Clinical features and recurrent attack in gout patients according to serum urate levels during an acute attack

Objective.To study the frequency of normal serum urate (SU) levels during acute gout in the largest studies of acute gout treatment to date.Methods.Data collected from 2 randomized controlled clinical trials assessing the efficacy of etoricoxib or indomethacin for 7 days in acute gout were used to assess SU levels during acute gouty attacks. Efficacy was similar with both agents, so both groups were combined for analysis.Results.A total of 339 patients were enrolled in the 2 studies; 94% were male; mean age was 50.5 years. At baseline, 14% of patients had a “true” normal SU (≤ 6 mg/dl) and 32% had SU ≤ 8 mg/dl during acute gout. Baseline mean SU was 7.1 versus 8.5 mg/dl (p < 0.001) in those taking allopurinol versus nonusers. Patients taking chronic allopurinol were more likely to have lower SU at baseline compared to those not taking chronic allopurinol (p < 0.001) during the acute attack.Conclusion.A normal SU level at presentation does not exclude an acute gouty attack. In the largest studies of acute gout to date, attacks still occurred despite SU levels being below 6.8 mg/dl, the saturation level for urate. This may be attributed to persistence of tophi and an increased body uric acid pool. Additional studies are needed to determine the correlation between SU and the body uric acid pool as well as the relationship to timing of changes during acute gout.

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Characteristics of Menstrual and Nonmenstrual Attacks in Women with Menstrually Related Migraine Referred to Headache Centres

Cephalalgia ◽

10.1111/j.1468-2982.2004.00741.x ◽

2004 ◽

Vol 24 (9) ◽

pp. 707-716 ◽

Cited By ~ 138

Author(s):

F Granella ◽

G Sances ◽

G Allais ◽

RE Nappi ◽

A Tirelli ◽

...

Keyword(s):

Migraine Attack ◽

Clinical Features ◽

Tertiary Care ◽

Acute Attack ◽

Diary Study ◽

Menstrually Related Migraine ◽

Work Related ◽

Abortive Treatment ◽

Headache Centres

Aim of this study was to determine whether menstrual attacks differ from non-menstrual attacks (NMA) as regards clinical features or response to abortive treatment in women affected by menstrually related migraine (MRM) referred to tertiary care centres. Sixty-four women with MRM were enrolled in a 2-month diary study. Perimenstrual attacks were split into three groups – premenstrual (PMA), menstrual (MA) and late menstrual (LMA) – and compared to nonmenstrual ones. Perimenstrual attacks were significantly longer than NMA. No other migraine attack features were found to differ between the various phases of the cycle. Migraine work-related disability was significantly greater in PMA and MA than in NMA. Acute attack treatment was less effective in perimenstrual attacks. Pain-free at 2 h after dosage was achieved in 13.5% of MA (OR 0.41; 95% CI 0.22, 0.76) vs. 32.9% of NMA. We concluded that, in MRM, perimenstrual attacks are longer and less responsive to acute attack treatment than NMA.

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Gout

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0141_update_004 ◽

2013 ◽

pp. 1199-1210

Author(s):

Nicola Dalbeth

Keyword(s):

Disease Patient ◽

Joint Damage ◽

Serum Urate ◽

Acute Attack ◽

Dietary Factors ◽

Acute Gout ◽

Chronic Synovitis ◽

Renal Tubular

Gout is a common and treatable disorder of purine metabolism. Gout typically presents as recurrent self-limiting episodes of severe inflammatory arthritis affecting the foot. In the presence of persistent hyperuricaemia, tophi, chronic synovitis, and joint damage may develop. Diagnosis of gout is confirmed by identification of monosodium urate (MSU) crystals using polarizing light microscopy. Hyperuricaemia is the central biochemical cause of gout. Genetic variants in certain renal tubular urate transporters including SLC2A9 and ABCG2, and dietary factors including intake of high-purine meats and seafood, beer, and fructose, contribute to development of hyperuricaemia and gout. Gout treatment includes: (1) management of the acute attack using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or low-dose colchicine; (2) prophylaxis against gout attacks when commencing urate-lowering therapy (ULT), with NSAIDs or colchicine; and (3) long-term ULT to achieve a target serum urate of less than 0.36 mmol/litre. Interleukin (IL)-1β‎‎ is a central mediator of acute gouty inflammation and anti-IL-1β‎‎ therapies show promise for treatment of acute attacks and prophylaxis. The mainstay of ULT remains allopurinol. However, old ULT agents such as probenecid and benzbromarone and newer agents such as febuxostat and pegloticase are also effective, and should be considered in patients in whom allopurinol is ineffective or poorly tolerated. Management of gout should be considered in the context of medical conditions that frequently coexist with gout, including type 2 diabetes, hypertension, dyslipidaemia, and chronic kidney disease. Patient education is essential to ensure that acute gout attacks are promptly and safely managed, and long-term ULT is maintained.

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THE CONCEPT OF NIQRIS (GOUT) AND ITS MANAGEMENT WITH THE HELP OF REGIMENAL THERAPY: A REVIEW

Indian Journal of Unani Medicine ◽

10.53390/ijum.v13i1.2 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Nida Umer Khan ◽

Akhtar Husain Farooqui ◽

Ahmad Mahfooz ◽

Zakir Khan ◽

Tausif S. Khan ◽

...

Keyword(s):

Joint Pain ◽

Preventive Measures ◽

Serum Urate ◽

Therapeutic Agents ◽

Recurrent Attack ◽

The World ◽

Principles Of Treatment ◽

Ancient Times ◽

Skeletal Disorder ◽

Acute Attacks

Gout is one of the oldest known diseases and described in Unani system of medicine under the term Niqras.Niqris (gout) is a type of Waja' al-Mafasil(arthritis) which is characterized by recurrent attack of acute pain and swelling primarily affecting one joint usually the metatarsal joint of big toe and small joints of hand and feet. It is a commonest joint pain creating problems in day to day life of various people of the world. In Modern drugs used for subsiding acute attacks or lowering serum uric acid are associated with potent adverse effects. Moreover, these commonly used therapeutic agents often, and for various reasons, do not achieve the desired lowering of serum urate levels to below 6.0 mg/dl. The objective of present study was to ascertain the Unani concept described in Unani classical literatures regarding various causes, symptoms and management of this common arthritic disorder by Renowned Unani Physicians with an aim to spread the knowledge for preventive measures, home remedies, regimenal therapy to get relief from the disease and the management of gout by Unani compound formulations, which are not only easily available but also have no side effect on human body. In this regard, we may conclude that spread of knowledge of enormous effective Unani components and general principles of treatment, which are being used by Unani physicians since ancient times, shall be extremely effective in the management of this musculo skeletal disorder.

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Gout

10.1093/med/9780199642489.003.0141_update_003 ◽

2016 ◽

Author(s):

Nicola Dalbeth

Keyword(s):

Disease Patient ◽

Joint Damage ◽

Serum Urate ◽

Acute Attack ◽

Dietary Factors ◽

Acute Gout ◽

Chronic Synovitis ◽

Inflammatory Drugs ◽

Renal Tubular

Gout is a common and treatable disorder of purine metabolism. Gout typically presents as recurrent self-limiting episodes of severe inflammatory arthritis affecting the foot. In the presence of persistent hyperuricaemia, tophi, chronic synovitis, and joint damage may develop. Diagnosis of gout is confirmed by identification of monosodium urate (MSU) crystals using polarizing light microscopy. Hyperuricaemia is the central biochemical cause of gout. Genetic variants in certain renal tubular urate transporters including SLC2A9 and ABCG2, and dietary factors including intake of high-purine meats and seafood, beer, and fructose, contribute to development of hyperuricaemia and gout. Gout treatment includes: (1) management of the acute attack using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or low-dose colchicine; (2) prophylaxis against gout attacks when commencing urate-lowering therapy (ULT), with NSAIDs or colchicine; and (3) long-term ULT to achieve a target serum urate of less than 0.36 mmol/litre. Interleukin (IL)-1β‎ is a central mediator of acute gouty inflammation and anti-IL-1β‎ therapies show promise for treatment of acute attacks and prophylaxis. The mainstay of ULT remains allopurinol. However, old ULT agents such as probenecid and benzbromarone and newer agents such as febuxostat and pegloticase are also effective, and should be considered in patients in whom allopurinol is ineffective or poorly tolerated. Management of gout should be considered in the context of medical conditions that frequently coexist with gout, including type 2 diabetes, hypertension, dyslipidaemia, and chronic kidney disease. Patient education is essential to ensure that acute gout attacks are promptly and safely managed, and long-term ULT is maintained.

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Gout

10.1093/med/9780199642489.003.0141 ◽

2013 ◽

Author(s):

Nicola Dalbeth

Keyword(s):

Disease Patient ◽

Joint Damage ◽

Serum Urate ◽

Acute Attack ◽

Dietary Factors ◽

Acute Gout ◽

Chronic Synovitis ◽

Inflammatory Drugs ◽

Renal Tubular

Gout is a common and treatable disorder of purine metabolism. Gout typically presents as recurrent self-limiting episodes of severe inflammatory arthritis affecting the foot. In the presence of persistent hyperuricaemia, tophi, chronic synovitis, and joint damage may develop. Diagnosis of gout is confirmed by identification of monosodium urate (MSU) crystals using polarizing light microscopy. Hyperuricaemia is the central biochemical cause of gout. Genetic variants in certain renal tubular urate transporters including SLC2A9 and ABCG2, and dietary factors including intake of high-purine meats and seafood, beer, and fructose, contribute to development of hyperuricaemia and gout. Gout treatment includes: (1) management of the acute attack using non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or low-dose colchicine; (2) prophylaxis against gout attacks when commencing urate-lowering therapy (ULT), with NSAIDs or colchicine; and (3) long-term ULT to achieve a target serum urate of less than 0.36 mmol/litre. Interleukin (IL)-1β‎ is a central mediator of acute gouty inflammation and anti-IL-1β‎ therapies show promise for treatment of acute attacks and prophylaxis. The mainstay of ULT remains allopurinol. However, old ULT agents such as probenecid and benzbromarone and newer agents such as febuxostat and pegloticase are also effective, and should be considered in patients in whom allopurinol is ineffective or poorly tolerated. Management of gout should be considered in the context of medical conditions that frequently coexist with gout, including type 2 diabetes, hypertension, dyslipidaemia, and chronic kidney disease. Patient education is essential to ensure that acute gout attacks are promptly and safely managed, and long-term ULT is maintained.

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