тела, частота СЗ не изменилась. Ни у одного из 18 больных, соблюдавших диету и не принимавших аллопуринол, целевой уровень МК не достигнут. Заключение. Среди больных подагрой 36% воздерживаются от приема аллопуринола, только 23% из них подбирают дозу препарата до достижения целевого уровня МК. Соблюдения диеты недостаточно для достижения целевого уровня МК. Наличие хронического артрита ассоциируется с увеличением частоты развития СЗ.

Topics: Adult; Aged; Allopurinol; Arthritis, Gouty; Follow-Up Studies; Gout; Gout Suppressants; Humans; Middle Aged; Remission Induction; Retrospective Studies; Time Factors; Uric Acid

Effective treatment in gouty arthritis can prevent joint and renal damage. Target serum uric acid levels of < 6 mg/dl and < 5 mg/dl are recommended in gouty arthritis and those with tophi, respectively.. To evaluate: (i) whether patients achieved recommended serum uric acid target and assess influencing factors and (ii) renal function between patients who achieved and not achieved the goal.. The medical records of gouty arthritis patients treated in outpatient department at Thammasat University Hospital between January 2013 and December 2013 were reviewed. Patients were divided into adequately (ATG) and inadequately treated groups (ITG) based on the ACR uric acid criteria after six months of treatment. Factors associated with inadequate treatment were explored and post treatment renal function compared between A and ITGs.. Of 139 patients, 46 (33%) achieved target serum uric acid concentrations. Alcoholic consumption was the significant factor influencing the outcome. 75.5% of patients were followed-up > 1 month for second evaluation of uric acid and most of them not receiving dosage up-titration even though not achieving the target. Both groups had similar alterations of renal function after treatment (p = 0.68).. Most patients failed to achieve recommended uric acid targets. Alcohol consumption was identified as a key risk factorfor a suboptimal outcome. The treat-to-target approach should be underlined. Other risk factors should be explored prospectively.

Topics: Alcohol Drinking; Allopurinol; Arthritis, Gouty; Benzbromarone; Female; Follow-Up Studies; Gout Suppressants; Humans; Kidney Function Tests; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome; Uric Acid; Uricosuric Agents

In most cases (98-99 %) primary hyperuricemia is caused by impaired renal excretion of uric acid. Overproduction of uric acid is rare. Secondary hyperuricemia has to be differentiated from primary forms. Clinical manifestations of hyperuricemia are acute inflammatory arthritis, tenosynovitis, bursitis, chronic arthropathy and accumulation of urate crystals in the form of tophaceous deposits. In addition renal complications can occur. Pathophysiology and diagnosis of gout were described. Treatment of gout has two goals: Treatment of the acute gout attack, to terminate pain and disability and treatment of hyperuricemia by lifestyle modification and with urate lowering drugs. A serum uric acid value below 6 mg/dl (360 µmol/L) should be achieved.

Topics: Allopurinol; Arthritis, Gouty; Colchicine; Diagnosis, Differential; Drug Therapy, Combination; Furosemide; Gout; Humans; Hyperuricemia; Life Style; Male; Middle Aged

Topics: Allopurinol; Arthritis, Gouty; Benzbromarone; Combined Modality Therapy; Febuxostat; Female; Gout; Gout Suppressants; Humans; Middle Aged; Polyethylene Glycols; Urate Oxidase

Topics: Aged; Allopurinol; Arthritis, Gouty; Celecoxib; Crystallization; Foot Joints; Gout Suppressants; Humans; Male; Pyrazoles; Subcutaneous Tissue; Sulfonamides; Tomography, X-Ray Computed

Topics: Adult; Allopurinol; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Arthritis, Gouty; Drug Therapy, Combination; Gout Suppressants; Humans; Hyperuricemia; Male; Treatment Outcome

Joint pain is a common complaint in pediatrics and is most often attributed to overuse or injury. In the face of persistent, severe, or recurrent symptoms, the differential typically expands to include bony or structural causes versus rheumatologic conditions. Rarely, a child has two distinct causes for joint pain. In this case, an obese 15-year-old male was diagnosed with gout, a disease common in adults but virtually ignored in the field of pediatrics. The presence of juvenile idiopathic arthritis (JIA) complicated and delayed the consideration of this second diagnosis. Indeed, the absence of gout from this patient's differential diagnosis resulted in a greater than two-year delay in receiving treatment. The patients' BMI was 47.4, and he was also mis-diagnosed with osteochondritis dissecans and underwent medical treatment for JIA, assorted imaging studies, and multiple surgical procedures before the key history of increased pain with red meat ingestion, noticed by the patient, and a subsequent elevated uric acid confirmed his ultimate diagnosis. With the increased prevalence of obesity in the adolescent population, the diagnosis of gout should be an important consideration in the differential diagnosis for an arthritic joint in an overweight patient, regardless of age.

Topics: Adolescent; Allopurinol; Ankle Joint; Arthritis, Gouty; Arthritis, Juvenile; Colchicine; Delayed Diagnosis; Diagnosis, Differential; Gout Suppressants; Humans; Magnetic Resonance Imaging; Male; Obesity; Orthopedic Procedures; Osteochondritis Dissecans; Severity of Illness Index; Time-to-Treatment; Treatment Failure; Uric Acid

Gouty arthritis is a metabolic disorder associated with hyperuricemia. Despite the development of novel pharmacotherapies, some hyperuricemia patients are drug refractory and develop gout. A 74-year-old man with frequent gouty attacks and chronic renal failure presented with asymmetrical polyarthritis affecting multiple joints. The diagnosis of gout was confirmed based on the presence of monosodium urate crystals in the patient's right wrist. The administration of systemic corticosteroids relieved the joint inflammation and pain; however, the urate level increased to 28 mg/dL and the gout attacks recurred. Combined allopurinol, febuxostat, and benzbromarone therapy reduced the urate level to <6 mg/dL, and the attacks gradually declined. This is the first report of two xanthine oxidase inhibitors being used to treat refractory gout.

Topics: Adrenal Cortex Hormones; Aged; Allopurinol; Arthritis, Gouty; Benzbromarone; Drug Therapy, Combination; Febuxostat; Gout Suppressants; Humans; Hyperuricemia; Kidney Failure, Chronic; Male; Thiazoles; Treatment Outcome; Xanthine Oxidase

We report 2 cases of familial juvenile hyperuricemic nephropathy, a rare autosomal dominant disorder characterized by uromodulin gene mutations leading to hyperuricemia secondary to profound renal uric acid underexcretion, gout, and chronic renal disease. Case 1 involves a 56-year-old woman who underwent a kidney transplant after steady decline in kidney function since the age of 19 years. Her gout had been successfully controlled with varying doses of daily allopurinol. Case 2, the son of case 1, presented with already progressive and debilitating arthritis at the age of 34 years with relatively stable chronic renal failure that was also subsequently managed with daily allopurinol and judicious anti-inflammatory prophylaxis.

Topics: Adult; Allopurinol; Arthritis, Gouty; Diagnosis, Differential; Disease Progression; Female; Follow-Up Studies; Gout; Graft Survival; Humans; Hyperuricemia; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Pedigree; Sampling Studies; Severity of Illness Index; Treatment Outcome

Topics: Aged; Allopurinol; Arthritis, Gouty; Colchicine; Female; Gout Suppressants; Humans; Low Back Pain; Lumbar Vertebrae; Radiography; Spondylarthritis; Treatment Outcome

This study aims to investigate the disease-related knowledge of gout patients and doctors in south China and to identify the important targets of education for patients and doctors. A cross-section survey of 154 primary gout patients and 185 doctors who may see gout patients was conducted with a modified questionnaire with ten items of gout-related knowledge. The participants were considered to have gout-related knowledge if he or she correctly answered seven or more items. One hundred and forty-nine valid questionnaires from patients, 33 from rheumatology physicians, and 151 from non-rheumatology doctors were collected for statistical analysis. The mean correctly answered items of three groups were 6.6 ± 2.2, 9.6 ± 0.53, and 8.0 ± 1.4, with rate of being considered to have knowledge about gout 51.7, 100, and 90.1 %, respectively (P < 0.05). The correct answer rate for each particular item was over 80 % in the rheumatology physician group. Patients or non-rheumatology doctors knew the optimal serum uric acid (sUA) level (48.3 vs 55.6 %), the need to take lifelong urate-lowering drugs (29.5 vs 43.6 %), that allopurinol is a urate-lowering drug (55.7 vs 76.0 %), and how to prevent attacks induced by urate-lowering therapy (ULT) (60.4 vs 74.0 %). Logistic regression showed that higher education predicted which patients had gout-related knowledge. Both the gout patients and non-rheumatology doctors in south China had poor knowledge on ULT. Since many gout patients do not see rheumatologists, our data suggest that further education should focus on patients and non-rheumatologists and emphasize the use of urate-lowering drugs, treatment duration, the target sUA level, and prophylaxis against acute attacks.

Topics: Adult; Aged; Allopurinol; Arthritis, Gouty; China; Cross-Sectional Studies; Female; Gout; Gout Suppressants; Health Knowledge, Attitudes, Practice; Humans; Hyperuricemia; Male; Middle Aged; Physicians; Rheumatology; Surveys and Questionnaires

Jatropha isabellei Müll Arg. (Euphorbiaceae) is a medicinal plant that has been used in South American folk medicine for the treatment of arthritic diseases, particularly gout.. This study was designed to verify the antinociceptive, anti-inflammatory and hypouricemic potential of Jatropha isabellei.. Rats were orally administered with the crude extract (100-300 mg/kg) or a fraction that is rich in alkaloids (0.15 mg/kg) of Jatropha isabellei. An intra-articular (i.a.) injection of 50 μl of monosodium urate (MSU) crystals (1.25mg/site) was used to generate the gout model to assess the effect of the treatment on nociception (thermal and mechanical hyperalgesia) and inflammation (oedema and neutrophil infiltration). The effect of Jatropha isabellei on the serum levels of uric acid was evaluated in a model of hyperuricaemia induced by the intraperitoneal injection of potassium oxonate (250 mg/kg). The side effects were analysed using an open-field test, gastric lesion assessment and by measuring the levels of the ALT and AST enzymes.. Our study demonstrated that the crude extract of Jatropha isabellei and a fraction rich in alkaloids were able to prevent the thermal hyperalgesia, mechanical allodynia, oedema and neutrophil infiltration induced by intra-articular MSU injection in rats. On the other hand, treatment with Jatropha isabellei did not alter the uric acid levels increased by potassium oxonate in the hyperuricaemia model. In addition, Jatropha isabellei did not induce gastric lesions or liver damage and did not alter spontaneous locomotor activity.. The crude extract of Jatropha isabellei and its fraction rich in alkaloid presents antinociceptive and anti-inflammatory effects in a rat gout model, similar to that observed after treatment with colchicine, supporting the traditional use of this plant in gouty patients.

Topics: Alkaloids; Animals; Anti-Inflammatory Agents; Arthritis, Gouty; Biomarkers, Pharmacological; Disease Models, Animal; Edema; Hyperalgesia; Hyperuricemia; Jatropha; Male; Motor Activity; Neutrophil Infiltration; Oxonic Acid; Peroxidase; Phytotherapy; Plant Extracts; Rats; Stomach Ulcer; Uric Acid; Xanthine Oxidase

Topics: Allopurinol; Arthritis, Gouty; Asian People; Genetic Testing; HLA-B Antigens; Humans; Risk; Stevens-Johnson Syndrome

Topics: Allopurinol; Arthritis, Gouty; Drug Eruptions; Female; Forecasting; Gene Expression Regulation; Genotype; HLA-B Antigens; Humans; Male; Molecular Targeted Therapy; Pharmacogenetics; Risk Assessment; Treatment Outcome

Topics: Adult; Allopurinol; Anti-Bacterial Agents; Arthritis, Gouty; Biopsy; Bone Cysts; Gout Suppressants; Humans; Joint Diseases; Male; Metatarsophalangeal Joint; Panniculitis; Radiography; Skin Diseases; Uric Acid

The ethanolic extract of Lychnophora trichocarpha Spreng. is used in Brazilian folk medicine to treat bruise, pain and inflammatory diseases.. The present study aimed at investigating whether ethanolic extract of L. trichocarpha, its ethyl acetate fraction and its main bioactive compounds could be useful to treat gouty arthritis by countering hyperuricemia and inflammation.. L. trichocarpha ethanolic extract (LTE), ethyl acetate fraction from ethanolic extract (LTA) and isolated compounds were evaluated for urate-lowering activity and liver xanthine oxidase (XOD) inhibition in oxonate-induced hyperuricemic mice. Anti-inflammatory activity in monosodium urate crystal-induced paw oedema, an experimental model of gouty arthritis, was also investigated.. Crude ethanolic extract and its ethyl acetate fraction showed significant urate-lowering effects. LTE was also able to significantly inhibit liver xantine oxidase (XOD) activity in vivo at the dose of 250mg/kg. Luteolin, apigenin, lupeol, lychnopholide and eremantholide C showed the anti-hyperuricemic activities among tested compounds. Apigenin also showed XOD inhibitory activity in vivo. Luteolin, lychnopholide, lupeol and eremantholide C, in turn, did not shown significant inhibitory activity towards this enzyme, indicating that this mechanism is not likely to be involved in urate-lowering effects of those compounds. LTE, LTA, lupeol, β-sitosterol, lychnopholide, eremantholide, luteolin and apigenin were also found to inhibit monosodium urate crystals-induced paw oedema in mice.. Ethanolic extract of Lychnophora trichocarpha and some of its bioactive compounds may be promising agents for the treatment of gouty arthritis since they possesses both anti-hiperuricemic and anti-inflammatory properties.

Topics: Acetates; Animals; Anti-Inflammatory Agents; Arthritis, Gouty; Asteraceae; Ethanol; Flavonoids; Hyperuricemia; Inflammation; Liver; Male; Mice; Oxonic Acid; Phytotherapy; Plant Components, Aerial; Plant Extracts; Solvents; Uric Acid; Xanthine Oxidase

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Arthritis, Gouty; Diagnosis, Differential; Gout; Gout Suppressants; Humans; Kidney Function Tests; Male; Middle Aged; Recurrence; Uric Acid

The treatment of gout requires a lowering of serum urate (SU) levels, and allopurinol is the drug that is most commonly used for this purpose. The objectives of this study were to define the relationships between allopurinol dose on the one hand and plasma oxypurinol, renal function, and SU levels on the other and to determine the minimum plasma oxypurinol concentration that would result in a target level of <6 mg/dl (0.36 mmol/l) of SU. For this purpose, 82 patients who had been receiving allopurinol for at least 1 month were recruited. Patients with SU <6 mg/dl were followed up quarterly for 12 months. In patients with SU ≥6 mg/dl, the dose of allopurinol was increased to bring the level of SU to <6 mg/dl. These patients were followed up once a month until the SU level remained at <6 mg/dl for 3 consecutive months; thereafter they were seen quarterly. SU, creatinine, and plasma oxypurinol were measured 6-9 hours after administration of the allopurinol dose. There were significant inverse correlations between creatinine clearance (CrCl) and plasma oxypurinol (P = 0.002), between allopurinol dose and SU (P < 0.0001) and between plasma oxypurinol and SU (P < 0.0001). Using receiver operating characteristic analysis, the target SU of <6 mg/dl was achieved in 75% of serum samples with plasma oxypurinol levels of >100 µmol/l (15.2 mg/l). Increasing the allopurinol dose resulted in increased plasma oxypurinol and reduced SU concentrations. Plasma oxypurinol concentrations >100 µmol/l were required to achieve SU <6 mg/dl.

Topics: Adult; Aged; Aged, 80 and over; Allopurinol; Arthritis, Gouty; Chronic Disease; Creatinine; Dose-Response Relationship, Drug; Drug Monitoring; Enzyme Inhibitors; Female; Gout; Gout Suppressants; Humans; Kidney Function Tests; Male; Middle Aged; Oxypurinol; Standard of Care; Uric Acid

Urate-lowering therapy (ULT), adjusted to achieve and maintain a serum uric acid (SUA) of <6 mg/dl, remains the standard of care for the chronic management of gout. New urate-lowering medications are important options; however, these agents should be reserved for patients who do not tolerate or cannot achieve SUA <6 mg/dl on allopurinol. The result of oxypurinol monitoring to guide allopurinol therapy suggests that allopurinol should still be considered first-line ULT for gout.

Topics: Allopurinol; Arthritis, Gouty; Enzyme Inhibitors; Female; Gout; Gout Suppressants; Humans; Male; Oxypurinol; Uric Acid

To identify factors associated with acute gout attacks in normouricaemic gout patients receiving allopurinol.. We reviewed the medical records of 860 patients with chronic gout who were treated with allopurinol at a single tertiary hospital between 2003 and 2009. Of these, 135 patients had serum urate concentrations ≤ 360 μmol/L (6 mg/dL). Patients whose serum urate concentrations exceeded 360 μmol/L (6 mg/dL) at least once during follow-up were excluded. Patients who experienced at least one acute attack during follow-up, despite normouricaemia [≤ 360 μmol/L (6 mg/dL)], were classified as the Attack group (n = 51). The others were classified as the Non-attack group (n = 84).. The gout disease duration was significantly longer in the Attack group than in the Non-attack group (p = 0.036). The presence of tophi and multiple joint involvement were associated with acute attacks in normouricaemic gout patients. Multivariate analysis showed that both the presence of tophi [odds ratio (OR) 4.16, 95% confidence interval (CI) 1.41-12.23, p = 0.010] and the number of involved joints (OR 1.51, 95% CI 1.05-2.17, p = 0.028) were independently associated with acute attacks in normouricaemic gout patients receiving allopurinol.. The presence of tophi and multiple joint involvement were associated with acute attacks in normouricaemic gout patients receiving allopurinol.

Topics: Acute Disease; Aged; Allopurinol; Arthritis, Gouty; Gout; Gout Suppressants; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Uric Acid

A 67-years-old man suffered from relapsing moderate fever and back pain after arthroscopy of the knee under peridural anaesthesia. Antibiotics given for suspected iatrogenic infection was started, but was without improvement. After 4 months under several antibiotic regimes his condition rapidly deteriorated with high fever, excruciating lumbar back pain associated with elevated ESR/WBC (ESR = erythrocyte sedimentation rate, WBC = white blood cell count) along with arthritis of the shoulders, wrists, knees and ankles. Physical findings comprised swelling and restricted movement of the affected joints as well as pain related stiffness and immobility of the spine, but no neurological abnormalities.. An magnetic resonance imaging (MRI) of the lumbar spine revealed the uncommon finding of multilevel facet joint arthritis at lumbar L2/3 and L4/5, accompanied by cystic erosions of the lamina and widespread dorsal soft tissue edema. Serum uric acid was 11 mg/dl. Uric acid was found in the synovial fluid of the knees.. The fever, spinal symptoms as well as imaging findings improved together with the peripheral arthritis when treatment with colchicine and steroids was started, establishing the diagnosis of spinal gout. In the following year, no further or back pain or fever occurred. Despite continued allopurinol therapy the gouty arthritis of the peripheral joints re-occurred.. Despite its rarity, spinal gout should be considered in the differential diagnosis of intractable back pain and fever especially when imaging studies reveal posterior element involvement.

Topics: Aged; Allopurinol; Arthritis, Gouty; Arthroscopy; Back Pain; Colchicine; Diagnosis, Differential; Drug Therapy, Combination; Fever of Unknown Origin; Follow-Up Studies; Glucocorticoids; Gout Suppressants; Humans; Knee; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Postoperative Complications; Prednisolone; Spondylarthritis; Tomography, X-Ray Computed; Ultrasonography; Uric Acid

Symptomatic gout in an artificial joint is exceptionally rare. We present a 68-year-old male patient who developed progressive knee pain and swelling one year after the cemented total arthroplasty of his left knee. The diagnosis was confirmed by crystal identification in the synovial fluid. Beside thorough workout to rule out infection in a painful and inflamed prosthetic knee, specific history of gout should be sought and fluid aspirate examined cytologically and under polarised light for crystal arthropathy.

Topics: Acute Disease; Aged; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Arthroplasty, Replacement, Knee; Diagnosis, Differential; Drug Therapy, Combination; Etoricoxib; Follow-Up Studies; Gout Suppressants; Humans; Male; Osteoarthritis, Knee; Postoperative Complications; Pyridines; Sulfones

Clinical gout has rarely been described after pediatric renal transplantation (RTx), although asymptomatic hyperuricemia is common in these patients. We describe three male pediatric patients who presented with gouty arthritis 7-8.5 years following RTx. Since receiving allopurinol, all patients had been free of gouty symptoms. To prevent severe bone marrow depletion, the dosage of azathioprine, an immunosupressant drug, was reduced by 50% to prevent interaction with allopurinol. Because atypical presentation of gout can occur, a high index of suspicion is needed to allow appropriate diagnosis of this disease in patients with skeletal pain after RTx.

Topics: Adolescent; Allopurinol; Arthritis, Gouty; Azathioprine; Biopsy; Child; Gout Suppressants; Humans; Immunosuppressive Agents; Kidney Transplantation; Magnetic Resonance Imaging; Male; Treatment Outcome

To enable clinicians to initiate appropriate steps for long-term management of gout, including controlling acute exacerbations and pain and sustaining target serum uric acid (SUA) levels to control hyperuricemia as the underlying metabolic disorder.. Incorporation of pertinent rheumatology and primary care literature seeking a comprehensive overview about the disease state of gout and its symptoms, comorbidities, and impact on quality of life, with a key focus on the role of serum uric acid, evidence-based approaches to long-term management of gout, and the importance of a functioning clinician-patient relationship.. Gout is increasingly recognized as a prevalent chronic disease state requiring appropriate long-term management while controlling for risk factors and comorbid conditions. Effective treatment options can help gout patients achieve therapeutic SUA targets to control gout flares and prevent potentially destructive disease manifestations. Patient education is an important element in achieving treatment goals and ensuring adherence.. Effective treatment plans for any gout patient must be guided by a long-term approach that focuses on sustained control of hyperuricemia, while providing continuous control of chronic disease. Patient education can be a key element in this process.

Topics: Acute Disease; Aged; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Arthritis, Rheumatoid; Chronic Disease; Colchicine; Comorbidity; Disease Progression; Febuxostat; Gout; Gout Suppressants; Humans; Hyperuricemia; Male; Middle Aged; Patient Education as Topic; Quality of Life; Risk Factors; Thiazoles; Uric Acid; Uricosuric Agents; Xanthine Oxidase

Topics: Acute Disease; Adult; Allopurinol; Ankle Joint; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Arthritis, Gouty; Celecoxib; Cyclooxygenase 2 Inhibitors; Diagnosis, Differential; Edema; Gout Suppressants; Humans; Male; Pyrazoles; Sulfonamides

Topics: Administration, Oral; Allopurinol; Ankle; Arthritis, Gouty; Cervical Vertebrae; Drug Therapy, Combination; Glucocorticoids; Gout Suppressants; Humans; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Uric Acid

Gout is a disease of purine metabolism characterized by monosodium urate crystal deposition. Gouty tophi can mimic many conditions such as infection or neoplasm.. We descriptively presented a case of a 29-year-old male with gouty toph. Data was obtained from patient chart. This patient presented with limited knee joint range of motion after sport injury. Arthroscopic examination was performed in order to confirm the diagnosis of the meniscal injury.. The result showed the synovium with white toothpaste-like chalky urate crystals in the joint cartilage.. An atypical presentation of gouty tophi can sometime mislead to diagnose an internal derangement of the knee.

Topics: Adult; Allopurinol; Arthritis, Gouty; Arthroscopy; Diagnosis, Differential; Gout Suppressants; Humans; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Male; Naproxen; Radiography; Range of Motion, Articular; Synovial Membrane; Treatment Outcome; Uric Acid

Lithospermic acid (LSA) was originally isolated from the roots of Salvia mitiorrhiza, a common herb of oriental medicine. Previous studies demonstrated that LSA has antioxidant effects. In this study, we investigated the in vitro xanthine oxidase (XO) inhibitory activity, and in vivo hypouricemic and anti-inflammatory effects of rats. XO activity was detected by measuring the formation of uric acid or superoxide radicals in the xanthine/xanthine oxidase system. The results showed that LSA inhibited the formation of uric acid and superoxide radicals significantly with an IC50 5.2 and 1.08 microg/ml, respectively, and exhibited competitive inhibition. It was also found that LSA scavenged superoxide radicals directly in the system beta-NADH/PMS and inhibited the production of superoxide in human neutrophils stimulated by PMA and fMLP. LSA was also found to have hypouricemic activity on oxonate-pretreated rats in vivo and have anti-inflammatory effects in a model of gouty arthritis. These results suggested that LSA is a competitive inhibitor of XO, able to directly scavenge superoxide and inhibit superoxide production in vitro, and presents hypouricemic and anti-inflammatory actions in vivo.

Topics: Allopurinol; Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Benzofurans; Depsides; Disease Models, Animal; Dose-Response Relationship, Drug; Enzyme Inhibitors; Humans; Hyperuricemia; Inflammation; Male; Molecular Conformation; N-Formylmethionine Leucyl-Phenylalanine; Neutrophils; Oxonic Acid; Rats; Rats, Wistar; Reactive Oxygen Species; Tetradecanoylphorbol Acetate; Uric Acid; Xanthine Oxidase

A 31-year-old Army specialist was evaluated at Walter Reed Army Medical Center for an acute attack of arthritis in the left hand. After an initial evaluation, the patient was referred to the rheumatology service, and gout was diagnosed on the basis of synovial fluid analysis. This case demonstrates an uncommon presentation of a common disorder in an active duty soldier. The discussions presented following the clinical data are meant to expand diagnostic considerations for patients with similar symptoms, to address risk factors for gout relevant to the military, and to clarify the management of gout.

Topics: Acute Disease; Adult; Allopurinol; Arthritis, Gouty; Gout Suppressants; Humans; Male; Military Medicine; Military Personnel; Synovial Fluid; United States; Uric Acid

Topics: Adult; Allopurinol; Arthritis, Gouty; Arthroplasty; Biopsy, Needle; Debridement; Follow-Up Studies; Humans; Immunohistochemistry; Male; Pain Measurement; Range of Motion, Articular; Recovery of Function; Risk Assessment; Rotator Cuff; Shoulder Pain; Treatment Outcome

Ascidiathiazones A (3) and B (4), two new tricyclic thiazine-containing quinolinequinone alkaloids, were isolated from the New Zealand ascidian Aplidium species. Both compounds inhibited the in vitro production of superoxide by PMA-stimulated human neutrophils in a dose-dependent manner with IC50 1.55 +/- 0.32 and 0.44 +/- 0.09 microM, respectively. In vivo inhibition of superoxide production by peritoneal neutrophils in a murine model of gout was observed for both compounds with oral doses of 25.6 micromol/kg. Ascidiathiazone A (3) was synthesized in four steps from 8-hydroxyquinoline-2-carboxylic acid.

Topics: Alkaloids; Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Dose-Response Relationship, Drug; Humans; Mice; Models, Biological; Neutrophils; New Zealand; Respiratory Burst; Superoxides; Thiazines; Urochordata

Gout cannot be regarded a benign disease, as it is unfortunately often misunderstood. In view of the lack of recent evidence-based recommendations for the diagnosis and management of gout, the European League Against Rheumatism (EULAR) decided to commission a task force to develop such recommendations. A literature search was performed to comprehensively assess the clinical and epidemiological aspects, diagnostic tools, as well as effectiveness of therapeutic measures and the overall management. Subsequently, consensus among the participating experts should be achieved by applying a Delphi process. As a result of this project 10 recommendations for diagnosis of gout as well as 12 recommendations with respect to the management of the disease could be elaborated. Gout can be regarded as a disease with excellent prognosis in the light of the diagnostic and therapeutic possibilities available. However, this only holds true if all these possibilities are applied in the appropriate manner in daily routine. It constituted the primary goal of the EULAR project to deliver a substantial contribution to improve routine care of affected patients.

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Delphi Technique; Europe; Evidence-Based Medicine; Genetic Predisposition to Disease; Gout; Gout Suppressants; Humans; Life Style; Societies, Medical; Uric Acid

Juvenile chronic gout in its polyarticular deformative form has rarely been described in medical literature. We report a rare case of destructive polyarticular tophaceous gout in a 31-year-old Senegalese man. He consulted for bilateral asymmetric polyarthritis with deformities of the hands and feet that had been ongoing in recurrent episodes since the age of 18 years in association with tophus. He had received no previous medication. All laboratory investigations were normal except hyperuricemia 104 mg/l. Radiographs of affected joints demonstrated evidence of destructive polyarthritis, i.e., articular narrowing and osteo-condensation of the left great toe. The patient responded favourably to colchicine, allopurinol and diet. Gouty arthropathy must be differentiated from rheumatoid arthritis, psoriasic arthritis and distal chronic osteoarthrosis. In our case, definitive diagnosis of gouty arthropathy was based on chronic polyarthritis associated with tophus, hyperuricemia and therapeutic response to colchicine. Polyarticular gout can be suspected in case of chronic seronegative polyarthritis and diagnosis can be confirmed on the basis of plain radiographs and laboratory investigations showing uricemia. Treatment is effective, well tolerated and inexpensive.

Topics: Adult; Allopurinol; Arthritis; Arthritis, Gouty; Colchicine; Diagnosis, Differential; Humans; Male; Uric Acid

A 56-year-old white woman was referred to our institution with a 16-month history of severe, gouty, recurrent, acute polyarthritis involving the finger joints. She also had numerous small subcutaneous tophi in her hands. The patient was intolerant to allopurinol and had mild renal insufficiency attributed to uric-acid nephrolithiasis and interstitial nephropathy.. Physical examination, laboratory testing, X-rays of the hands, feet and pelvis, CT of the pelvis, microscopic analysis of an aspirate from a finger tophus.. Tophaceous gout associated with urate nephropathy in a patient intolerant to allopurinol.. Acute polyarthritis was successfully managed by intravenous bolus methylprednisolone combined with codeine, diclofenac and low-dose colchicine. Rasburicase infusions combined with fenofibrate and sodium bicarbonate achieved to maintain serum acid uric below 360 micromol/l.

Topics: Allopurinol; Arthritis, Gouty; Diagnosis, Differential; Female; Finger Joint; Gout Suppressants; Humans; Hypersensitivity; Middle Aged; Recombinant Proteins; Severity of Illness Index; Urate Oxidase

Withdrawal of urate-lowering therapy (ULT) is associated with recurrence of acute gouty arthritis and tophi, but no data are available about factors associated with recurrence of gouty symptoms. Therefore, life-long therapy prescription is usually advised, but the prospect of life-long therapy may contribute to very low compliance rates. Our objective was to ascertain the outcome of ULT withdrawal after long-term, documented control of serum urate levels.. We conducted a prospective, long-term, followup study of patients treated with ULT during a 5-year period. Both diagnosis and recurrence of gout were determined based on monosodium urate crystal identification in synovial fluid or material aspirated from tophi.. Low average serum urate levels while receiving ULT and during the followup period after ULT withdrawal were statistically associated with the longest period in which patients were free of gouty symptoms, suggesting that depletion and formation of the body's urate pool is dependent on both time and serum urate levels. Patients whose average serum urate levels were <5.05 mg/dl while receiving ULT and <8.75 mg/dl after ULT withdrawal had the longest (>4 years) time to recurrence.. Proper and long-term reduction of serum urate level is associated with long-term periods in which patients are free of gouty symptoms, probably due to the reduction of the urate pool. These results suggest that 5-year intermittent, instead of life-long, ULT could be offered to patients with good serum urate control during ULT.

Topics: Adult; Aged; Aged, 80 and over; Allopurinol; Arthritis, Gouty; Benzbromarone; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Gout Suppressants; Humans; Life Style; Middle Aged; Predictive Value of Tests; Prospective Studies; Secondary Prevention; Time Factors; Uric Acid

Our objective was to analyze serum total homocysteine (tHcy) levels for gouty patients and to study whether there are any level changes following treatment with allopurinol. We enrolled 90 male participants including patients with primary gout (n=51) and community-based healthy controls (n=39). Fasting tHcy levels were determined for all subjects and repeat measurements performed for 29 patients following treatment with allopurinol. The results revealed that gouty patients exhibited significantly greater serum tHcy levels (12.10+/-3.19 micromol/l) than healthy controls did (9.96+/-2.16 micromol/l) (p=0.0003), although there was no obvious difference between the pre-allopurinol treatment group (12.54+/-3.31 micromol/l) and its post-treatment analogue (11.90+/-4.68 micromol/l) (n=29, p=0.33). Elevated serum levels of tHcy were noted for this cohort of male gouty patients as compared to healthy controls, and these tHcy levels did not appear to change substantially following treatment with allopurinol. Although the pathogenesis of hyperhomocysteinemia for gouty patients still remains somewhat obscure, this study suggests that tHcy levels cannot be effectively modulated by treatment with allopurinol.

Topics: Adult; Allopurinol; Arthritis, Gouty; Case-Control Studies; Gout Suppressants; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Prospective Studies; Risk Factors

In most cases gout is the clinical manifestation of familial hyperuricemia. Pathogenesis of hyperuricemia, clinical manifestations, diagnosis and differential diagnosis of hyperuricemia and gout are described. Treatment of hyperuricemia consists of dietary measurements and administration of uric acid lowering drugs, such as allopurinol or uricosuric agents. Nonsteroidal antiinflammatory drugs, colchicine and glucocorticosteroids are the treatment of choice for the acute gout attack. Prophylaxis of acute uric acid nephropathy consists of hydration, urine alkalinization and administration of allopurinol or rasburicase. For treatment of acute uric acid nephropathy rasburicase is the drug of choice.

Topics: Allopurinol; Arthritis, Gouty; Diagnosis, Differential; Gout; Gout Suppressants; Humans; Hyperuricemia; Kidney Calculi; Prognosis; Purine-Pyrimidine Metabolism, Inborn Errors; Renal Insufficiency; Uricosuric Agents

Topics: Adult; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Benzbromarone; Diagnosis, Differential; Gout Suppressants; Humans; Hyperuricemia; Magnetic Resonance Imaging; Male; Spinal Neoplasms; Spondylitis

To characterize purine metabolism in osteoarthritis (OA) and gout arthritis (GA) diagnosis and differential diagnosis of these diseases.. We estimated xanthine oxidase (XA), xanthine dehydrogenase (XDG), 5'-nucleotidase (5'-NT) activity, esoenzymes of XDG and content of uric acid (UA) in the sera of 44 patients with osteoarthritis and 34 patients with gout arthritis.. Hyperuricemia was revealed in 25 percent of patients with osteoarthritis, in 64.7 percent of patients with gout arthritis. XO, XDG, 5'NT activity, XO/XDG activities ratio, XDG-2 esoenzymes and content of UA were increased in OA patients compared to healthy controls. XO, XDG activity, XDG-2 esoenzymes and UA content in GA patients were higher than those in OA patients.. The enzyme difference found may promote differential diagnosis of OA and GA. The enzyme indices essentially depend on clinical specificity of the disease and can be helpful in the assessment of the treatment efficiency.

Topics: 5'-Nucleotidase; Arthritis, Gouty; Biomarkers; Diagnosis, Differential; Female; Humans; Isoenzymes; Male; Middle Aged; Osteoarthritis; Purines; Severity of Illness Index; Uric Acid; Xanthine Dehydrogenase; Xanthine Oxidase

Topics: Adult; Allopurinol; Arthritis, Gouty; Combined Modality Therapy; Drug Resistance; Fatal Outcome; Gout Suppressants; Humans; Kidney Failure, Chronic; Male; Renal Dialysis; Uric Acid

Topics: Allopurinol; Arthritis, Gouty; Drug Eruptions; Gout Suppressants; Humans; Uricosuric Agents

Although the prevalence of tophaceous gout has decreased in the past few years, the disease still exists, and without accurate diagnosis and therapy, it can still result in destructive arthritis. However, use of urate-lowering drugs may reduce plasma urate concentrations enough to allow resorption of tophi and prevent painful tophaceous gout. Some patients may have mechanical problems from tophi, despite adequate control of acute arthritis; in such situations, joint replacement or surgical excision of tophi may be necessary.

Topics: Adrenal Cortex Hormones; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Diagnosis, Differential; Female; Gout; Gout Suppressants; Humans; Male; Uricosuric Agents

A 32-year-old man who had had frequent gouty arthritis over the past 17 years, was admitted for acute renal failure. Acute renal failure was improved rapidly after medication was resumed and the patient was sufficiently hydrated. The hypoxanthine-guanine phosphoribosyltransferase (HPRT) activity in the patient had been reduced to about 30% of the normal control. Therefore we considered that this patient suffered from a partial deficiency of HPRT. A point mutation of HPRT gene 68G (guanine) to T (thymine) was detected. This is a mutation that has not been previously reported. Familial analysis indicated that his mother and sister were heterozygotes.

Topics: Acute Kidney Injury; Adult; Allopurinol; Arthritis, Gouty; Diagnosis, Differential; DNA; DNA Probes; Follow-Up Studies; Gout Suppressants; Humans; Hypoxanthine Phosphoribosyltransferase; Male; Middle Aged; Nuclear Family; Point Mutation; Reverse Transcriptase Polymerase Chain Reaction

Topics: Adult; Aged; Allopurinol; Arthritis, Gouty; Benzbromarone; Diagnosis, Differential; Female; Gout; Gout Suppressants; Humans; Male; Middle Aged; Probenecid; Synovial Fluid; Uric Acid; Uricosuric Agents

Topics: Acute Disease; Allopurinol; Arthritis, Gouty; Gout Suppressants; Humans; Male; Prospective Studies; Retrospective Studies; Uric Acid

An eighty-year-old woman suffered from acute idiopathic gout of the right sacroiliac joint and tophaceous deposits in two fingers of her right hand. Hyperuricemia and findings consistent with gout detected by histological examination of a biopsy specimen taken from the digital nodules supported the diagnosis. The radiological workup revealed osteolytic changes at the bases of the phalanges in Roentgenograms of the feet. Various aspects of the very rare incidence of sacroiliac gout are discussed.

Topics: Acute Disease; Aged; Aged, 80 and over; Allopurinol; Arthritis, Gouty; Biopsy, Needle; Colchicine; Female; Finger Joint; Gout Suppressants; Humans; Sacroiliac Joint

To analyze the clinical features and identify factors associated with the development of gouty arthritis in nodal osteoarthritis (OA).. Thirty-two consecutive patients (21 women and 11 men, mean age 75.8 years) with both nodal OA and crystal proven acute gout and/or tophi of distal/proximal interphalangeal (DIP/PIP) joints were studied between 1986 and 1994.. Tophi of DIP and/or PIP joints were present in 29 (90%) patients; alone in 9 and together with acute DIP or PIP gouty arthritis in 20. Three patients had acute DIP or PIP gouty episodes but no digital tophi. Mean pretreatment serum urate was 614.9 +/- 163.2 (range 422-1088 mumol/l). Risk factors for gout included diuretic use (81%), renal failure (59%), hypertension (66%), alcoholism (22%), prophylactic low dose ASA (20%), and a positive family history (16%) of patients.. The coexistence of gouty arthritis in nodal OA is important to recognize and treat, particularly in elderly women with renal failure, hypertension, or cardiac failure who are receiving longterm diuretic therapy.

Topics: Acute Disease; Aged; Aged, 80 and over; Allopurinol; Arthritis, Gouty; Female; Finger Joint; Follow-Up Studies; Gout Suppressants; Humans; Male; Middle Aged; Osteoarthritis; Radiography; Retrospective Studies; Risk Factors; Treatment Outcome

The traditional Chinese antirheumatic herb Danggui-Nian-Tong-Tang (DGNTT) was studied comparatively with indomethacin and allopurinol to evaluate its anti-inflammatory and antihyperuricemic effects in patients with gout. Results in this study did not show any significant improvement in reducing the total number of painful and swollen joints, articular index and pain score (P > 0.05) by treatment with DGNTT. Unlike allopurinol, DGNTT did not lower the high serum level of uric acid. In vitro study in rats showed that DGNTT significantly inhibits the activity of beta-glucuronidase (P < 0.05) and lysozyme release (P < 0.01) from neutrophils. In conclusion, despite the effect of inhibition on enzyme release from neutrophils, DGNTT is not effective in treating acute arthritis or hyperuricemia.

Topics: Adolescent; Adult; Aged; Allopurinol; Arthritis, Gouty; Female; Humans; Indomethacin; Lymphocyte Activation; Male; Medicine, Chinese Traditional; Middle Aged; Treatment Outcome

To determine in a Canadian health care setting the cost effectiveness of urate lowering drugs (ULD) in the treatment of nontophaceous gouty arthritis with recurrent attacks and to evaluate the least costly regimen among available ULD.. A decision analysis model was designed using hypothetical cohort of patients who present 1 to 4 recurrent attacks/year. It incorporated costs and probabilities estimated from the published literature. Effectiveness was defined as the number of recurrent attacks averted by each treatment strategy (ULD or No ULD). The incremental cost effectiveness ratio was defined as the ratio of the additional cost incurred by a management strategy compared with the additional benefit derived from it. A multiway sensitivity analysis was built to allow the modelling of extreme case scenarios favoring (best ULD scenario) and disfavoring (worst ULD scenario) the ULD therapy.. Using the baseline scenario estimates for the hypothetical cohort of patients presenting one attack/year, the total annualized costs per patient associated with ULD and No ULD treatment were Cdn $426.27 and 267.27, respectively. The average cost effectiveness ratios were $592.25 and 5,345.37, respectively, per attack averted. For this cohort of patients the incremental cost effectiveness ratio ranged from $99.59 (best ULD scenario) to 489.26 (worst ULD scenario). The treatment with ULD is cost saving if patients present 2 or more attacks/year. Allopurinol in its generic formulation was the ULD that presented the lowest incremental cost effectiveness ratio.. ULD treatment is cost effective. It is also saving if patients present 2 or more recurrent attacks/year.

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Cost-Benefit Analysis; Decision Support Techniques; Gout Suppressants; Humans; Recurrence

Topics: Allopurinol; Arthritis, Gouty; Humans; Uric Acid; Urinary Calculi

Topics: Adult; Allopurinol; Arthritis, Gouty; Benzbromarone; Creatinine; Drug Combinations; Drug Evaluation; Female; Gout; Humans; Male; Middle Aged; Time Factors; Uric Acid

Urate oxidase, or uricase (EC 1.7.3.3), is a purine metabolic enzyme that catalyzes the conversion of uric acid to allantoin in most mammals except humans and certain other primates. The loss of urate oxidase in the human during primate evolution predisposes man to hyperuricemia, a metabolic disturbance that can lead to gouty arthritis and renal stones. To create a mouse model for hyperuricemia and gout, and to address the question of whether urate oxidase is essential in lower mammalian species, we have disrupted the urate oxidase gene in the mouse by homologous recombination in embryonic stem cells. Unlike the human situation, urate oxidase deficiency in mice causes pronounced hyperuricemia and urate nephropathy. More than half of the mutant mice died before 4 weeks of age, indicating that urate oxidase is essential in mice. These mutant mice may also serve as animal models for hyperuricemia and its related nephropathy in humans.

Topics: Allopurinol; Animals; Arthritis, Gouty; Disease Models, Animal; Genes, Lethal; Humans; Kidney Calculi; Kidney Diseases; Mice; Mice, Inbred C57BL; Mice, Mutant Strains; Species Specificity; Urate Oxidase; Uric Acid

The principles governing the pathogenesis and treatment of gout have been established with greater clarity than those for almost any other rheumatic disease. The benefits of treatment include the virtual cure of a disabling and deforming disease. Adherence to proper management guidelines provides predictable relief of symptoms for patients and great satisfaction for the treating physician.

Topics: Acute Disease; Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Humans; Indomethacin; Uric Acid; Uricosuric Agents; Xanthine Oxidase

Topics: Acute Disease; Adult; Allopurinol; Arthritis, Gouty; Colchicine; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Uric Acid

If Dr. Sydenham could have benefited from today's therapy, he likely would not have had to endure thirty years of "violent ... torture" that gave birth to his most elegant and classic description of acute gout. The five key points to remember in management of the gouty spectrum are: (1) Establish the diagnosis as clearly as possible or as clearly as seems necessary under the clinical circumstances (i.e. arthrocentesis with crystal analysis to establish diagnosis is not always necessary with reliable patients when septic joint seems highly unlikely). (2) Treat acute attacks with NSAIDs alone or perhaps steroids--or rarely IV colchicine under special circumstances. (3) DO NOT START ALLOPURINOL OR PROBENECID DURING AN ACUTE FLARE OF GOUT--IT MAY MAKE THE EPISODE WORSE. (4) The pattern of disease over time (frequency and severity of attacks) determines whether or not one decides to use an agent such as allopurinol, probenecid, or prophylactic colchicine chronically once a patient is over the acute attack--the mere presence of increased uric acid and a single or rare gouty attack would not usually require any other than the appropriate acute therapy. (5) The presence of visible tophi, uric acid renal calculi and destructive gouty arthritis nearly always warrant uric acid lowering therapy.

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Arthritis, Infectious; Gout; Humans; Uric Acid

Topics: Allopurinol; Arthritis, Gouty; Humans; Uric Acid

Ten years ago, we studied the clinical and radiographic manifestations of gout in 60 patients and described 3 patterns of disease. To determine the consequences of management over a 10-year period, we recently reassessed the 39 available patients of this population. We found that although reduced tophaceous deposition on physical examination correlated with normalization of the serum urate concentration, no correlation existed between radiographic changes and mean serum urate concentrations. Progression of gouty changes on radiography reflected progressive deformity on physical examination. We have described the radiographic changes that occurred in a well-characterized population of subjects with gout over 10 years and determined that serum urate concentrations alone may not provide an effective means of monitoring the progression of tophaceous disease in bone.

Topics: Aged; Aged, 80 and over; Allopurinol; Arthritis, Gouty; Humans; Middle Aged; Probenecid; Radiography; Uric Acid; Wrist

Thirty patients with gouty arthritis were studied over 3 years. The diagnosis was established with the help of polarised light microscopy. All the patients were males, with a median age of 45 years. They belonged to the middle or upper socio-economic class and were obese (mean body mass index 29.7). Chronic alcoholism, diabetes mellitus and hypertension were present in one patient each. No patient had symptomatic coronary artery disease. Although 6 patients had a history of renal colic, only one had gouty nephropathy with chronic renal failure. Six patients had a positive family history of gout. The disease involved mostly the joints of the lower extremity and podagra was observed in 70% of patients. Eight patients had tophi at various sites. There were 17 'over producers' and 13 'under excretors' of uric acid. The treatment consisted of patient education, symptomatic control with non steroidal anti-inflammatory drugs and/or colchicine and antihyperuricaemic therapy. The overproducers were treated with allopurinol while the under excretors were treated with [corrected] sulfinpyrazone. In general, there was a good response to therapy as indicated by lowering of serum uric acid and the number of painful episodes per year. The overall profile of the disease appears similar to that seen in the West.

Topics: Adult; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Evaluation Studies as Topic; Humans; India; Male; Middle Aged; Patient Education as Topic; Sulfinpyrazone; Uric Acid

Topics: Allopurinol; Arthritis, Gouty; Gout; Humans; Middle Aged; Uric Acid

We recently have conducted a cross-sectional survey to determine the prescribing practices of rheumatologists and a random sample of general practitioners in New South Wales and Queensland. While in general there was agreement as to the preferred management of gout, several important differences were noted between the two groups of doctors. In particular, general practitioners were more liberal than were rheumatologists in their use of allopurinol. However, they were less likely to cover the introduction of allopurinol with anti-inflammatory agents, to titrate the dose against the serum uric acid level or to adjust the dose according to the serum creatinine level. A small number of doctors continued to use urate-lowering drugs as a routine in the treatment of entirely asymptomatic hyperuricaemia. The data indicate a continuing need to disseminate information regarding the preferred management of hyperuricaemic states.

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Gouty; Colchicine; Drug Utilization; Family Practice; Humans; New South Wales; Queensland; Rheumatology; Uric Acid