scholarly journals Gender characteristics of gout and differences in response to taking xanthioxidase inhibitors

2021 ◽  
pp. 164-169
Author(s):  
V. V. Tsurko ◽  
M. A. Gromova
Keyword(s):  
Uric Acid ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Joint Damage ◽  
Chronic Arthritis ◽  
Upper Extremities ◽  
Pronounced Increase ◽  
Men And Women ◽  
Lowering Therapy ◽  
Gender Characteristics

Introduction. To date, there is no consensus regarding the gender characteristics of the course of gout. There is little data on the possible difference between men and women in response to uric acid-lowering therapy.Aim. To compare the clinical characteristics of the course of gout and evaluate the differences in response to urate-lowering therapy (ULT) with allopurinol and febuxostat in men and women.Material and methods. The retrospective cohort study included 279 men and 83 women diagnosed with gout (ACR/EULAR, 2015). The comparative analysis of the clinical characteristics of gout, as well as responses to the intake of xanthioxidase (XO) inhibitors in representatives of different sexes, was carried out. We compared the gender characteristics of obtaining a positive response to ULT, defined as achieving a target serum uric acid (sUA) level of < 360 μmol / l within 6 months of treatment, while taking allopurinol and febuxostat.Results. By the age at which the onset of gout took place, women were older than men, the duration of the disease in them was shorter. Men showed a shorter duration of the first attack of arthritis. Chronic arthritis was diagnosed in 56% of men and 35% of women (p < 0.05). The process involved the joints of both the lower and upper extremities. However, more often the joints of the lower extremities were affected in men, and in the upper extremities in women. Tophus were detected in 35% of patients, of whom 30.3% were men, 4.7% were women (p < 0.05). Allopurinol was prescribed to 216 men and 54 women, and febuxostat was prescribed to 63 men and 29 women. After six months, the proportion of women who achieved the target sUA was 57.5% and 65.8%, the proportion of men – 60.4% and 76.2% for allopurinol and febuxostat, respectively.Conclusion. The clinical manifestations of gout in men and women differ. Due to the pronounced increase in the level of uric acid, men develop more severe joint damage due to the tendency to chronicity. However, the study did not reveal gender differences in the response to XO inhibitors, which indicates that there is no need to choose therapy depending on the patient’s gender.

scholarly journals SAT0507 CLINICAL CHARACTERISTICS AND TREATMENT RESPONSE IN JUVENILE GOUT PATIENTS: A SINGLE CENTER EXPERIENCE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1210.2-1210
Author(s):  
S. Zheng ◽  
P. Y. Lee ◽  
Y. Huang ◽  
Q. Huang ◽  
S. Chen ◽  
...  
Keyword(s):  
Renal Function ◽  
Uric Acid ◽  
Treatment Response ◽  
Serum Uric Acid ◽  
Clinical Characteristics ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Joint Involvement ◽  
Normal Body Mass Index ◽  
Finger Joints

Background:The incidence of juvenile gout is increasing in China. The clinical manifestations of juvenile gout and treatment strategies to reduce uric acid levels in children are not well described due to the limited number of cases in the past.Objectives:We aim to describe the clinical characteristic of children with gout and study the treatment response to febuxostat.Methods:These studies were approved by the Institutional Review Board of Guangdong Second provincial General Hospital. We performed a retrospective analysis on 98 juvenile gout patients (age ≤ 18 years) evaluated in our hospital from Jan 2016 to Dec 2019. We analyzed clinical parameters, laboratory data and treatment response.Results:The average age of disease onset in children with gout was 15.2 ± 2.0 years and the youngest patient was 9 years old. The majority of patients were male (94/98) and mean serum uric acid (sUA) level were 705.8 ± 145.7 μmol/L (reference range <420 μmol/L). More than half of the cohort had normal body mass index (mean 24.7 ± 4.7 kg/m2; range 14.9 to 36.1 kg/m2). Renal function was generally normal in these children (serum creatinine 96.9 ± 17.8 μmol/L). In terms of joint manifestations, juvenile gout preferentially affected finger joints (29%), ankles (28%) and metatarsal joints (MTP; 20%). The most frequent sites of initial gout attack were ankles (45%), MTP (39%) and fingers (6%). In addition, tophi can occur in pediatric patients and typically develop in the finger joints (54%). Tophi was observed in about 25% of juvenile gout patients, typically within the first two years of disease onset (mean duration 1.7 ± 0. 9 years). We have found tophi in children as young as 10 years of age.For treatment for chronic hyperuricemia, 32 patients (32.7%) were started on febuxostat and 5 patients (5.1%) received allopurinol. A decrease in sUA was observed in both groups after the first month of treatment (febuxostat: baseline 690.4 ± 99.7 μmol/L to 482.7 ± 140.8 μmol/L vs. allopurinol: baseline 728.8 ±112.8 μmol/L to 565.0 ± 116.7 μmol/L, P=0.477). Serum uric acid of 6 patients in the febuxostat group (none in the allopurinol group) dropped below 360 μmol/L. There were no statistical differences in Cr, AST and ALT between the groups. During follow-up after 3 months, further decline in sUA level were observed in patients treated with febuxostat (409.5 ± 83.4, compared with baseline P<0.001).Conclusion:Juvenile gout has a different pattern of joint involvement and is less associated with elevated BMI compared to gout in adults. We show that febuxostat is effective in reducing uric acid levels in juvenile gout. These findings will help clinicians better understand the clinical manifestations and treatment response in juvenile gout.Figure 1Compared treatment response with allopurinol and febuxostatReferences:[1]Kishimoto K, Kobayashi R, Hori D, et al. Febuxostat as a Prophylaxis for Tumor Lysis Syndrome in Children with Hematological Malignancies. Anticancer Res. 2017 Oct;37(10):5845-5849.[2]Lu, C.C., et al. Clinical characteristics of and relationship between metabolic components and renal function among patients with early-onset juvenile tophaceous gout. J Rheumatol, 2014. 41(9): p. 1878-83.Disclosure of Interests:None declared

CLINICAL CHARACTERISTICS AND DETERMINE THE CONCENTRATIONS OF AUTOBODIES AND CYTOKINES IN PATIENTS WITH RHEUMATOID ARTHRITIS

2015 ◽  
pp. 86-92
Author(s):  
Van Ai Luu ◽  
Tam Vo
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Joint Damage ◽  
Key Words Rheumatoid Arthritis ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Tnf Α ◽  
Ifn Γ ◽  
Positive Results

Background: Rheumatoid arthritis is an autoimmune disease with complex pathophysiological mechanisms, in which cytokines plays an important role. Currently, based on the understanding of the cytokines, the treatment of rheumatoid arthritis with biological agents had changed the course of the disease. Objectives: Study the clinical characteristics and determine the concentrations of autoantibodies (RF, Anti CCP) and cytokines (IL-1α,IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFN-γ, TNF-α, MCP1, EGF) in patients with rheumatoid arthritis, simultaneously, evaluate the correlation between the cytokines concentrations and levels of autoantibodies in patients with rheumatoid arthritis treated at Cho Ray Hospital.Subjects and Methods: Descriptive cross-sectional study conducted in 76 patients with rheumatoid arthritis treated at Cho Ray Hospital form June 2013 to April 2014.Results: - Clinical and laboratory characteristics: The most common clinical manifestations are arthritis (98.7%), symmetry joint damage (96.1%), morning stiffness over 1 hour (90.8%). Subcutaneous nodule is accounted for 3.9%. The most common joints involved in rheumatoid arthritis are wrist (93.4%), MCP and knee (90.8%), PIP (76.3%) and ankle (67.1%), the least common is the hip (14.5%). The percentage of autoantibodies and cytokines: rheumatoid arthritis patients with positive results of anti – CCP is accounted for 86%. rheumatoid arthritis patients with increased IL-1α concentrations is accounted for 40,8%; increased IL-1β concentration in 48.7%; increased IL-2 concentration in 32,9%; increased IL-4 concentration in 86%; increased IL-6 concentration in 100%; increased IL-8 concentration in 39,5%; increased IL-10 concentration in 81,6%; increased VEGF concentration in 51,3%; increased IFN-γ concentration in 67,1%; increased TNF-α concentration in 61,8%; increased MCP1 concentration in 30,3%; increased EGF concentration in 39,43%. The average concentrations of cytolines in rheumatoid arthritis patients is as followings: IL-1α (57.36 ± 196.43), IL-1β (123.77± 532.51), Il-2 (279.93 ± 945.04), IL-4(279.93 ± 945.04), IL-6(91.35 ± 170.52), IL-8(270.84 ± 445.45), IL-10(134.58 ± 496.14), VEGF(638.87 ± 540.18), IFN-γ(136.43 ± 338.68), TNF-α(106.27 ± 265.57), MCP1(292.34 ± 265.52), EGF(152.62 ± 123.64).RF is correlated with IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IFN-γ, and TNF-α. Anti – CCP is correlated with IL-1α, IL-6. Key words: Rheumatoid arthritis, cytokines

Postoperative cognitive dysfunction: progress mechanisms and clinical characteristics

2019 ◽  
Vol 2 (19) ◽  
pp. 29-33
Author(s):  
K. B. Manysheva ◽  
M. A. Akhmedov ◽  
A. A. Rakhmanova ◽  
S. M. Khutalieva
Keyword(s):  
Cognitive Dysfunction ◽  
Clinical Characteristics ◽  
Cognitive Deficit ◽  
Neuropsychological Testing ◽  
Postoperative Cognitive Dysfunction ◽  
Clinical Manifestations ◽  
Postoperative Recovery ◽  
Neuropsychological Rehabilitation ◽  
Brain Barrier Permeability ◽  
The Central Nervous System

The article is devoted to the study of postoperative cognitive dysfunction — a syndrome that is often found in the postoperative period and does not depend on the volume of surgeon. Based on the analysis of the results of modern studies, the authors cite the most likely etiological causes of the syndrome, grouped according to different categories of risk factors. The pathogenetic algorithm for cognitive dysfunction includes the appearance of systemic inflammation, improving blood-brain barrier permeability with the endothelial dysfunction, the migration of inflammatory agents into the central nervous system, and the formation of oxidative stress. The clinical manifestations of cognitive deficit in the outcome of surgeon performed under general anesthesia, the authors illustrate with their own observations of patients with a neurosurgical profile with spinal pathology operated on with the use of propofol anesthesia, comparing the results of neuropsychological testing with an assessment of the level of anxiety. In conclusion, the authors outline a strategy for the prevention of postoperative cognitive dysfunction and recommend conducting neuropsychological rehabilitation as an important component of postoperative recovery for all patients with a diagnosed cognitive deficit that occurred after surgery.

Ultrasound features of peripheral angiodistonic syndrome of the upper extremities in vibration disease

2020 ◽  
Vol 60 (11) ◽  
pp. 815-817
Author(s):  
Nadezhda I. Kuprina ◽  
Ekaterina V. Ulanovskaya ◽  
Olga A. Kochetova
Keyword(s):  
Blood Flow ◽  
Heart Defects ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Ulnar Artery ◽  
Upper Extremities ◽  
Disease Stage ◽  
Peripheral Blood Flow ◽  
Pronounced Increase ◽  
Vibration Disease

Introduction. Vibration disease (VD) is an example of the most common pathology due to the systematic exposure of the worker to intense vibration with sufficient work experience, the main manifestation of which is peripheral angiodystonic syndrome. The aim of study was to learn the features of peripheral blood flow in the arteries of the forearm in vibration disease using the ultrasound method. Materials and methods. The radial and ulnar arteries in patients with vibration disease were examined by ultrasound in B- and PW-mode. These materials present the results of an ultrasound assessment of the speed indicators of the main arteries of the forearm in vibration disease stages 1 and 2. The selection criteria for patients in the study ware the presence of pronounced clinical manifestations of angiodystonic syndrome in vibration disease, confirmed by instrumental research methods and data on the sanitary and hygienic characteristics of working conditions, the absence of cardiovascular chronic diseases (ischemic heart disease, heart defects, rhythm and conduction disturbances), rheumatic, oncological, infectious diseases, osteo-traumatic changes in the upper extremities. Results. The groups of patients with the established diagnosis of vibration disease of 1 and 2 degrees were studied. With vibration disease stage 1 a decrease in the pulse velocity of blood flow was observed in isolation on the ulnar artery and an increase in peripheral resistance (pulsation index and resistance index) in the radial and ulnar arteries symmetrically on both upper extremities. The second stage of vibration disease differed from the first by a more significant decrease in speed indicators both on the ulnar and radial arteries on both sides, symmetrically in combination with a more pronounced increase in peripheral resistance indicators on both main arteries of the forearm (pulsation index and resistance index). The revealed changes were determined with the same frequency in men and women. Conclusions. A significant decrease in speed indicators on the ulnar artery and an increase in peripheral resistance indicators are detected already at the initial stages of vibration disease. Thus, the method of ultrasound examination of the main arteries of the middle caliber of the upper extremities is currently the only available and objective method for examining the vascular system in vibration disease.

Can Serum Uric Acid Lowering Therapy Contribute to the Prevention or Treatment of Nonalcoholic Fatty Liver Disease?

2018 ◽  
Vol 16 (3) ◽  
pp. 269-275 ◽  
Author(s):  
Paschalis Paschos ◽  
Vasilios G. Athyros ◽  
Achilleas Tsimperidis ◽  
Anastasia Katsoula ◽  
Nikolaos Grammatikos ◽  
...  
Keyword(s):  
Uric Acid ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Serum Uric Acid ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Lowering Therapy

scholarly journals Uric Acid and Hypertension: Prognostic Role and Guide for Treatment

2021 ◽  
Vol 10 (3) ◽  
pp. 448
Author(s):  
Federica Piani ◽  
Arrigo F. G. Cicero ◽  
Claudio Borghi
Keyword(s):  
Clinical Trials ◽  
Uric Acid ◽  
Mendelian Randomization ◽  
Strong Association ◽  
Epidemiological Studies ◽  
Hypertensive Disease ◽  
Genetic Studies ◽  
Lowering Therapy ◽  
The Relationship

The relationship between serum uric acid (SUA) and hypertension has been a subject of increasing interest since the 1870 discovery by Frederick Akbar Mahomed. Several epidemiological studies have shown a strong association between high SUA levels and the presence or the development of hypertension. Genetic analyses have found that xanthine oxidoreductase (XOR) genetic polymorphisms are associated with hypertension. However, genetic studies on urate transporters and Mendelian randomization studies failed to demonstrate a causal relationship between SUA and hypertension. Results from clinical trials on the role of urate-lowering therapy in the management of patients with hypertension are not uniform. Our study sought to analyze the prognostic and therapeutic role of SUA in the hypertensive disease, from uric acid (UA) biology to clinical trials on urate-lowering therapies.

scholarly journals 369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S254-S254
Author(s):  
Victoria Bengualid ◽  
Maria Martinez ◽  
Zhenisa Hysenaj ◽  
Debra M Willner ◽  
Judith Berger
Keyword(s):  
Oxygen Saturation ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Altered Mental Status ◽  
Channel Blockers ◽  
First Case ◽  
Overall Mortality

Abstract Background The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients. Patient Characteristics and Outcome Methods IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome. Results A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%. Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms. Mortality The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die. Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001). Conclusion This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality. Disclosures All Authors: No reported disclosures

AB0837 Patients' Knowledge and Perspectives about Gout and Adherence to Uric-Acid Lowering Therapy: A Qualitative Study

2014 ◽  
Vol 73 (Suppl 2) ◽  
pp. 1079.3-1079
Author(s):  
M. van Onna ◽  
E. Hinsenveld ◽  
H. de Vries ◽  
A. Boonen
Keyword(s):  
Uric Acid ◽  
Qualitative Study ◽  
Lowering Therapy

MO491ASSOCIATION BETWEEN SERUM URIC ACID LEVEL AND CHRONIC KIDNEY DISEASE INCIDENCE STRATIFIED BY SEX IN MIDDLE-AGED ADULTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Shingo Nakayama ◽  
Michihiro Satoh ◽  
Takahisa Murakami ◽  
Yukako Tatsumi ◽  
Tomoko Muroya ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Kidney Disease ◽  
Serum Uric Acid ◽  
Health Check ◽  
Middle Aged ◽  
Men And Women ◽  
Increased Risk ◽  
The Mean ◽  
Middle Aged Adults

Abstract Background and Aims While previous studies have reported the association between serum uric acid (SUA) and chronic kidney disease (CKD) incidence, the sex differences in this association remain controversial. Therefore, we examined the association between SUA levels and CKD incidence in middle-aged adults stratified by sex using data from a large-scale health check-up. Method We analyzed information from the JMDC database, which included the annual health check-up data of Japanese employees and their dependents aged &lt;75 years. Among those individuals, we analyzed data from 138,511 individuals without CKD, kidney disease, or a history of cardiovascular disease at baseline. CKD was defined as an estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m2 and/or proteinuria. We divided the participants into 9 and 7 groups according to SUA levels for men and women, respectively. A Cox model was applied to assess the adjusted hazard ratios (HRs) for CKD incidence in each SUA level group using an SUA concentration of 4.0–4.9 mg/dL as the reference after adjusting for age, body mass index, current or ex-smoker, current or ex-drinker, diabetes mellitus, dyslipidemia, systolic blood pressure, use of anti-hyperuricemic drugs, and baseline eGFR. Results The mean participant age was 44.1 years, and 29.6% were women. The mean SUA levels were 5.9 mg/dL and 4.1 mg/dL in men and women, respectively. During the mean follow-up period of 4.68 years, 12,589 participants developed CKD. The age-standardized incidence rates for CKD were 17.88/17.80 per 1000 person-years in men/women with SUA concentrations of 4.0–4.9 mg/dL, 209.76 per 1000 person-years in men with SUA ≥11.0 mg/dL, and 73.38 per 1000 person-years in women with SUA ≥ 9.0 mg/dL. The fully adjusted HRs (95% confidence interval [CI], P value) for CKD incidence in the groups with SUA concentrations of &lt;4.0, 10.0–10.9, and ≥11.0 mg/dL compared with those with SUA of 4.0–4.9 mg/dL among men were 1.13 (1.01–1.26, P=0.030), 1.98 (1.32–2.97, P=0.0010), and 3.74 (1.68–8.35, P=0.0013), respectively. In women, the fully adjusted HRs for CKD incidence in the groups with SUA concentrations of &lt;4.0, 8.0–8.9, and ≥9.0 mg/dL were 1.08 (1.01–1.16, P=0.032), 2.39 (1.07–5.35, P=0.034), and 3.20 (0.80–12.8, P=0.10), respectively. Similar results were observed when we performed the sensitivity analysis excluding 8,411 individuals with hypertensive treatment from the main analysis. The HRs for the outcomes caused by the onset of eGFR &lt;60 mL/min/1.73 m2 or proteinuria separately were similar to those for the main results. Conclusion The results of the present study demonstrated an increased risk of CKD in men with SUA concentrations of &lt;4.0 and ≥10.0 mg/dL and &lt;4.0 and ≥8.0 mg/dL in women compared to those with SUA concentrations of 4.0–4.9 mg/dL after adjusting for various covariates. Both high and low SUA levels were risk factors for CKD in middle-aged men and women. Hyperuricemia was demonstrated to cause renal injury due to the intraluminal deposition of uric acid crystals in the renal collecting duct. Hyperuricemia may also induce endothelial dysfunction, activation of the renin-angiotensin system, and induction of inflammation and stimulation of vascular smooth muscle cell proliferation by the induction of cyclooxygenase-2. However, as uric acid is one of the most important antioxidants in human plasma, low SUA levels may increase the risk of CKD incidence through decreased antioxidant activity. These mechanisms are implicated in the pathogenesis of CKD caused by high and low SUA levels. In addition, the SUA levels and ranges associated with increased risks of CKD incidence differed by sex.

Clinical Characteristics and Genetic Analysis of Interstitial Lung Disease in Chinese Children (Genes and Interstitial Lung Disease)

2021 ◽  
Author(s):  
Mei-Xia Huang ◽  
Lu Qin ◽  
Fei-Zhou Zhang ◽  
Lei Wu ◽  
Jia-Hui Yu ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Failure To Thrive ◽  
Surfactant Protein ◽  
Chinese Children ◽  
Common Mutation ◽  
Onset Age ◽  
Surfactant Dysfunction

Abstract BackgroundMutation in the surfactant protein C gene (SFTPC) is a cause of interstitial lung disease (ILD). Our objective was to investigate the clinical characteristics, outcome and influencing factors of ILD in Chinese children with SFTPC mutations.MethodA total of 8 Chinese children with ILD heterozygous for SFTPC mutations that were treated in our hospital from January 2014 to December 2020 were included in our study. Candidate genes responsible for surfactant dysfunction were sequenced by next-generation sequencing. The clinical and genetic data were reviewed retrospectively.ResultsThe children’s onset age was before the age of 2 years, and one case was just after birth. The most significant clinical manifestations were cough, tachypnea, hypoxemia and failure to thrive. The most common mutation was p. lle73Thr, which accounted for 87.5% (7/8) of our patients. Four patients whose onset was within 3 months, including 3 children with CMV infection, died. Conclusionp. lle73Thr mutation of SFTPC was an important and common cause of ILD in the Chinese children. The clinical manifestations of ILD associated with this mutation are not specific. The severity and outcome of the disease may be affected by factors such as onset age and viral infection.

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