Gout Pages Needed

The following list of gout pages shows what I’m working on at the moment, or planning to do soon.

Gout Remedies - click to see original from Flickr

If there are any topics you are particularly interested in, please add a comment below, or, better still, add to the gout forum wish list.

The list is in no particular order, but the top few are likely to be next.

http://www.goutpal.com/gout-pain.html – bone erosion. Done – see my Gout Pain page.

A febuxostat review, possibly in research section until approval given, then in treatments
. Done see febuxostat.

http://www.goutpal.com/natural-remedy-for-gout.htmlBlack bean brothThis Natural Remedy For Gout Is Cheap & Easy To Make

natural gout cure

remedy for gout – etoricoxib/arcoxia

http://www.goutpal.com/cure-gout.html

http://www.goutpal.com/gout-natural-remedy.html

http://www.goutpal.com/treatment-gout.html

gout treatment diet

http://www.goutpal.com/home-remedy-for-gout.html

http://www.goutpal.com/gout-remedy.html

http://www.goutpal.com/gout-medicine.html

medicine gout

http://www.goutpal.com/gout-relief.html Done – see Gout Relief Measurement

health gout

gout alternative medicine

http://www.goutpal.com/gout-pain-relief.html

alternative gout medicine

http://www.goutpal.com/gout-home-remedy.html

home remedy gout

gout.com

gout com

gout therapy

http://www.goutpal.com/treat-gout.html

gout drug

http://www.goutpal.com/gout-food-diet.html

Searches
gout of the ankle
treatment gout cure
tofu gout recipe
tens nerve machine (tag)
treatment for gout
diet for gout
gout treatments
purine rich foods are
gouty tophus
pseudogout vs gout
managing gout
uricacid (common misspelling)
gout and alcohol pdf
coffee uric acid
what is gout
uric acid exercise
food low in purines
gout and leg swelling
uric acid lumps
gouty tophus elbow
uric acid effects
uric acid diet
gout in arm
swelling numbness feet
meal plan for gout
right foot swollen

Rheumatology Meeting 2008

The annual Scientific Meeting from the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP) took place last week.

A lot of gout research was presented at the meeting, and I aim to review it over the next few weeks.

The following few posts are details of what was discussed. This is going to take a day or two to compile, as there is a lot of research presented at these meetings.

Once I’ve summarized all the sessions, I’ll start to review the results and prepare a proper analysis aimed at the layman.

Stayed tuned for lots of new gout information. Please let me know if anything interests you, and I will prioritize my review schedule accordingly. You can comment below, or in the gout forum.

ACR/ARHP 2008 Summary

Gout & GLUT9 Gene

The GLUT9 Gene and Susceptibility to Gout in the New Zealand Population

Gout And Alcohol

Risk of Gout Attacks: Does Type of Alcohol and Concomitant Purine Intake Matter?

Hmong Gout Incidence

Gout in the Hmong in US Presents at a Young Age and is More Severe Compared to Caucasian Controls

Gout And Aspirin

Low-dose Aspirin Intake Increases Risk of Recurrent Gout Attacks: The Online Case-crossover Gout Study

Refractory Gout & Health-Related Quality-of-Life (HRQOL)

Health-Related Quality-of-Life (HRQOL) of Patients with Refractory Gout (Refractory-Gout) and US Veterans Administration Patients with Gout+Comorbities (VA-Gout) is Poor, and Comparable to that in other Severe Chronic Conditions

Allopurinol A Lifesaver

Gout Research:

Also see Allopurinol Tablets Give Kidney Disease Relief

---

Allopurinol and mortality in hyperuricaemic patients.

Luk AJ, Levin GP, Moore EE, Zhou XH, Kestenbaum BR, Choi HK.

Department of Medicine, Division of Rheumatology, University of British Columbia, Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, BC V5Z 1L7, Canada. hchoi@arthritisresearch.ca.

Objectives

While studies have suggested that gout and hyperuricaemia are associated with the risk of premature death, none has investigated the role of urate-lowering therapy on this critical outcome. We examined the impact of allopurinol, the most commonly used urate-lowering drug, on the risk of mortality in hyperuricaemic patients.

Methods

From a population of hyperuricaemic veterans of [serum urate level >416 mumol/l (7.0 mg/dl)] at least 40 years of age, we compared the risk of death between incident allopurinol users (n = 2483) and non-users (n = 7441). We estimated the multivariate mortality hazard ratio (HR) of allopurinol use with Cox proportional hazards models.

Results

Of the 9924 veterans (males, 98% and mean age 62.7 years), 1021 died during the follow-up. Patients who began treatment with allopurinol had worse prognostic factors for mortality, including higher BMI and comorbidities. After adjusting for baseline urate levels, allopurinol treatment was associated with a lower risk of all-cause mortality (HR 0.78; 95% CI 0.67, 0.91). Further adjustment with other prognostic factors did not appreciably alter this estimate (HR 0.77; 95% CI 0.65, 0.91). The mean change from baseline in serum urate within the allopurinol group was -111 mumol/l (-1.86 mg/dl). Adjusting for baseline urate level, allopurinol users had a 40 mumol/l (0.68 mg/dl) lower follow-up serum urate value than controls (95% CI -0.55, -0.81).

Conclusion

Our findings indicate that allopurinol treatment may provide a survival benefit among patients with hyperuricaemia.

PMID: 19447769 [PubMed - in process]
Rheumatology (Oxford). 2009 Jul;48(7):804-6. Epub 2009 May 15.

Adjust / explain
hyperuricaemia = hyperuricemia

Gout Joint Aspiration

New review data to update:

• Gout Forum : Joint Aspiration
• Painful, swollen or tingling joints? See these signs and symptoms of gout

Gout Joint Aspiration / Arthrocentesis review from:
Best Pract Res Clin Rheumatol. 2009 Apr;23(2):161-92.
Joint aspiration and injection and synovial fluid analysis.

Courtney P, Doherty M.

Nottingham City Hospital, Nottingham, UK.

Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. This chapter addresses: (1) the indications, the technical principles and the expected benefits and risks of aspiration and injection of intra-articular corticosteroid; and (2) practical aspects relating to SF analysis, especially in relation to crystal identification. Intra-articular injection of long-acting insoluble corticosteroids is a well-established procedure that produces rapid pain relief and resolution of inflammation in most injected joints. The knee is the most common site to require aspiration, although any non-axial joint is accessible for obtaining SF. The technique requires a knowledge of basic anatomy and should not be unduly painful for the patient. Provided sterile equipment and a sensible, aseptic approach are used, it is very safe. Analysis of aspirated SF is helpful in the differential diagnosis of arthritis and is the definitive method for diagnosis of septic arthritis and crystal arthritis. The gross appearance of SF can provide useful diagnostic information in terms of the degree of joint inflammation and presence of haemarthrosis. Microbiological studies of SF are the key to the confirmation of infectious conditions. Increasing joint inflammation is associated with increased SF volume, reduced viscosity, increasing turbidity and cell count, and increasing ratio of polymorphonuclear: mononuclear cells, but such changes are non-specific and must be interpreted in the clinical setting. However, detection of SF monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis.

PMID: 19393565 [PubMed - in process]

Gout Resource

Best Pract Res Clin Rheumatol – Best practice & research. Clinical rheumatology – http://www.elsevier.com/wps/find/journaldescription.cws_home/623005/description#description

Evidence-based updates of best clinical practice across the spectrum of musculoskeletal conditions

Best Practice and Research Clinical Rheumatology keeps the clinician or trainee informed of the latest developments and current recommended practice in the rapidly advancing fields of musculoskeletal conditions and science.

Iron Test

In the continuing quest to understand the effect of iron on gout, I’m looking at test levels

This is part of my research project into gout and iron prompted by Near-iron deficiency-induced remission of gouty arthritis.

Blood Iron Testing

Adult Health Advisor 2005.4:
Serum iron

For men and women the normal range is 20 to 150 ng/mL.

Total iron binding capacity (TIBC)

For men and women the normal range is 250 to 450 ng/mL.

Ferritin

* Males: 20 to 300 nanograms per milliliter (ng/mL)
* Females: 20 to 120 ng/mL

Results of these iron studies tests may mean the following:

* A low serum iron level and low serum ferritin level may be caused by iron deficiency anemia.
* A high TIBC and low serum iron level may be caused by iron deficiency anemia, pregnancy, and chronic blood loss.
* A high serum iron level may be caused by too much iron in your diet, vitamin B6 therapy, or some anemias caused by an inability to use iron.
* A high ferritin level and a normal serum iron level might indicate liver disease from infection or alcoholism, chronic inflammatory disease (such as arthritis or asthma), hypothyroidism, and type 2 diabetes.
* A high ferritin level combined with a high serum iron level may be a sign of hemosiderosis (an accumulation of iron in some of your tissues).
* A low TIBC and high serum iron may be a sign of sideroblastic anemia (a condition that prevents your red blood cells from using iron).
* A high serum ferritin level, high serum iron, and low TIBC may be caused by hemochromatosis.

MedlinePlus Medical Encyclopedia:
Normal Results

• Iron: 60-170 mcg/dL
• TIBC: 240-450 mcg/dL

  Total iron binding capacity (TIBC) is a blood test that shows if there is too much or too little iron in the blood. Iron is carried in the blood attached to the protein transferrin. This test helps measure the ability of a protein called transferrin to carry iron in the blood.

• Transferrin saturation: 20-50%

Gout Treatment

Free Gout Pain Treatment Guide now available on Scribd.

View this document on Scribd

For full description and other guides see Gout Treatment For Pain: 7 Prescriptions.

What other free guides would you like to see? What are your top 3 gout questions?

Comment below, or better still, discuss in the gout guide forum.

Iron Regulates Xanthine Oxidase

Gout Research from

Am J Physiol Lung Cell Mol Physiol. 2002 Sep;283(3):L563-72.

Iron regulates xanthine oxidase activity in the lung.

Ghio AJ, Kennedy TP, Stonehuerner J, Carter JD, Skinner KA, Parks DA, Hoidal JR.

National Health and Environmental Effects Research Laboratory, Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA.

The iron chelator deferoxamine has been reported to inhibit both xanthine oxidase (XO) and xanthine dehydrogenase activity, but the relationship of this effect to the availability of iron in the cellular and tissue environment remains unexplored. XO and total xanthine oxidoreductase activity in cultured V79 cells was increased with exposure to ferric ammonium sulfate and inhibited by deferoxamine. Lung XO and total xanthine oxidoreductase activities were reduced in rats fed an iron-depleted diet and increased in rats supplemented with iron, without change in the ratio of XO to total oxidoreductase. Intratracheal injection of an iron salt or silica-iron, but not aluminum salts or silica-zinc, significantly increased rat lung XO and total xanthine oxidoreductase activities, immunoreactive xanthine oxidoreductase, and the concentration of urate in bronchoalveolar fluid. These results suggest the possibility that the production of uric acid, a major chelator of iron in extracellular fluid, is directly influenced by iron-mediated regulation of the expression and/or activity of its enzymatic source, xanthine oxidase.

PMID: 12169576 [PubMed - indexed for MEDLINE]

Full article at ajplung.physiology.org/cgi/content/full/283/3/L563

See also Alternative Treatment For Gout – Blood Letting

Natures Allopurinol

Gout Research from Planta Med. (Planta medica.) 2009 Mar;75(4):302-6. Epub 2009 Jan 30.

Lonicera hypoglauca Inhibits Xanthine Oxidase and Reduces Serum Uric Acid in Mice.

Chien SC, Yang CW, Tseng YH, Tsay HS, Kuo YH, Wang SY.

School of Chinese Medicine Resources, China Medical University, Taichung, Taiwan.

Xanthine oxidase (XOD) catalyzes the oxidation of hypoxanthine to xanthine and then to uric acid, and is a key enzyme in the pathogenesis of hyperuricemia. The ability of extracts of LONICERA HYPOGLAUCA (Caprifoliaceae) to inhibit XOD was investigated in this study. An ethanol extract (LH-crude) of the leaves of L. HYPOGLAUCA and its derived EtOAc soluble sub-fractions (LH-EA) significantly inhibited XOD activity, with IC (50) values for LH-crude and LH-EA of 48.8 and 35.2 microg/mL. Moreover, LH-EA reduced serum urate levels IN VIVO in a potassium oxonate-induced hyperuricemic mouse model, by 70.1 % and 93.7 % of the hyperuricemic untreated group at doses of 300 and 500 mg/kg of LH-EA, respectively. Finally, we used bioactivity-guided fractionation to isolate a new bisflavonoid, loniceraflavone, which showed significant inhibition of XOD (IC (50) = 0.85 microg/mL). These results suggest that L. HYPOGLAUCA and its extracts may have a considerable potential for development as an anti-hyperuricemia agent for clinical application.

PMID: 19184967 [PubMed - in process]

Gout And Anthocyanins

Cherries are well known for helping gout sufferers.

May be due to anthocyanins, which are compounds that add colour to many fruit and veg.

Black bean broth seems to have similar effect and also rich in anthocyanins.

Some related research follows. This is not specifically about gout and anthocyanins because there appears to be no relation between anthocyanins and uric acid reduction.

However, there is lots of research about inflammation and anthocyanins.

Uric Acid And Dementia

Gout Research Report

Serum uric acid and cognitive function and dementia.

Euser SM, Hofman A, Westendorp RG, Breteler MM.

Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.

Uric acid is a risk factor of cardiovascular disease, as well as a major natural antioxidant, prohibiting the occurrence of cellular damage. The relation between uric acid and cognitive decline, in which both vascular mechanisms and oxidative stress are thought to play a role, is unknown. Therefore we assessed the relation between serum uric acid levels and the risk of subsequent dementia in a prospective population-based cohort study among 4618 participants aged 55 years and over. Additionally, we investigated the relation between serum uric acid and cognitive function later in life (on average 11.1 years later) in a subsample of 1724 participants who remained free of dementia during follow-up. All analyses were adjusted for age, sex and cardiovascular risk factors. Our data showed that only after correcting for several cardiovascular risk factors, higher serum uric acid levels were associated with a decreased risk of dementia (HR, adjusted for age, sex and cardiovascular risk factors, 0.89 [95% confidence interval (CI) 0.80-0.99] per standard deviation (SD) increase in uric acid). In participants who remained free of dementia, higher serum uric acid levels at baseline were associated with better cognitive function later in life, for all cognitive domains that were assessed [adjusted difference in Z-score (95% CI) per SD increase in uric acid 0.04 (0.00-0.07) for global cognitive function; 0.02 (-0.02 to 0.06) for executive function; and 0.06 (0.02-0.11) for memory function], but again only after correcting for cardiovascular risk factors. We conclude that notwithstanding the associated increased risk of cardiovascular disease, higher levels of uric acid are associated with a decreased risk of dementia and better cognitive function later in life.

Publication Types:

* Research Support, Non-U.S. Gov’t

PMID: 19036766 [PubMed - in process]

From:
Brain. 2009 Feb;132(Pt 2):377-82. Epub 2008 Nov 26.
http://brain.oxfordjournals.org/ – A Journal Of Neurology – Brain provides researchers and clinicians with the finest original contributions in neurology. Leading studies in neurological science are balanced with practical clinical articles. Its citation rating is one of the highest for neurology journals, and it consistently publishes papers that become classics in the field.

Gout & Laser Therapy

Thanks to Stéphane Magnenat at Flickr for this cool laser light image. Click image for more details.

Gout Research Report

See GoutPal.com for Laser Therapy For Gout Gives Instant Pain Relief.

Photobiomodulation of pain and inflammation in microcrystalline arthropathies: experimental and clinical results.

Soriano F, Campana V, Moya M, Gavotto A, Simes J, Soriano M, Soriano R, Spitale L, Palma J.

Instituto Argentino de Medicina Láser (IAMEL), Rosario, Argentina.

OBJECTIVE

This article presents the results of laser therapy in crystal (hydroxyapatite, calcium pyrophosphate, and urates) deposition-induced arthritis in rats and the clinical applications in humans.

BACKGROUND DATA

Microcrystalline arthropathies are prevalent among geriatric patients, who are more vulnerable to the side effects of drugs. The effectiveness of laser therapy for pain relief, free of side effects, has been reported in painful conditions.

METHODS

Two milligrams of each of the above-mentioned crystals was injected in both joints of the back limbs in three groups of rats; these groups were then treated with laser irradiation. Three other groups received no treatment after the injections.

We determined the plasmatic levels of inflammatory markers (fibrinogen, prostaglandin E2, and TNF(alpha)), tissues (prostaglandin E(2)) and conducted anatomopathological studies.

• Twenty-five patients with acute gout arthritis were randomized into two groups and treated over 5 days: group A, diclofenac 75 mg orally, twice a day; and group B, laser irradiation once a day.
• Forty-nine patients with knee chronic pyrophosphate arthropathy were randomized into two groups and treated over 21 days; group A, diclofenac 50 mg orally, twice a day; and group B, laser irradiation once a day.
• Thirty patients with shoulder chronic hydroxyapatite arthropathy were randomized into two groups and treated over 21 days; group A, diclofenac 50 mg orally, twice a day; and group B, laser irradiation once a day.

RESULTS

Fibrinogen, prostaglandin E(2), and TNF(alpha) concentrations in the rats injected with crystals and treated with laser decreased significantly as compared with the groups injected with crystals without treatment.

Both laser therapy and diclofenac achieved rapid pain relief in patients with acute gouty arthritis without significant differences in efficacy. Laser therapy was more effective than diclofenac in patients with chronic pyrophosphate arthropathy and in patients with chronic apatite deposition disease.

CONCLUSION

Laser therapy represents an effective treatment in the therapeutic arsenal of microcrystalline arthropathies.

From Photomed Laser Surg. 2006 Apr;24(2):140-50.
Photomedicine and laser surgery – http://www.liebertpub.com/products/product.aspx?pid=128
Photomedicine and Laser Surgery provides rapid publication of new and cutting-edge techniques and research in phototherapy, low level laser therapy (LLLT), and laser medicine and surgery. The Journal publishes basic and clinical research, expanded applications, and procedures in medicine, surgery, dentistry, safety, new instrumentation, optical diagnostics, and the broad range of activities related to the understanding and applications of biophotonics in medicine.

PMID: 16706692 [PubMed - indexed for MEDLINE]

Photobiomodulation = low level laser therapy (LLLT), cold laser therapy, laser biostimulation

arthropathy = joint disease

For Sub-Optimal Read Frightening

This Gout & Uric Acid Research post is part of my ACR/ARHP Rheumatology 2008 review. I will summarize this vital gout information from rheumatologists from every quarter of the globe. If you are particularly interested in this gouty topic, please let me know in the gout forum.

Session: Fellows-in-Training Posters

Presentation: F17 – Gout Management in a Primary Care Setting: Evidence for Possible Suboptimal Treatment

Category: 14. Metabolic and crystal arthropathies

Author(s): Robert T. Keenan1, William R. O’Brien1, Daria B. Crittenden1, David S. Goldfarb2, Michael H. Pillinger2. 1NYU Hospital for Joint Diseases, New York, NY; 2New York Harbor VAMC, New York, NY

Abstract: Purpose: Epidemiologic studies suggest that gout is highly prevalent (≈ 3%), increasing in incidence, and associated with significant morbidity and mortality. The purpose of this retrospective chart review was to assess gout management by a group of primary care physicians, (PCP)s, including the achievement of target serum uric acid (UA) levels (≤6 mg/dL) during urate-lowering therapy.

Methods: Gout was identified among all patients in the NY Harbor VAMC ages 18-100 (n-33,000) by ICD codes for gout documented in the electronic medical record. Patients were defined as managed by a PCP if they saw a rheumatologist ≤1 time in the past year. Among the 807 patients meeting criteria for gout, we analyzed a convenience sample of 100 randomly chosen patients managed by PCPs. GraphPad statistical software was used to determine Student’s t-test with hypothetical means of 7.0 mg/dL and 6.0 mg/dL were used for all patients with measured UA and allopurinol treated patients. The mean UA of hydrochlorothiazide (HCTZ) treated patients was compared with patients not taking HCTZ.

Results: Prevalence of gout in the overall population was 2.5% (42% African-American, 40% White, 9% Hispanic, 1% Pacific Islander, 8% unknown). All subjects were male; average age was 72 years. Among the study subpopulation with gout, the mean UA was 7.6 mg/dL. 9/100 had no UA measurement, and the mean duration since last UA measurment among the remainder was 30.2 months. Only 6/100 had crystal confirmation of their disease. 95/100 received prophylaxis for their gout (daily colchicine and/or allopurinol and/or probenecid). Among patients receiving allopurinol (n=46) or probenecid (n=1), 4/47 (8.5%) had no recorded UA measurement after initiation of therapy. Among the remainder, allopurinol dose was either 100 (n=26) or 300 mgs (n=20) daily, and mean UA level while on allopurinol was 7.0 mg/dL. Among gout patients with a co-diagnosis of hypertension (n=87), 20% were taking HCTZ. The average serum UA among these patients was 8.23 mg/dL.

Validation of the difference between observed and theoretical means (Student’s t-test)

Patient Group	Mean UA	95% Confidence Interval	P-value α=0.05
All patients with measured UA (n=91)	7.59	7.17, 8.00	0.0058
Allopurinol-treated patients (n=46)	7.01	6.37, 7.66	0.0014
Pts taking HCTZ (n=16)	8.23	7.136, 9.314	0.0636

Conclusion: Our analyses suggest that PCPs do not optimally diagnose gout or regularly monitor UA levels, may underutilize UA lowering therapies, and are likely to underdose and inadequately monitor the results of urate-lowering therapy. PCPs treating patients with gout and hypertension may also fail to account for the UA-raising properties of anti-hypertensive diuretics. To ensure proper clinical care, rheumatologists may need to assume a greater role in treating gout patients, or better educate PCPs in appropriate gout management.

Research Method: Clinical

Type of Trial: Not Applicable

Phase: Not Applicable