exudates and Gout

Gout is one of the most common inflammatory arthritis in Malaysia. It is due to persistent hyperuricemia that leads to the formation and deposition of intra- and periarticular monosodium urate crystals either due to excessive production or insufficient excretion of uric acid. Incidence and prevalence of gout is increasing worldwide, with a higher rate among men compared to women. Malay is the largest ethnic group in Malaysia, followed by Chinese and Indian. SLC2A9 is a renal urate transporter that controls renal uric acid excretion and genetic variants in SLC2A9 are associated with the risk of gout in several populations. This study aimed to test if the SLC2A9 variant (R265H, rs3733591) is also associated with gout among Malays in Malaysia.. A total of 89 patients with gouty arthritis and 100 normal subjects who consented and were recruited in this study. The serum urate and creatinine were measured. The SNP genotyping was performed using PCR-RFLP method for rs3733591 and BST 1236 was used as a restriction enzyme to cut the targeted amplicons.. SLC2A9 variant was associated with gout, p-value of 0.007, OR=4.713 [95%CI 1.530-14.513], however this association was not significant after adjustment for age and gender with p=0.465 (OR=1.950; 95%CI[0.325-11.718]).. Our data suggest that the genetic variant of SLC2A9 may contribute to the susceptibility of gout among Malays in Malaysia.

Topics: Adolescent; Adult; Aged; Asian People; Case-Control Studies; Creatinine; Female; Genetic Association Studies; Genetic Predisposition to Disease; Glucose Transport Proteins, Facilitative; Gout; Humans; Malaysia; Male; Middle Aged; Polymorphism, Single Nucleotide; Uric Acid; Young Adult

The main objective of this study is to elucidate the clinical significance of the SLC2A9/GLUT9 rs11722228 polymorphism among male gout patients.. We consecutively recruited all newly diagnosed male gout patients who were treatment-naive from the rheumatology outpatient clinics of two Malaysian hospitals. Age-matched healthy male adults were employed as controls. All subjects were tested for the SLC2A9/GLUT9 rs11722228 genotypes, serum uric acid (SUA), urine uric acid and creatinine levels. All gout subjects were examined for the presence of tophi and sonographically screened for renal calculi.. A total of 73 male gout patients and 73 age-matched healthy male adults were recruited in this study. The genotypic frequencies of SLC2A9/GLUT9 rs1172228 did not differ significantly between the gout cases and the healthy controls. The gout subjects with the CC genotype had significantly higher SUA levels (P = 0.002), family history of gout (P < 0.050) and the occurrence of renal calculi (P = 0.026). The SUA-adjusted odds ratios (OR) of the occurrence of renal calculi in the CC genotype (OR = 1 [reference]) was significantly higher than the CT genotype (OR = 0.338, 95%CI: 0.141-0.813) and the TT genotype (OR = 0.271, 95%CI: 0.086-0.854).. The genotypic distribution of SLC2A9/GLUT9 rs1172228 in male gout patients did not differ significantly from that of healthy male controls. However, the CC genotype in gout had significant associations with higher levels of SUA, renal calculi and a positive family history of gout.

Topics: Adult; Aged; Case-Control Studies; Chi-Square Distribution; Creatinine; Gene Frequency; Genetic Association Studies; Genetic Markers; Genetic Predisposition to Disease; Glucose Transport Proteins, Facilitative; Gout; Heredity; Heterozygote; Homozygote; Humans; Kidney Calculi; Logistic Models; Malaysia; Male; Middle Aged; Odds Ratio; Pedigree; Phenotype; Polymorphism, Single Nucleotide; Risk Factors; Ultrasonography; Uric Acid

We performed a prospective study of all patients diagnosed with gout and who received treatment in Sarawak General Hospital from 1 July 2010 to 31 December 2010. There was a total of 138 patients in our study of which 92 (66.7%) were from the indigenous populations. They have a mean age of 56.5 ± 12.5 years with a mean duration of illness of 11.6 ± 8.7 years. The mean lag time between symptom onset to the diagnosis of gout was 2.8 ± 4.8 years and a mean lag time to appropriate treatment of gout of 8.8 ± 8.4 years. Sixty-six (47.8%) patients have family history of gout. The common complications of gout in our patients were tophi (47.1%), joint deformities (39.1%), kidney stones (16.7%), and uric acid nephropathy (0.7%). Hospitalization occurred in 93 (67.4%) patients. Gout is a serious medical problem in our centre. Gout affects middle-aged men, especially the indigenous populations. Almost half of our patients have a family history of gout and have tophi formations. Our gout patients have a significant delay in diagnosis and appropriate treatment, thus contributing to more complications and hospitalizations in our centre. There is an urgent need to educate both patients and healthcare workers on gout and its treatment to reduce the burden of chronic gout in Sarawak.

Topics: Adult; Aged; Female; Gout; Gout Suppressants; Hospitalization; Humans; Malaysia; Male; Middle Aged; Prospective Studies

Gout and hyperuricaemia attributed to genetic and lifestyle factors have been associated with several chronic diseases. This study aimed to determine the association and interaction effects between vascular endothelial growth factor receptor-2 (VEGFR-2) gene polymorphisms (rs1870377 and rs2071559) and dietary patterns on blood uric acid in Malay and Indian adults.. Dietary intakes of 153 Malays and 177 Indians were obtained using a food frequency questionnaire for the construction of dietary patterns using factor analysis. Genotyping of rs1870377 and rs2071559 was performed by real-time PCR using TaqMan probes. Anthropometric measurements, body mass index (BMI) and blood pressure and biomarkers, uric acid, glycated haemoglobin A1c (HbA1c), and blood lipids were determined.. There were significant differences in the mean values for HbA1c (41 +/- 12 vs 45 +/- 8 mmol/mol, p < 0.001) and blood lipids levels (p < 0.05) between Malays and Indians. Significant correlations were obtained between uric acid with selected blood lipids (p < 0.05) and BMI in Malays (r = 0.362, p < 0.001) and Indians (r = 0.212, p < 0.01). Four dietary patterns were extracted from dietary intakes of all subjects: 'Vegetables diet'; 'Fruits diet' (FD); 'Animal protein and rice diet'; and 'Fast foods and preserved foods diet'. There were no significant associations between dietary patterns (p = 0.054-0.609) and VEGFR-2 gene polymorphisms (p = 0.348-0.778) with uric acid. In Malay subjects, the interaction of rs2071559 and FD had a borderline effect (p = 0.05) on blood uric acid after adjusting for potential confounders.. The associations and gene-diet interactions involving VEGFR-2 gene polymorphisms and FD on uric acid provide new information on gout and hyperuricaemia risks in Malays.

Topics: Adult; Animals; Body Mass Index; Diet; Dietary Proteins; Fast Foods; Female; Food; Fruit; Genotype; Glycated Hemoglobin; Gout; Humans; Hyperuricemia; India; Lipids; Malaysia; Male; Middle Aged; Polymorphism, Genetic; Polymorphism, Single Nucleotide; Real-Time Polymerase Chain Reaction; Surveys and Questionnaires; Uric Acid; Vascular Endothelial Growth Factor Receptor-2; Vegetables

The aim of this study was to ascertain the management of gout by doctors in Malaysia.. A cross-sectional questionnaire survey was carried out among doctors attending rheumatology post-graduate courses, where gout was not a lecture topic.. A total of 128 questionnaires were analyzed, of which the majority (67: 52.3%) were general practitioners. In the treatment of acute gout, 68.0% use non-selective non-steroidal anti-inflammatory drugs (NSAIDs), 53.9% use selective COX-2 inhibitors (coxibs), 66.4% use colchicine and 10.2% use allopurinol (ALLO). In the treatment of chronic gout, 36.7% use NSAIDs, 44.5% use coxibs, 19.5% use colchicine and 93% use ALLO. In both acute and chronic gout, corticosteroids (CS) are not used by over 90% of respondents. Fifty percent would stop ALLO during an acute attack. 95.3% do not start ALLO during an acute attack; 87.5% would start ALLO after the attack, with a median of 14 days afterwards. Once ALLO was started, 54.7% would continue indefinitely. Regarding target urate levels while on treatment, 10.9% would be satisfied with a high normal range, 21.9% middle of the range, 18.0% low normal range and 45.3% anywhere within the normal range. Fifteen percent would treat asymptomatic hyperuricemia.. In Malaysia, anti-inflammatory agents are most commonly used for the treatment of acute and chronic gout, with corticosteroid usage at a low level. However, there are areas of concern regarding the diagnosis of gout and the usage of ALLO which are not consistent with current guidelines.

Topics: Acute Disease; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Colchicine; Cross-Sectional Studies; Cyclooxygenase 2 Inhibitors; Glucocorticoids; Gout; Gout Suppressants; Humans; Malaysia; Primary Health Care; Professional Practice; Reference Values; Surveys and Questionnaires; Uric Acid

We describe a 10 year observation of the effect of control of hyperuricemia compared with self-medication alone in patients with chronic gout.. We studied 299 consecutively self-referred Malayo-Polynesian men with chronic gout, mean age 35 +/- 14.3 SD years. Subjects comprised 228 cases with chronic gout without tophi or urolithiasis (Group 1) and 71 with those complications (Group 2). Attacks of acute gouty arthritis were treated with nonsteroidal antiinflammatory drugs (NSAID) and/or corticosteroids. After acute arthritis had settled, urate-lowering drugs were instituted in both groups combined with low dose colchicine and/or low dose NSAID for at least 0.5-2 years. Urate levels were maintained longterm at a mean of < 5 mg/dl. After 10 years, the dropouts were traced and evaluated for comparison with baseline and those who remained in the study. In Group 2 the urate-lowering drugs were continued.. Control of gout and hyperuricemia was achieved in all patients who remained under control: 91.6% of the 299 patients for at least 2 years (short-term), up to 5 years in 87.5% (medium term), and up to 10 years in 79.6% (longterm). In Group 1 (chronic gout without complication) only 36.8% had no attacks during 8 years, after they had tapered urate-lowering drug after the first 2 years of the study. In the 61 dropouts the intermittent symptomatic treatment and/or self-medication without longterm control of hyperuricemia resulted after 1 decade in chronic gout with more complications and associated conditions leading to increased morbidity, disability, and comorbidity, and 3 early mortalities.. By controlling hyperuricemia, improvement of the prognosis of chronic gout, comorbidity, and early death was achieved compared with self-medication alone. Self-medication in a developing country if continued unchecked may become a public health problem in a population with a high prevalence rate of gout.

Topics: Adult; Chronic Disease; Developing Countries; Gout; Humans; Indonesia; Joints; Malaysia; Male; Polynesia; Self Medication; Treatment Outcome; Uric Acid; Urinary Calculi

The aim of this retrospective study was to characterise the clinical presentation and disease associations of Oriental patients with gout seen in our hospital over a six-month period. One hundred patients comprising of 77 males and 23 females [89% Chinese, 7% Malays, 2% Indians and 2% others; mean age was 50.9 years (range 18 to 82 years), mean age at onset of disease was 43.7 years (range 16 to 78 years)] were studied. The disease was familial in 18% and 44% of patients had a history of alcohol ingestion. Co-morbid conditions included hypertension (36%), hyperlipidaemia (25%), renal failure (17%), ischaemic heart disease (13%), diabetes mellitus (4%), systemic lupus erythematosus (3%), psoriasis (2%) and ankylosing spondylitis (1%). The majority of patients (68%) had at least one associated disease. At the onset of disease, the joints commonly involved were the ankles (39%) and knees (27%) whilst the first metatarsophalangeal (MTP) joint was affected in only 26% of cases. Polyarticular onset was uncommon (n = 6). The precipitating factors reported by the patients included food (n = 23), alcohol (n = 12), drugs (n = 4), trauma (n = 3) and surgery (n = 2). Eleven patients had a history of renal calculi and 15% had tophaceous gout. Majority of patients (71%) had been treated with urate-lowering drugs (allopurinol). We concluded that gout in Singapore predominantly affects middle-aged men who often have an accompanying illness.

Topics: Adolescent; Adult; Age Distribution; Age of Onset; Aged; Aged, 80 and over; China; Cohort Studies; Comorbidity; Female; Gout; Gout Suppressants; Hospitals; Humans; Incidence; Malaysia; Male; Middle Aged; Random Allocation; Retrospective Studies; Risk Factors; Sampling Studies; Sex Distribution; Singapore

Topics: Adolescent; Adult; Age Factors; Aged; Arthritis, Rheumatoid; China; Climate; Female; gamma-Globulins; Gout; Humans; India; Latex Fixation Tests; Lupus Erythematosus, Systemic; Malaysia; Male; Middle Aged; Racial Groups; Rheumatoid Factor; Rheumatoid Nodule; Serum Albumin

Topics: Female; Gout; Hemoglobinopathies; Humans; Hypersplenism; Malaysia; Male; Middle Aged; Racial Groups; Radiography; Sacroiliac Joint; Thalassemia

Topics: Adolescent; Adult; Age Factors; Asian People; Colorimetry; Ethnicity; Female; Gout; Humans; Malaysia; Male; Michigan; Middle Aged; New Guinea; Philippines; Sex Factors; Taiwan; Uric Acid; White People

Topics: Blood Chemical Analysis; Female; Gout; Humans; Malaysia; Male

Topics: Arthritis; Arthritis, Reactive; Borneo; Epidemiology; Gout; Humans; Malaysia; Osteoarthritis; Purpura