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Prevention of comorbidity and acute attack of gout by uric acid lowering therapy.

The object of this study was to evaluate the effect of uric acid lowering therapy in reducing the new development of comorbidities and the frequency of acute attacks in gout patients. We retrospectively reviewed patients who were diagnosed to have gout with at least 3 yr of follow up. They were divided into 2 groups; 53 patients with mean serum uric acid level (sUA)<6 mg/dL and 147 patients with mean sUA≥6 mg/dL. Comorbidities of gout such as hypertension (HTN), type II diabetes mellitus (DM), chronic kidney disease, cardiovascular disease (CVD) and urolithiasis were compared in each group at

Cinnamaldehyde Attenuates Hyperuricemia-Associated Renal Injury by Modulating Urate Transporters and AIF1- and CMPK2/NLRP3-Related Inflammatory Signaling.

Background: Hyperuricemia is a well-established risk factor for both chronic kidney disease and gout. Currently available urate-lowering dru … lial cells to uric acid. For the in vivo study, mice were divided into five groups (control, model, febuxostat, low-dose CA, and high-dose CA; n = 9 per group) and were treated by oral gavage. Serum biochemical indices, renal and intestinal histopathology, inflammatory cytokines, renal urate transporter proteins (OAT1, OCT2, ABCG2, and SLC2A9), and component …

Plasma adsorption in refractory chronic gouty arthritis flare: A case report.

BACKGROUND: Along with uric acid, which is the primary driving factor of gout, downstream inflammatory mediators have been shown to be invol … ares had become more frequent, and resistant to the medications, including colchicine, allopurinol, febuxostat, glucocorticoids, and NSAID analgesics. He had experienced a triad of chills, high fever and arthritis for the past 2 weeks. Therefore, he took 2 mg colchicine twice daily for 2 weeks with no improvement in his pain. Proinflammatory cytokines, such …

An updated systematic review and meta-analysis of randomised controlled trials on the effects of urate-lowering therapy initiation during a gout flare.

BACKGROUND: There is uncertainty about the optimal time to start urate-lowering therapy (ULT) in the setting of a gout flare. The aim was to … tion of ULT and 219 to placebo or delayed initiation of ULT. Allopurinol was used in three studies, febuxostat in two studies and probenecid in one study. Few participants (n = 62, 13.9 %) had tophaceous gout. Participants with renal impairment were excluded from most studies. There were no differences in patient-rated pain scores at baseline, days 3-4, days …

Assessment of urate-lowering therapies on lipid metabolism and kidney function in non-dialysis chronic kidney disease patients: 12 months multicenter cohort study.

BACKGROUND AND OBJECTIVES: Urate lowering therapies (ULTs) are primarily used to manage hyperuricemia (HUA), which refers to an increase in … with stages 3/4 CKD. Patients were divided into two groups: the ULT group (n=94) who were receiving febuxostat or allopurinol, and the Non-ULT group (n=106) who were receiving their conventional CKD therapy, the study employed clinically indicated allocation. ULT initiation was based on physician judgment per guidelines persistent HUA with SUA ≥7 mg/dL in ma …

Burden and management of gout in a multi-ethnic Asian cohort.

Gout has significant impact on the quality of life with over-utilisation of health resources. While lowering serum urate (SU) to ≤ 360 µmol/L improves clinical outcomes, this is usually not achieved. We describe the burden of gout and determine predictors of achieving SU target in gout patients in Singapore. This was a cross-sectional study of 282 gout patients from a Singapore hospital rheumatology service. Sociodemographic and lifestyle factors, co-existing medical conditions and medications, gout history and severity, SU levels and treatment were obtained. Patients with SU ≤ 360 µmol/L were

The impact of dysfunctional variants of ABCG2 on hyperuricemia and gout in pediatric-onset patients.

BACKGROUND: ABCG2 is a high-capacity urate transporter that plays a crucial role in renal urate overload and extra-renal urate underexcretion. Previous studies have suggested an association between hyperuricemia and gout susceptibility relative to dysfunctional ABCG2 variants, with rs2231142 (Q141K) being the most common. In this study, we analyzed the ABCG2 gene in a hyperuricemia and gout cohort focusing on patients with pediatric-onset, i.e., before 18 years of age. METHOD: The cohort was recruited from the Czech Republic (n = 234) and consisted of 58 primary hyperuricemia and 176 gout pat

Pathogenesis and Clinical Management of Gouty Arthritis.

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

Hypouricemic and nephroprotective effects of palmatine from Cortex Phellodendri Amurensis: A uric acid modulator targeting Keap1-Nrf2/NLRP3 axis.

ETHNOPHARMACOLOGICAL RELEVANCE: Palmatine (Pal) is a major bioactive alkaloid originated from ancient Chinese herbal medicine Cortex Phellod … ve days. The HUA mice were orally given three doses (25, 50 and 100 mg/kg) of Pal daily for a week. Febuxostat (Feb, 5 mg/kg) was given as a positive control. At the scheduled termination of the experiment, the whole blood, liver and kidney were collected for subsequent analyses. The concentrations of uric acid (UA), creatinine (CRE) and blood urea nitrogen …

Managing Tumor Lysis Syndrome in the Era of Novel Cancer Therapies.

Abstract Tumor lysis syndrome (TLS) is a potentially life-threatening emergency that can develop rapidly after the release of intracellular contents from lysed malignant cells. The advent of novel and targeted therapies that have improved tumor-killing efficacy has the potential to increase the risk of TLS when used as part of front-line therapy. A recent review of TLS risk in patients with hematologic malignancies treated with newer targeted agents highlighted the need to revisit TLS risk stratification and to describe the practical challenges of TLS prevention, treatment, and monitoring. Alt

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… Figure 2 Mechanism of action for allopurinol, febuxostat, and rasburicase. Information from Sanofiaventis ( 2011 ); Hu & Tomlinson ( 2008 ); Pession et al. ( 2008 ). … Annals of hematology 2016 95 563 573 26758269 10.1007/s00277-015-2585-7 37 Hu Miao Tomlinson Brian Febuxostat in the management of hyperuricemia and chronic gout: a review. …

Экономия и безопасность дотинурада в связи с кислотой и реанимацией у пациентов с гиперперурицемией и повышенными хроническими почечными заболеваниями: единый центр, ретроспективный анализ.

ЦЕЛЬ: мы изучили эффективность и безопасность дотинурада, селективного ингибитора реабсорбции у гиперурисемичных пациентов с продвинутой хронической болезнью почек (CKD) (стадия) G3-5). ВОЗМОЖНОСТИ И МЕТОДЫ: Мы ретроспективно проанализировали случаи 34 больные (средний возраст, 68.6 ± 13.3 годы; 17 мужчин и женщин 17 женщин) после 12 Количество месяцев дотинурадной обработки на основе изменений в мочеисперсной кислоте (UA) и соотношении белков и креатининов мочи (UPCR) плюс ежегодное изменение расчетной гермекулярной фильтрации (eGFR). Гиперурикемия (UA) ≥6.0 мг/дл) и усовершенствованная CKD (

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… Safety and efficacy of benzbromarone and febuxostat in hyperuricemia patients with chronic kidney disease: a prospective pilot study. Clin Exp Nephrol . 2018;22(6):1324–1330. doi: 10.1007/s10157-018-1586-y 7. Jeyaruban A, Hoy W, Cameron A, et al. … Effect of febuxostat on biochemical parameters of hyperlipidemia induced by a high-fat diet in rabbits. Can J Physiol Pharmacol . 2019;97(7):611–622. doi: 10.1139/cjpp-2018-0731 25. Marinchev L, Kunev K. …

Emerging therapies for gout.

Over the past decade much has been learned about the mechanisms of crystal-induced inflammation and renal excretion of uric acid, which has led to more specific targeting of gout therapies and a more potent approach to future management of gout. This article outlines agents being developed for more aggressive lowering of urate and more specific anti-inflammatory activity. The emerging urate-lowering therapies include lesinurad, arhalofenate, ulodesine, and levotofisopam. Novel gout-specific anti-inflammatories include the interleukin-1β inhibitors anakinra, canakinumab, and rilonacept, the mel

An update on the treatment options for gout and calcium pyrophosphate deposition.

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.

The current state of care in gout: Addressing the need for better understanding of an ancient disease.

PURPOSE: 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. DATA SOURCES: 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

Advanced Practice Perspectives on Preventing and Managing Tumor Lysis Syndrome and Neutropenia in Chronic Lymphocytic Leukemia.

Tumor lysis syndrome (TLS) and neutropenia are significant toxicities in the treatment of chronic lymphocytic leukemia (CLL). Both TLS and neutropenia can lead to potentially life-threatening complications for patients with chronic lymphocytic leukemia undergoing antineoplastic therapy. This article focuses on diligent risk assessment, prophylaxis, early identification, monitoring, patient education, and prompt intervention for TLS and neutropenia. These are all necessary steps to reduce life-threatening complications. Guidelines are available for risk assessments for both TLS and neutropenia.

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… Febuxostat is also ideally started 2 to 3 days before antineoplastic therapy and is continued for a minimum of 7 days. … In a phase III study of allopurinol vs. febuxostat that randomized 346 patients at intermediate to high risk for TLS, patients treated with febuxostat achieved significantly superior uric acid control, with comparable side effect profiles and renal function preservation between the two arms. …

Kidney Transplant Outcomes in Patients With Adenine Phosphoribosyltransferase Deficiency.

BACKGROUND: Adenine phosphoribosyltransferase (APRT) deficiency is a rare, hereditary cause of kidney stones and chronic kidney disease (CKD) which is characterized by 2,8-dihydroxyadenine renal parenchymal crystal deposition. The aim of this study was to examine outcomes of kidney transplantation in APRT deficiency patients. METHODS: Included were 13 patients in the APRT Deficiency Registry of the Rare Kidney Stone Consortium, 2 from Westmead Hospital in Sydney, Australia, and 2 from Necker Hospital in Paris, France. The CKD-EPI and CKiD equations were used to calculate glomerular filtration

Anakinra treatment in patients with gout and type 2 diabetes.

We report three Caucasian patients affected by gout and type 2 diabetes, who were treated with the recombinant nonglycosylated human interleukin-1 receptor antagonist anakinra (100 mg/day subcutaneously) after an unsatisfactory or incomplete response to urate-lowering therapy, colchicine, nonsteroidal anti-inflammatory drugs, and prednisone. The remarkable clinical improvement in joint symptoms within 24 h and in glycemic control during a 6-month period gives anakinra a potential therapeutic role in the management of gout and type 2 diabetes. When anakinra was discontinued, a gout attack occur

Acute kidney injury in the patient with cancer.

Dramatic advances in the care of patients with cancer have led to significant improvement in outcomes and survival. However, renal manifestations of the underlying cancer as well as the effects of anti-neoplastic therapies leave patients with significant morbidity and chronic kidney disease risks. The most common renal manifestations associated with cancer include acute kidney injury (AKI) in the setting of multiple myeloma, tumor lysis syndrome, post-hematopoietic stem cell therapy, and AKI associated with chemotherapy. Knowledge of specific risk factors, modification of risk and careful atte

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… Prevention and treatment of TLS complications include administration of intravenous fluids (~3 L/day) and xanthine oxidase inhibition (allopurinol or febuxostat) in high-risk patients prior to chemotherapy [ 90 , 91 , 94 ]. … Febuxostat is a non-purine analogue xanthine oxidase inhibitor and is useful in patients that are intolerant to allopurinol. One recent trial demonstrated that febuxostat was superior in lowering uric acid levels but there was no difference in clinical outcomes vs. allopurinol [ 95 ]. …