Gout: state of the art after a decade of developments.
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TLDR
It is emphasized that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics.Abstract:
This review article summarizes the relevant English literature on gout from 2010 through April 2017. It emphasizes that the current epidemiology of gout indicates a rising prevalence worldwide, not only in Western countries but also in Southeast Asia, in close relationship with the obesity and metabolic syndrome epidemics. New pathogenic mechanisms of chronic hyperuricaemia focus on the gut (microbiota, ABCG2 expression) after the kidney. Cardiovascular and renal comorbidities are the key points to consider in terms of management. New imaging tools are available, including US with key features and dual-energy CT rendering it able to reveal deposits of urate crystals. These deposits are now included in new diagnostic and classification criteria. Overall, half of the patients with gout are readily treated with allopurinol, the recommended xanthine oxidase inhibitor (XOI), with prophylaxis for flares with low-dose daily colchicine. The main management issues are related to patient adherence, because gout patients have the lowest rate of medication possession ratio at 1 year, but they also include clinical inertia by physicians, meaning XOI dosage is not titrated according to regular serum uric acid level measurements for targeting serum uric acid levels for uncomplicated (6.0 mg/dl) and complicated gout, or the British Society for Rheumatology recommended target (5.0 mg/dl). Difficult-to-treat gout encompasses polyarticular flares, and mostly patients with comorbidities, renal or heart failure, leading to contraindications or side effects of standard-of-care drugs (colchicine, NSAIDs, oral steroids) for flares; and tophaceous and/or destructive arthropathies, leading to switching between XOIs (febuxostat) or to combining XOI and uricosurics.read more
Citations
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Journal ArticleDOI
Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial
Carly A. Janssen,Martijn A. H. Oude Voshaar,Harald E. Vonkeman,Harald E. Vonkeman,T.L.Th.A. Jansen,Matthijs Janssen,Marc R. Kok,Bea Radovits,Caroline van Durme,Hetty Baan,Mart A F J van de Laar,Mart A F J van de Laar +11 more
TL;DR: Efficacy of anakinra was shown to be non-inferior to treatment as usual for the treatment of acute gout flares, suggesting that anakinRA is an effective treatment alternative for acute g out flares.
Journal ArticleDOI
The gut microbiota as a target to control hyperuricemia pathogenesis: Potential mechanisms and therapeutic strategies.
Jing Wang,Yong Chen,Yong Chen,Hao Zhong,Fang Chen,Joe M. Regenstein,Xiaosong Hu,Luyun Cai,Fengqin Feng +8 more
TL;DR: In this paper, the relationship between hyperuricemia and the gut microbiota is elucidated, and anti-hyperuricemic mechanisms targeting the intestine are discussed, such as the promotion of purine and UA catabolism by the Gut microbiota, increases in UA excretion by the gut metabolites, regulation of UA absorption or secretion in the intestinal tract by certain transporters.
Journal ArticleDOI
The systems biology of uric acid transporters: the role of remote sensing and signaling.
Sanjay K. Nigam,Vibha Bhatnagar +1 more
TL;DR: The remote sensing and signaling hypothesis provides a useful systems-level framework for understanding the complex interplay of uric Acid transporters expressed in different tissues involved in optimizing uric acid levels under normal and diseased conditions.
Journal ArticleDOI
The altered gut microbiota of high-purine-induced hyperuricemia rats and its correlation with hyperuricemia.
Xiu Liu,Qiulan Lv,Hongyan Ren,Liu Gao,Peng Zhao,Xiaomin Yang,Guanpin Yang,Daxing Xu,Guangtao Wang,Wan Yang,Pengjun Wang,Zenglan Wang,Shichao Xing +12 more
TL;DR: This work established a HUA rat model with high-purine diet, and used 16S rRNA genes sequencing to analyze gut microbiota changes in HUA rats, and identified the genera Vallitalea, Christensenella and Insolitispirillum that may associate with HUA.
Iconography : Ultrasound in gout: A useful tool for following urate-lowering therapy
Sébastien Ottaviani,Ghislaine Gill,Aurore Aubrun,Elisabeth Palazzo,Olivier Meyer,Philippe Dieudé +5 more
TL;DR: US could show disappearance of urate deposits after ULT and appears to be well correlated with efficacy of ULT.
References
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Journal ArticleDOI
Gout-associated uric acid crystals activate the NALP3 inflammasome
TL;DR: It is shown that MSU and CPPD engage the caspase-1-activating NALP3 (also called cryopyrin) inflammasome, resulting in the production of active interleukin (IL)-1β and IL-18 in mice deficient in the IL-1β receptor.
Journal ArticleDOI
Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008.
TL;DR: The findings from nationally representative samples of US adults suggest that the prevalence of both gout and hyperuricemia remains substantial and may have increased over the past 2 decades, which is likely related to increasing frequencies of adiposity and hypertension.
Journal ArticleDOI
Preliminary criteria for the classification of the acute arthritis of primary gout
Stanley L. Wallace,Harry Robinson,Alfonse T. Masi,John L. Decker,Daniel J. McCarty,Ts'Ai‐Fan Yu +5 more
TL;DR: The American Rheumatism Association sub-committe on classification criteria for gout analyzed data from more than 700 patients with gout, pseudogout, rheumatoid arthritis, or septic arthritis to establish criteria for classifying a patient as having gout.
Journal ArticleDOI
2012 American College of Rheumatology guidelines for management of gout. Part 1: Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia
Dinesh Khanna,John FitzGerald,Puja P. Khanna,Sangmee Bae,Manjit K. Singh,Tuhina Neogi,Michael H. Pillinger,Joan Merill,Susan J. Lee,Shraddha Prakash,Marian Kaldas,Maneesh Gogia,Fernando Perez-Ruiz,William J. Taylor,Frédéric Lioté,Hyon K. Choi,Jasvinder A. Singh,Nicola Dalbeth,Sanford Kaplan,Vandana Dua Niyyar,Danielle Jones,Steven A. Yarows,Blake J. Roessler,Gail S. Kerr,Charles H. King,Gerald Levy,Daniel E. Furst,N. Lawrence Edwards,Brian F. Mandell,H. Ralph Schumacher,Mark L. Robbins,Neil S. Wenger,Robert Terkeltaub +32 more
TL;DR: DINESH KHanNA, JOHN D. FITZGERALD, PUJA P. KHANNA, SANGMEE BAE, MANJIT K. SINGH, TUHINA NEOGI, MICHAEL H. PILLINGER, JOAN MERILL, SUSAN LEE, SHRADDHA PRAKASH, MARIAN KALDAS, MANEESH GOGIA, FERNANDO PEREZ-RUI
Journal ArticleDOI
Febuxostat compared with allopurinol in patients with hyperuricemia and gout
Michael Becker,H. Ralph Schumacher,Robert L. Wortmann,Patricia A. MacDonald,Denise Eustace,William A. Palo,Janet Streit,Nancy Joseph-Ridge +7 more
TL;DR: Although the incidence of gout flares diminished with continued treatment, the overall incidence during weeks 9 through 52 was similar in all groups andFebuxostat, at a daily dose of 80 mg or 120 mg, was more effective than allopurinol at the commonly used fixed daily doses of 300 mg in lowering serum urate.
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