scholarly journals Gout – management of a chronic disease: a systematic review

2020 ◽  
Vol 3 (1) ◽  
pp. 70-77
Author(s):  
Petruţa Violeta Filip ◽  
Sorina Laura Diaconu ◽  
Diana Chetroiu ◽  
Denisa Cuciureanu ◽  
Corina Silvia Pop
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Chronic Phase ◽  
Optimal Strategies ◽  
Serum Urate ◽  
Lifestyle Changes ◽  
Term Therapy ◽  
Therapeutic Goals ◽  
Long Term Treatment

AbstractObjectives: Gout is the most common inflammatory arthritis of the 21 century, but is still frequently misdiagnosed. This review aims to provide guidance for gout management in clinical practice, which includes the diagnosis, treatment of acute episodes, but also long-term therapy to reduce serum urate, as well as lifestyle changes and prevention of recurrent episodes.Design: Systematic review without meta-analysis.Methods: We have systematically searched Google Scholar, PubMed, and all relevant worldwide guidelines to identify and select clinical guidelines for gout. We have included eligible gout articles according to predefined inclusion and exclusion criteria after selecting titles, abstracts and full texts. The characteristics of the recommendations reported in the guidelines included were extracted and analyzed.Results: We selected 27 eligible papers and tried to facilitate the identification of recommendations for the treatment of gout in the acute phase, but also in the chronic phase. The recommendations were detailed and explained during this extensive review.Conclusions: Despite the availability of effective serum urate reduction therapies, overall gout management is poor. Achieving therapeutic goals is often low both at the initiation of therapy and in long-term treatment. Optimal strategies for managing gout are necessary in both acute and chronic gout flames in patients who are prone to the development of this pathology.

Long-term management of gout

2016 ◽  
Author(s):  
Fernando Perez-Ruiz ◽  
Irati Urionagüena ◽  
Sandra P. Chinchilla
Keyword(s):  
Structural Damage ◽  
Serum Urate ◽  
Term Treatment ◽  
Lifestyle Changes ◽  
Long Term Treatment ◽  
Patient Reported ◽  
Concomitant Medications ◽  
Urate Lowering Treatment ◽  
Term Management

Long-term management of gout comprises several aspects. Although in the short term, prophylaxis and treatment of acute episodes of inflammation are of great importance, the milestone for the long-term management of gout is targeted, sustained, and long-term control of hyperuricaemia. Treating to target subsaturating serum urate (SUA) levels, which may be initially dependent on the severity of the disease in the individual patient, is associated with a progressive reduction to no episodes of acute inflammation, regression and disappearance of subcutaneous and articular monosodium urate deposits and associated chronic inflammation, and improvement in patient-reported, health-related quality of life. Early and effective urate-lowering treatment to target levels will also prevent the development of structural damage. Urate-lowering treatment includes any measure intending to reduce SUA levels to target: lifestyle changes, modifications of concomitant medications favouring hyperuricaemia, and urate-lowering medications (ULMs). Availability of ULMs is variable worldwide, and prescription should be judicious, according to approved labels, and always considering associated health conditions and concomitant medications. Effectiveness and safety should be periodically monitored. Long-term treatment of gout still remains suboptimal in the twenty-first century. As practising clinicians, we cannot afford to neglect a ‘curable disease’.

scholarly journals 162 Post-lithium Delirious Mania in Patients with Bipolar Disorder

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 303-304
Author(s):  
Muhammad Zaidi ◽  
Michael Champ ◽  
Aquanette Brown ◽  
Tzvetelina Dimitrova
Keyword(s):  
Bipolar Disorder ◽  
Meta Analysis ◽  
Definitive Treatment ◽  
Term Therapy ◽  
Relative Reduction ◽  
List Type ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Bipolar Patients

Abstract:Delirious mania is a life-threatening condition, presenting with symptoms of acute delirium and psychotic mania as a complication of medical or psychiatric condition. It is not recognized as a diagnosis in DSM-V and is under recognized in clinical practice. It was first described by Calmeil (Calmeil, 1832). In 1849 Luther Bell described 40 cases with an associated 75% mortality rate. More recently, Jacobowski et al (2013) compiled a comprehensive review of clinical characteristics, diagnostic work up, and treatment recommendations for delirious mania. In addition to acute onset, clinical course is frequently worsened by psychosis and catatonia. Delirium leads to disequilibrium of neurotransmitters, particularly depletion of acetylcholine and elevation of dopamine.Lithium has been used for the treatment of mania for many decades. Suppes et al performed a meta-analysis of 14 studies including 257 patients with Bipolar I disorder and concluded that patients relapsed 28 times more when stopping lithium compared to those who continued this medication. Baldessarini et al (1999) completed analysis of 227 patients with Bipolar I and II disorders, dividing the sample into “abrupt” (1-14 days) and “gradual” (15-30 days) discontinuation groups and concluded that the frequency of relapse following “abrupt” cessation was four times higher compared to following “gradual” cessation. In a study of 450 bipolar patients, Baldessarini et al (2003) reviewed the long-term treatment of lithium as monotherapy (86 % of the study’s population) in the context of lithium maintenance population morbidity. Greater pretreatment morbidity lead to larger relative reduction in morbidity as a result of treatment with lithium. A subgroup of bipolar patients with “abrupt” discontinuation became refractory when re-challenged with lithium.Describing three clinical cases of delirious mania following conclusions can be derived:•Patients with bipolar disorder and comorbid chronic kidney injury currently or formerly receiving long-term therapy with lithium are at increased risk for delirious mania.•Abrupt lithium discontinuation in patients with bipolar disorder and comorbid chronic medical conditions (especially chronic kidney disease) increases risk for mania refractory to conventional treatment with medications.•In such patients, definitive treatment is ECT.

scholarly journals Metabolic side effects of antipsychotic drugs in individuals with schizophrenia during medium- to long-term treatment: protocol for a systematic review and network meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Johannes Schneider-Thoma ◽  
Angelika Kapfhammer ◽  
Dongfang Wang ◽  
Irene Bighelli ◽  
Spyridon Siafis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Antipsychotic Drugs ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Term Treatment ◽  
Controlled Trials ◽  
Metabolic Side Effects ◽  
Long Term Treatment

Abstract Background Antipsychotic drugs and especially the newer compounds are known to cause metabolic side effects. However, a comprehensive comparison of the different substances regarding their propensity to cause metabolic side effects in medium- to long-term treatment of schizophrenia is lacking. Methods We will conduct a systematic review and network meta-analysis (NMA). We will include randomized controlled trials (RCTs) in which participants received either placebo or an antipsychotic (i.e. placebo-controlled trials and head-to-head comparisons of drugs). We will include studies in individuals with schizophrenia or related disorders (such as schizophreniform or schizoaffective disorders) at any stage of the disease (acute episode; maintenance phase). We will include studies with a duration of more than 3 months (medium- to long-term treatment). The primary outcome will be the change in body weight. Secondary outcomes will be the further metabolic parameters: fastening glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides. We will search for eligible studies (independent of the publication status) in Cochrane Schizophrenia Group’s Study-Based Register of Trials, which is compiled by regular searches in trial registries and multiple electronic databases from their inception onwards including MEDLINE, EMBASE and PsycINFO. Additionally, we will search previously published systematic reviews and websites of pharmaceutical companies for eligible studies. At least two reviewers will independently conduct the process of study selection and data extraction. We will use the Cochrane Risk of Bias 2 tool to evaluate the risk of bias in studies. We will conduct random-effects NMA within a Bayesian framework to synthesize all evidence for each outcome. We will conduct sensitivity and subgroup analyses to assess the robustness of the findings and to explore heterogeneity. The confidence in the results will be evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework. Discussion This systematic review and network meta-analysis will provide a synthesis of the existing evidence from RCTs how antipsychotic drugs differ in terms of metabolic side effects during medium- to long-term treatment. The findings have the potential to influence the choice of antipsychotic medication made by individuals with schizophrenia and their physicians. Systematic review registration PROSPERO CRD42020175414

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