41,616 research outputs found

    What makes gouty inflammation so variable?

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    Acute gout arthritis flares contribute dominantly to gout-specific impaired health-related quality of life, representing a progressively increasing public health problem. Flares can be complex and expensive to treat, partly due to the frequent comorbidities. Unmet needs in gout management are more pressing given the markedly increasing gout flare hospital admission rates. In addition, chronic gouty arthritis can cause joint damage and functional impairment. This review addresses new knowledge on the basis for the marked, inherent variability of responses to deposited urate crystals, including the unpredictable and self-limited aspects of many gout flares. Specific topics reviewed include how innate immunity and two-signal inflammasome activation intersect with diet, metabolism, nutritional biosensing, the microbiome, and the phagocyte cytoskeleton and cell fate. The paper discusses the roles of endogenous constitutive regulators of inflammation, including certain nutritional biosensors, and emerging genetic and epigenetic factors. Recent advances in the basis of variability in responses to urate crystals in gout provide information about inflammatory arthritis, and have identified potential new targets and strategies for anti-inflammatory prevention and treatment of gouty arthritis

    Gouty arthritis of the spine in a renal transplant patient : a clinical case report: an unusual presentation of a common disease

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    Axial gout is a well-documented but uncommon manifestation of gout. Its mimicking nature and the impracticality of axial joint aspiration might considerably delay its diagnosis. We report a case in a normouricemic renal transplant recipient, whereby the primary symptom of severe neck pain suggested pyogenic spondylodiscitis as an initial tentative diagnosis. Clinical findings included a high C-reactive protein concentration and elevated body temperature. The patient did not respond to empiric antibiotic treatment and suffered consecutive attacks of severe wrist and ankle pain in conjunction with a persistent fever. Blood and joint cultures were negative, but analysis of aspirated ankle joint fluid revealed monosodium urate crystals. A dual-energy computed tomography scan confirmed the presence of monosodium urate crystals in the costovertebral joints. Colchicine treatment dramatically improved the patient's clinical condition. Axial gout should be considered in transplant recipients with severe neck or back pain, fever, and increased inflammatory parameters with a high likelihood of an infectious etiology, despite the presence of paradoxically normal or even decreased serum urate concentrations. Dual-energy computed tomography is a noninvasive technique of possible benefit in the detection of axial gout when joint fluid aspiration is not deemed safe

    Hyperuricaemia and gout

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    Gout is a painful, inflammatory disease that affects more men than women. The incidence of gout has increased substantially over the past few decades, as evidenced by information from the Rochester project. Some of the risk factors for the development of gout include: increased ethanol intake, high dietary purine consumption, obesity and the use of certain drugs, such as diuretics. Another important risk factor for the development of gout is hyperuricaemia. Hyperuricaemia results from an imbalance between the rate of production and excretion of uric acid in the body. An excess of uric acid thus builds up in the body, supersaturating body fluids and leading to the formation of monosodium urate crystals. These crystals accumulate in tissue and around joints, leading to an acute gout attack. Gout can be divided into four phases, namely asymptomatic hyperuricaemia, acute gout attacks or recurrent gout, intercritical gout and chronic tophaceous gout. Various treatment options are available for gout, and the treatment for each gout patient is determined by the stage of the disease. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, corticotropin and colchicine are used for the treatment of acute gout attacks. Allopurinol and probenecid are used for long-term hypouricaemic therapy, while NSAIDs and colchicine are prescribed for the prophylaxis of future gout attacks. All of these treatments have side effects, ranging from mild to life-threatening in nature. There is a need for novel gout therapies that have fewer side effects but are still as effective.Keywords: hyperuricaemia; gout; gout treatmen

    The association between thyroid disorders and incident gout: population-based case-control study

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    Thyroid hormones influence kidney function and thereby might alter serum urate levels, a major risk factor for gouty arthritis.; To assess the risk of developing incident gout in association with hypothyroidism or hyperthyroidism.; Retrospective population-based case-control analysis.; UK-based Clinical Practice Research Datalink, a primary care research database.; We identified adult patients with a diagnosis of incident gout between 1990 and 2014. We matched one control to each gout case in terms of age, sex, general practice, calendar time, and years of active history in the database.; We used conditional logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for developing gout in association with hypo- or hyperthyroidism and adjusted for potential confounders.; The study population encompassed 68,159 incident gout cases, of whom 78.8% were male, and the same number of matched controls. There was no increased risk of gout in patients with hypothyroidism: adjusted OR of gout of 1.12 (95% CI 1.05-1.20) compared with no hypothyroidism. Current short-term treatment of thyroid hormone replacement therapy was associated with an adjusted OR of gout of 1.54 (95% CI 1.24-1.92), compared with no treatment. Neither hyperthyroidism nor current treatment with thyroid suppression therapy was associated with gout (adjusted OR, 1.08 [95% CI 0.95-1.22] and 0.82 [95% CI 0.57-1.17], respectively).; This large observational study does not provide evidence that hypothyroidism or hyperthyroidism, irrespective of treatment, is associated with a clinically relevant increased risk of developing incident gout. There may be an exception among patients with newly diagnosed and treated hypothyroidism

    The fungal etiology of gout and hyperuricemia: the antifungal mode of action of colchicine

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    The concept of a fungal/mycotoxin etiology of gout/hyperuricemia in humans was first reported by Costantini in 1989. Gout and/or hyperuricemia have been induced in animals by the fungal species Ustilago maydis, Chaetomium trilaterale, Saccharomyces cerevisiae, and by the mycotoxins, aflatoxin, ochratoxin, oosporein, oxalic acid. Gout and/or hyperuricemia have been induced in humans by the yeast Candida utilis and by the fungal metabolites cyclosporin, ergotamine and penicillin. Gout is documented to be etiologically linked to beer, a Saccharomyces fermented beverage. Beers contain significant amounts of ochratoxin and large amounts (7 to 9 mg/dl of uric acid, a metabolite produced by the brewer's yeast Saccharomyces cerevisiae. Consistent with the fungal etiology of gout and hyperuricemia, the mode of action of colchicine in the treatment of gout is antifungal. Colchicine shares antitubulin activity with griseofulvin, a potent antifungal antibiotic. Griseofulvin is as equally effective in the treatment of gout as colchicine. Similarly, another antitubulin drug, vinblastine is also antifungal and effective in the treatment of gout. All of the other drugs used to treat gout and/or hyperuricemia possess antifungal activity.Biomedical Reviews 1992; 1: 47-52

    Nutritional factors in the prevention and treatment of gout

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    Introduction and purpose: Despite the fact that effective urate lowering therapy and anti-inflammatory drugs for the treatment of gout are commonly available, there is considerable interest in novel treatment approaches. Gouty patients often have a multitude of comorbidities, which lead to concern over drug–drug interactions and medication adverse events. Thus, diet modifications are examined as a way of nonpharmacological treatment of gout. In this review, we explore the potential impact of nutritional factors on hyperuricemia and clinical gout outcomes. A search was conducted using PubMed and Google Scholarship databases. Brief description of the state of knowledge: Management in patients with gout should be holistic. Incorrect nutrition may lead to hyperuricemia. Studies to date suggest that avoidance of certain foods and beverages can decrease the frequency of gout flares. Weight loss may be beneficial for prevention as well as treatment of gout and its comorbidities. The impact of various types of diet on the course of gout has been given particular attention and recent research suggests that vegetarian, mediterranean and dash diets may be beneficial for gouty patients. Also, some vitamins and omega-3 PUFA have favorable effects and the potential clinical use in gout treatment. Conclusions: We propose that simple dietary regimens may be beneficial to complement therapeutic management or contribute to the prevention of flares in gout patients. Although piecemeal modifications of various nutrients often provide incomplete dietary recommendations, understanding the role of nutritional factors in gout development would be helpful for patients in choosing their healthy diet

    The Pathogenesis and Treatment of Gout

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    In the past, the etiology of gout was simplistically believed to be based in the generous indulgence of rich foods and alcohol. However, research has revealed that gout has complex environmental and genetic origins. Specifically, researchers have begun to focus attention on the molecular basis of gout and its related features. These features include hyperuricemia, the stages of gout, and the decreased solubility of uric acid. Furthermore, with epidemiologic evidence indicating that the prevalence of gout is consistently rising, it is imperative that medical providers understand the research-based guidelines for treatment. This includes what medications to administer, monitoring for drug-induced adverse effects, and modifying the treatment plan in elderly or unresponsive patients. Medical providers must also be aware of the importance of diet as a contributing factor to gout and which foods increase or decrease the risk of gout. This review will, therefore, attempt to present the current understanding of the pathophysiology of gout and guidelines for treatment and dietary modifications. Because gout is a disease related to metabolic dysfunction and produces arthritic symptoms, the information presented in this review was extracted from textbooks and journals chiefly relating to biochemistry, rheumatology, and pharmacology. The results of the research conducted revealed that there are three features that are genetically induced that independently contribute to the onset of gout: phosphoribosyl pyrophosphate (PRPP) synthetase hyperactivity, partial deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPT), and hyperactivity of the uric acid transporter in the renal tubule. In addition, diets rich in meat and seafood and devoid of dairy products substantially increase the risk of developing gout. Finally, research has indicated that the preferred treatment plan for gout includes using NSAIDs to alleviate the pain and inflammation of an acute gout attack, using colchicine for prophylactic therapy, and using either uricosurics or xanthine oxidase inhibitors for the long-term management of uric acid levels. Based on the results presented, medical providers will be better informed of methods to treat gout by knowing how to skillfully manage drug therapy, thereby reducing dangerous adverse effects and improving patient adherence to the drug regimen. In addition, by understanding the role of diet in the onset of gout, providers will better be able to advise patients on what foods to include or limit in their diet. From a research perspective, the elucidation of the pathophysiology of gout can lead to the development of even more effective therapeutic options

    Pengaruh Pendidikan Kesehatan Tentang Diet Gout Terhadap Pengetahuan Penyakit Gout Athritis di Posyandu Lansia Bagas Waras Kartasura

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    Gout arthritis is a disease that attacks the joints due to abnormal purine metabolism. One of the prevention of gout is to avoid consuming foods high in purines such as offal foods, foods that have been preserved, goose meat. Elderly who suffer from gout athritis often have a relapse; this is the case because it deals with the knowledge and awareness related atrhritis gout sufferers. of the value - the value of health or health behaviors so that, still play an optimal role in the provision of health education. This study as a research plan Quasi Experiment using pre-test and post-test control group design. Collection date usid a questionnaire while the test data analysis using Independent sample t-test and paired sample t-test. The test results Independent sample t-test pre-test treatment group and control group (p-value = 0.112). Post-test treatment group and control group (p-value = 0.001). The test results pairet sample t-test pre-test and post-test control group (p-value = 0.770), while the pre-test and post-test (p-value = 0.001) treatment group. Conclusion of the study is the level of knowledge about the disease gout arthritis before health education about gout diet is largely lacking and pretty, the level of knowledge about the disease gout arthritis after health education about gout diet is largely good, while the elderly who do not receive health education is largely self and there are significant health education about gout diet to decrease the knowledge about the disease gout arthritis in elderly Posyandu elderly Bagas Kartasura Sane


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    Gout is a syndrome caused by an inflammatory response creating an over production of uric acid increasing uric acid levels in the blood and body fluids. Gout is defined as a disorder resulting from tissue deposition of MSU crystals (in joints, bursae, bone, and certain other soft tissues, such as ligaments, tendons and occasionally, skin) and/or crystallization of uric acid within the renal collecting system (tubules and renal pelvis) that typically occurs in acid urine” (Terkeltaub & Edwards, 2013, p. 20). Gout is among the oldest diseases affecting approximately 3.9% of adults in America (Terkeltaub & Edwards, 2013, p. xv). Historically, Gout was the “disease of kings.” An early century caricature depicts gout in affluent middle-aged men that over indulge in alcohol and food. Today, the population stereotypes the average patient with impressions of self-limiting behavior such as drinking and diet (Terkeltaub & Edwards, 2013, p. xv). Gout prevalence and incidence are on the rise. Gout pathophysiology is complex and not easily understood affecting the patients’ quality of life. Gout treatment is associated with treatment failure and noncompliance. Consequently, “Most patients with gout are treated in general practice and never enter the domain of the rheumatologist, and general practitioners (GPs) are unlikely to read guidelines that are published in rheumatology journals or present on rheumatology websites” (Perry & Madhok, 2010, p. 2233). Increasing knowledge and understanding of gout, clinicians can significantly influence the quality of life through treatment options for patients and practitioners