Interdisciplinary approach to the management of patients with chronic gout

2020 ◽  
pp. 144-152
Author(s):  
V. V. Tsurko ◽  
M. A. Gromova ◽  
N. V. Malysheva
Keyword(s):  
Current Knowledge ◽  
Interdisciplinary Approach ◽  
Clinical Diagnostics ◽  
Acute Gout ◽  
Chronic Gout ◽  
American College Of Rheumatology ◽  
Treatment And Prevention ◽  
European League Against Rheumatism ◽  
Based Medicine ◽  
New Strategies

Gout, one of the most common forms of inflammatory arthritis, is characterized by severe joint pain, which often interferes with daily activities. In recent years, further research on its causes and on improving diagnosis, treatment and prevention has been ongoing. It is known that gout usually occurs due to the accumulation of sodium monourate crystals in joints due to high levels of serum uric acid. In 2019, the Annals of the Rheumatic Diseases journal published new data on imaging and clinical diagnostics methods based on the principles of evidence-based medicine. Formulated by experts, they were adopted as a consensus of the European League Against Rheumatism (EULAR). The American College of Rheumatology (ACR) has now developed new strategies to treat and prevent gout. On May 11, 2020, the Arthritis & Rheumatology Journal presented guidelines for the management of gout patients, including the treatment of acute gout attack, indications for urate-lowering therapy and instructions for its optimal use, as well as recommendations on lifestyle and drugs that are often prescribed to patients with comorbidity. The purpose of this review is to summarize current knowledge with a focus on recent advances in the algorithm for managing acute and chronic gout patients.

scholarly journals Interdisciplinary approach to the management of patients with chronic gout

2020 ◽  
pp. 144-152
Author(s):  
V. V. Tsurko ◽  
M. A. Gromova ◽  
N. V. Malysheva
Keyword(s):  
Current Knowledge ◽  
Interdisciplinary Approach ◽  
Clinical Diagnostics ◽  
Acute Gout ◽  
Chronic Gout ◽  
American College Of Rheumatology ◽  
Treatment And Prevention ◽  
European League Against Rheumatism ◽  
Based Medicine ◽  
New Strategies

Gout, one of the most common forms of inflammatory arthritis, is characterized by severe joint pain, which often interferes with daily activities. In recent years, further research on its causes and on improving diagnosis, treatment and prevention has been ongoing. It is known that gout usually occurs due to the accumulation of sodium monourate crystals in joints due to high levels of serum uric acid. In 2019, the Annals of the Rheumatic Diseases journal published new data on imaging and clinical diagnostics methods based on the principles of evidence-based medicine. Formulated by experts, they were adopted as a consensus of the European League Against Rheumatism (EULAR). The American College of Rheumatology (ACR) has now developed new strategies to treat and prevent gout. On May 11, 2020, the Arthritis & Rheumatology Journal presented guidelines for the management of gout patients, including the treatment of acute gout attack, indications for urate-lowering therapy and instructions for its optimal use, as well as recommendations on lifestyle and drugs that are often prescribed to patients with comorbidity. The purpose of this review is to summarize current knowledge with a focus on recent advances in the algorithm for managing acute and chronic gout patients.

Diagnosis of Chronic Gout: Evaluating the American College of Rheumatology Proposal, European League Against Rheumatism Recommendations, and Clinical Judgment

2010 ◽  
Vol 37 (8) ◽  
pp. 1743-1748 ◽  
Author(s):  
INGRIS PELÁEZ-BALLESTAS ◽  
CLAUDIA HERNÁNDEZ CUEVAS ◽  
RUBÉN BURGOS-VARGAS ◽  
LIZANDRA HERNÁNDEZ ROQUE ◽  
LEOBARDO TERÁN ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Past History ◽  
Rapid Progression ◽  
Cross Sectional ◽  
Chronic Gout ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
History Of ◽  
Msu Crystals ◽  
European League

Objective.Observation of monosodium urate (MSU) crystal is the gold standard for diagnosis of gout, but is rarely performed in daily clinical practice, and diagnosis is based on clinical judgment. Our aim was to identify clinical and paraclinical data included in the European League Against Rheumatism recommendations (EULARr) and American College of Rheumatology proposed criteria (ACRp) for diagnosis of gout in patients with chronic gout according to their attending rheumatologists.Methods.This cross-sectional and multicenter study included consecutive patients from outpatient clinics with a diagnosis of gout by their attending rheumatologists according to their expertise. The frequency of each item from the ACRp and EULARr was determined. Possible combinations of the items that were frequent, clinically relevant, and simple to evaluate in daily practice were determined.Results.We studied 549 patients (96% men), mean age 50 ± 14 years. Analysis of MSU crystals was performed in 15%. We selected 7 clinical criteria and 1 laboratory measure because of their frequency, importance, and simplicity to obtain: current or past history of: > 1 attack of acute arthritis (93%); mono or oligoarthritis attacks (74%); rapid progression of pain and swelling (< 24 hours; 74%); podagra (70%); erythema (56%); unilateral tarsitis (33%); tophi (52%); and hyperuricemia (93%). The chronic gout diagnosis (CGD) proposal comprised ≥ 4/8 of these; 88% of patients had the criteria of the CGD proposal while 75% had 6/11 ACRp criteria (p = 0.001). When analysis of MSU crystals was added, 90.1% (CGD) and 83.9% (ACRp) met the criteria (p = 0.004).Conclusion.Current or past history of ≥ 4/8 CGD parameters is highly suggestive of chronic gout.

scholarly journals Adrenal Crises in Children: Perspectives and Research Directions

2018 ◽  
Vol 89 (5) ◽  
pp. 341-351 ◽  
Author(s):  
R. Louise Rushworth ◽  
David J. Torpy ◽  
Constantine A. Stratakis ◽  
Henrik Falhammar
Keyword(s):  
Current Knowledge ◽  
Essential Element ◽  
Paediatric Population ◽  
Health Impact ◽  
Research Directions ◽  
Adverse Health Outcomes ◽  
Treatment And Prevention ◽  
Paediatric Age ◽  
Life Threatening ◽  
New Strategies

Adrenal crises (AC) are life-threatening physiological disturbances that occur at a rate of 5–10/100 patient years in patients with adrenal insufficiency (AI). Despite their seriousness, there is a paucity of information on the epidemiology of AC events in the paediatric population specifically, as most investigations have focused on AI and ACs in adults. Improved surveillance of AC-related morbidity and mortality should improve the delineation of AC risk overall and among different subgroups of paediatric patients with AI. Valid incidence measures are essential for this purpose and also for the evaluation of interventions aimed at reducing adverse health outcomes from ACs. However, the absence of an agreed AC definition limits the potential benefit of research and surveillance in this area. While approaches to the treatment and prevention of ACs have much in common across the lifespan, there are important differences between children and adults with regards to the physiological, psychological, and social milieu in which these events occur. Education is considered to be an essential element of AC prevention but studies have shown that ACs occur even among well-educated patients, suggesting that new strategies may be needed. In this review, we examine the current knowledge regarding AC events in children with AI; assess the existing definitions of an AC and offer a new definition for use in research and the clinic; and suggest areas for further investigation that are aimed at reducing the incidence and health impact of ACs in the paediatric age group.

scholarly journals SAT0560 THE PROGNOSTIC VALUE OF ULTRASONOGRAPHIC FINDINGS IN INDIVIDUALS WITH ASYMPTOMATIC HYPERURICEMIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1238.2-1238
Author(s):  
W. Li ◽  
W. Fan ◽  
J. Zhu ◽  
Z. Chen ◽  
F. Liu
Keyword(s):  
Blood Flow ◽  
Prognostic Value ◽  
Soft Tissues ◽  
Bone Erosion ◽  
Gouty Arthritis ◽  
Diagnostic Value ◽  
First Metatarsal ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Peking University

Background:Chronic and steady asymptomatic hyperuricemia (AHU) can eventually lead to the deposition of monosodium urate crystals in joints and soft tissues. The rate of progression from AHU to clinically evident gout varies and mainly depends on serum uric acid levels. However, little is known about the prognostic value of ultrasonographic findings in individuals with AHU in detail.Objectives:To explore the prognostic value of ultrasonographic findings in individuals with asymptomatic hyperuricemia.Methods:We analyzed the ultrasonographic findings (snowstorm sign, double-contour (DC) sign, tophi, bone erosion, and abnormal blood flow) of bilateral knees, ankles and the first metatarsal-phalangeal joints (1st MTP) of individuals with AHU at Peking University People’s hospital between June 2014 and May 2016. All individuals were followed up for two years.Results:Among 218 individuals with AHU, the prevalence of snowstorm sign, DC sign, tophi, bone erosion and abnormal blood flow was 41%, 23%, 4%, 9% and 13%, respectively. Gout attacked in 36 patients during 2-year follow-up with 4.5 years of HU duration. The first attack affected the 1st MTP in 60%, the ankle in 31%, and the knee in 11% of the patients with gout. Patients with gout attack has longer hyperuricemia duration compared with individuals with AHU without gout attack. DC sign, tophi, and bone erosion on ultrasound were more frequently presented in patients with gout attack compared with individuals with AHU without gout attack. However, the prevalence of snowstorm sign and and abnormal blood flow on ultrasound has no significant differences between patients with gout attack and individuals with AHU without gout attack.Conclusion:Longer hyperuricemia duration, DC sign, tophi, and bone erosion on ultrasound in individuals with AHU could be associated with gout attack.References:[1]Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, et al. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789-98.[2]Estevez-Garcia IO, Gallegos-Nava S, Vera-Pérez E, Silveira LH, Ventura-Ríos L, Vancini G, et al. Levels of cytokines and MicroRNAs in individuals with asymptomatic hyperuricemia and ultrasonographic findings of gout: A Bench-to-Bedside Approach. Arthritis Care Res. 2018;70(12):1814-21.[3]Elsaman AM, Muhammad EM, Pessler F. Sonographic findings in gouty arthritis: diagnostic value and association with disease duration. Ultrasound Med Biol. 2016;42(6):1330-6.[4]Joosten LAB, Crişan TO, Bjornstad P, Johnson RJ. Asymptomatic hyperuricaemia: a silent activator of the innate immune system. Nat Rev Rheumatol. 2020;16(2):75-86.Acknowledgments:This work was supported by National Natural Science Foundation of China (No. 81571684 to Jiaan Zhu), Peking University People’s Hospital Research and Development Funds (RDC2014-02 to Wenting Fan).Disclosure of Interests:None declared

scholarly journals Tophaceous gout of the atlantoaxial joint: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Andrew Benjamin Romero ◽  
Evan Paul Johnson ◽  
John S. Kirkpatrick
Keyword(s):  
Cervical Spine ◽  
Tissue Sample ◽  
Significant Finding ◽  
Atlantoaxial Joint ◽  
Tophaceous Gout ◽  
Case Presentation ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
History Of ◽  
Clinically Significant

Abstract Background To report the occurrence of tophaceous gout in the cervical spine and to review the literature on spinal gout. Case presentation This report details the occurrence of a large and clinically significant finding of tophaceous gout in the atlantoaxial joint of the cervical spine in an 82-year-old Caucasian man with a 40-year history of crystal-proven gout and a 3-month history of new-onset progressive myelopathy. The patient's American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria score was 15.0. Conclusion Spinal gout is more common than previously thought, and it should be considered in patients who present with symptoms of myelopathy. Diagnosis can be made without a tissue sample of the affected joint(s) with tools like the ACR/EULAR criteria and the use of the “diagnostic clinical rule” for determining the likelihood of gout. Early conservative management with neck immobilization and medical management can avoid the need for surgical intervention.

scholarly journals Curcuma Longa, the “Golden Spice” to Counteract Neuroinflammaging and Cognitive Decline—What Have We Learned and What Needs to Be Done

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1519
Author(s):  
Alessandra Berry ◽  
Barbara Collacchi ◽  
Roberta Masella ◽  
Rosaria Varì ◽  
Francesca Cirulli
Keyword(s):  
Molecular Structure ◽  
Cognitive Decline ◽  
Neurodegenerative Disorders ◽  
Natural Compound ◽  
Water Solubility ◽  
Current Knowledge ◽  
Curcuma Longa ◽  
Biomedical Literature ◽  
Global Increase ◽  
New Strategies

Due to the global increase in lifespan, the proportion of people showing cognitive impairment is expected to grow exponentially. As target-specific drugs capable of tackling dementia are lagging behind, the focus of preclinical and clinical research has recently shifted towards natural products. Curcumin, one of the best investigated botanical constituents in the biomedical literature, has been receiving increased interest due to its unique molecular structure, which targets inflammatory and antioxidant pathways. These pathways have been shown to be critical for neurodegenerative disorders such as Alzheimer’s disease and more in general for cognitive decline. Despite the substantial preclinical literature on the potential biomedical effects of curcumin, its relatively low bioavailability, poor water solubility and rapid metabolism/excretion have hampered clinical trials, resulting in mixed and inconclusive findings. In this review, we highlight current knowledge on the potential effects of this natural compound on cognition. Furthermore, we focus on new strategies to overcome current limitations in its use and improve its efficacy, with attention also on gender-driven differences.

scholarly journals Metabolic Acidosis in Patients with CKD: Epidemiology, Pathogenesis, and Treatment

2021 ◽  
pp. 1-16
Author(s):  
Marcin Adamczak ◽  
Stanisław Surma
Keyword(s):  
Metabolic Acidosis ◽  
Sodium Bicarbonate ◽  
Current Knowledge ◽  
Venous Blood ◽  
The Body ◽  
Hydrogen Ions ◽  
Ckd Progression ◽  
New Drug ◽  
Treatment And Prevention

<b><i>Background:</i></b> Metabolic acidosis in CKD is diagnosed in patients with plasma or venous blood bicarbonate concentration lower than 22 mmol/L. Metabolic acidosis occurs in about 20% of patients with CKD. Metabolic acidosis may lead to dysfunction of many systems and organs as well as CKD progression. Currently, sodium bicarbonate is mainly used for pharmacological treatment of metabolic acidosis in patients with CKD. Veverimer is a new drug dedicated to treatment of metabolic acidosis in patients with CKD. Orally given veverimer binds hydrogen ions in the intestines and subsequently is excreted from the body with feces. Clinical studies have shown that veverimer is effective in increasing serum bicarbonate concentrations in CKD patients with metabolic acidosis. Here, we present review of the epidemiology, pathogenesis, diagnosis, treatment, and prevention of metabolic acidosis in CKD patients. <b><i>Summary:</i></b> Metabolic acidosis is common in patients with CKD and contributes to CKD progression and many complications, which worsen the prognosis in these patients. Currently, sodium bicarbonate is mainly used in metabolic acidosis treatment. The role of the new drug veverimer in the metabolic acidosis therapy needs further studies. <b><i>Key Message:</i></b> The aim of this review article is to summarize the current knowledge concerning the epidemiology, pathogenesis, diagnosis, treatment, and prevention of metabolic acidosis in CKD patients.

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