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https://www.readbyqxmd.com/read/27886694/update-on-crystal-induced-arthritides
#1
REVIEW
Hossam El-Zawawy, Brian F Mandell
The prevalence of gout increases with age. Once serum concentration of urate exceeds the saturation/solubility point, it deposits in and around the joints. Clinical presentation in the elderly often has "atypical" features and is challenging to diagnose. Treatment depends on the stage of the disease and the patient's health status and comorbidities. Elderly patients often have several confounding issues; thus, treatment decisions can be complicated and therapeutic options limited. To prevent the recurrence of gout attacks, serum concentration of urate should be maintained well below the saturation threshold of 6...
February 2017: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/27843869/skin-rash-eosinophilia-and-renal-impairment-in-a-patient-recently-started-on-allopurinol
#2
Ashraf Jmeian, Amer Hawatmeh, Razan Shamoon, Fayez Shamoon, Michael Guma
Allopurinol is a hypoxanthine analog which inhibits xanthine oxidase, it is a widely used medication for the treatment of hyperuricemia and gout. Allopurinol-induced drug-induced rash with eosinophilia and systemic symptoms syndrome is an infrequent, life-threatening adverse reaction of allopurinol therapy that is remarkable for the higher mortality rate with the use of allopurinol than with the use of another agent. We present a case of a 62-year-old male with a history of chronic kidney disease stage 3, hypertension and gout who developed skin rash, eosinophilia, and renal impairment 2 weeks after he was started on allopurinol therapy for gout...
April 2016: Journal of Family Medicine and Primary Care
https://www.readbyqxmd.com/read/27825577/efficacy-and-safety-of-febuxostat-in-73-gouty-patients-with-stage-4-5-chronic-kidney-disease-a-retrospective-study-of-10-centers
#3
Pierre-Antoine Juge, Marie-Elise Truchetet, Evangeline Pillebout, Sébastien Ottaviani, Cécile Vigneau, Clotilde Loustau, Divi Cornec, Tristan Pascart, Renaud Snanoudj, Florian Bailly, Emilie Cornec-Le Gall, Thierry Schaeverbeke, Alain Saraux, Philippe Dieudé, René-Marc Flipo, Pascal Richette, Frédéric Lioté, Thomas Bardin, Gérard Chalès, Hang-Korng Ea
OBJECTIVES: The allopurinol dose is limited in chronic kidney disease, particularly stage 4/5 chronic kidney disease. Febuxostat has a hepatic metabolism and has been approved without dose adaptation in gouty patients with stage 1-3 chronic kidney disease. We aimed to study the safety and efficacy of febuxostat for stage 4/5 chronic kidney disease. METHODS: In this retrospective study, we included patients with (1) a diagnosis of gout, (2) febuxostat treatment, (3) estimated glomerular filtration rate≤30mL/min/1...
November 4, 2016: Joint, Bone, Spine: Revue du Rhumatisme
https://www.readbyqxmd.com/read/27763557/decrystallization-of-crystals-using-gold-nano-bullets-and-the-metal-assisted-and-microwave-accelerated-decrystallization-technique
#4
Nishone Thompson, Zainab Boone-Kukoyi, Raquel Shortt, Carisse Lansiquot, Bridgit Kioko, Enock Bonyi, Salih Toker, Birol Ozturk, Kadir Aslan
Gout is caused by the overproduction of uric acid and the inefficient metabolism of dietary purines in humans. Current treatments of gout, which include anti-inflammatory drugs, cyclooxygenase-2 inhibitors, and systemic glucocorticoids, have harmful side-effects. Our research laboratory has recently introduced an innovative approach for the decrystallization of biological and chemical crystals using the Metal-Assisted and Microwave-Accelerated Evaporative Decrystallization (MAMAD) technique. In the MAMAD technique, microwave energy is used to heat and activate gold nanoparticles that behave as "nano-bullets" to rapidly disrupt the crystal structure of biological crystals placed on planar surfaces...
October 18, 2016: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/27615128/the-role-of-hepatocyte-nuclear-factor-1%C3%AE-in-disease-and-development
#5
REVIEW
R El-Khairi, L Vallier
Heterozygous mutations in the gene that encodes the transcription factor hepatocyte nuclear factor 1β (HNF1B) result in a multi-system disorder. HNF1B was initially discovered as a monogenic diabetes gene; however, renal cysts are the most frequently detected feature. Other clinical features include pancreatic hypoplasia and exocrine insufficiency, genital tract malformations, abnormal liver function, cholestasis and early-onset gout. Heterozygous mutations and complete gene deletions in HNF1B each account for approximately 50% of all cases of HNF1B-associated disease and may show autosomal dominant inheritance or arise spontaneously...
September 2016: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/27577941/evaluation-of-cardiovascular-risk-in-stages-of-gout-by-a-complex-multimodal-ultrasonography
#6
Rada Gancheva, Atanas Kundurdjiev, Mariana Ivanova, Todor Kundurzhiev, Zlatimir Kolarov
The aim of our work was to assess ultrasound features of cardiovascular (CV) risk in stages of gout. Cross-sectional complex multimodal ultrasound study of 169 age-matched patients, with similar distribution of arterial hypertension, diabetes mellitus, obesity and chronic renal failure, was divided into four groups: 41 with asymptomatic hyperuricemia, 52 gout without tophi, 42 gouty tophi and 34 controls with osteoarthritis. Parameters independently associated with CV risk were measured: renal resistive index (RRI), left ventricular mass index (LVMi), mitral annulus early diastolic velocity (e'), intima-media thickness (IMT) and common carotid artery resistive index (CCARI)...
August 30, 2016: Rheumatology International
https://www.readbyqxmd.com/read/27529533/sensitivity-and-specificity-of-ultrasonographic-features-of-gout-in-intercritical-and-chronic-phase
#7
Shyamashis Das, Alakendu Ghosh, Parasar Ghosh, Debasish Lahiri, Pradyot Sinhamahapatra, Kaushik Basu
AIM: This study aimed to assess the sensitivity and specificity of ultrasonographic features of gout in intercritical and chronic stages and compared ultrasonographic features of gout between patients with persistent high serum uric acid (SUA) and patients with low SUA. METHODS: Adult patients with gout confirmed by demonstration of monosodium urate crystals were recruited, if they were in intercritical or chronic stage clinically. Ultrasonographic examination of the first metatarsophalangeal joints (MTPJs) and the knee joints of both sides were done by a blinded rheumatologist trained in musculoskeletal ultrasound...
August 16, 2016: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/27523583/effects-of-the-dietary-approaches-to-stop-hypertension-dash-diet-and-sodium-intake-on-serum-uric-acid
#8
Stephen P Juraschek, Allan C Gelber, Hyon K Choi, Lawrence J Appel, Edgar R Miller
OBJECTIVE: Randomized trial data guiding dietary recommendations to lower serum uric acid (SUA), the etiologic precursor of gout, are scarce. We examined the effects of the DASH diet (a well-established diet that lowers blood pressure) and levels of sodium intake, on SUA. METHODS: We conducted an ancillary study of a randomized, crossover feeding trial in 103 adults with pre- or stage 1 hypertension. Participants were randomly assigned to receive either the DASH diet or a control diet (typical of the average American diet) and were further fed low, medium, and high sodium levels for 30 days each in random order...
August 14, 2016: Arthritis & Rheumatology
https://www.readbyqxmd.com/read/27506295/epidermal-growth-factor-gene-is-a-newly-identified-candidate-gene-for-gout
#9
Lin Han, Chunwei Cao, Zhaotong Jia, Shiguo Liu, Zhen Liu, Ruosai Xin, Can Wang, Xinde Li, Wei Ren, Xuefeng Wang, Changgui Li
Chromosome 4q25 has been identified as a genomic region associated with gout. However, the associations of gout with the genes in this region have not yet been confirmed. Here, we performed two-stage analysis to determine whether variations in candidate genes in the 4q25 region are associated with gout in a male Chinese Han population. We first evaluated 96 tag single nucleotide polymorphisms (SNPs) in eight inflammatory/immune pathway- or glucose/lipid metabolism-related genes in the 4q25 region in 480 male gout patients and 480 controls...
2016: Scientific Reports
https://www.readbyqxmd.com/read/27489636/tocilizumab-improved-clinical-symptoms-of-a-patient-with-systemic-tophaceous-gout-who-had-symmetric-polyarthritis-and-fever-an-alternative-treatment-by-blockade-of-interleukin-6-signaling
#10
Sho Mokuda, Masamoto Kanno, Kiyoshi Takasugi, Chikara Okumura, Yuki Ito, Junya Masumoto
Chronic tophaceous gout is the end stage of gout. We employed a blockade of interleukin-6 signaling therapy by tocilizumab instead of anakinra, an interleukin-1 receptor antagonist, for a 61-year-old Japanese woman diagnosed with tophaceous gout. Laboratory data showed that serum interleukin-6 concentration was elevated. Serum interleukin-1β concentration was under the detectable level, although serum uric acid was elevated due to renal dysfunction. The secretion patterns of interleukin-1β, tumor-necrosis factor-α, interleukin-6, and interleukin-8 from peripheral mononuclear cells isolated from the patient exhibited no remarkable differences compared with those of healthy volunteers...
2014: SAGE open medical case reports
https://www.readbyqxmd.com/read/27384670/what-outcomes-are-important-for-gout-patients-in-depth-qualitative-research-into-the-gout-patient-experience-to-determine-optimal-endpoints-for-evaluating-therapeutic-interventions
#11
Sophi Tatlock, Katja Rüdell, Charlotte Panter, Rob Arbuckle, Leslie R Harrold, William J Taylor, Tara Symonds
BACKGROUND AND OBJECTIVES: Characterized by sudden onset of severe joint pain, swelling, redness, and tenderness to touch, gout 'flare ups' have a substantial impact on quality of life (QoL). This research employed a patient-centered approach to explore the symptoms and impacts of gout, and assess the content validity of existing patient-reported outcomes (PROs). METHODS: Qualitative interviews were conducted with 30 US gout patients (non-tophaceous: n = 20, tophaceous: n = 10) and five expert rheumatologists...
July 6, 2016: Patient
https://www.readbyqxmd.com/read/27355475/stroke-and-risks-of-development-and-progression-of-kidney-diseases-and-end-stage-renal-disease-a-nationwide-population-based-cohort-study
#12
Chia-Lin Wu, Chun-Chieh Tsai, Chew-Teng Kor, Der-Cherng Tarng, Ie-Bin Lian, Tao-Hsiang Yang, Ping-Fang Chiu, Chia-Chu Chang
BACKGROUND: There is little information about the association between stroke and kidney diseases. We aimed to investigate the impact of stroke on long-term renal outcomes. METHODS: In this large population-based retrospective cohort study, we identified 100,353 subjects registered in the National Health Insurance Research Database of Taiwan from January 1, 2000, through December 31, 2012, including 33,451 stroke patients and 66,902 age-, sex- and Charlson's comorbidity index score-matched controls...
2016: PloS One
https://www.readbyqxmd.com/read/27296322/are-allopurinol-dose-and-duration-of-use-nephroprotective-in-the-elderly-a-medicare-claims-study-of-allopurinol-use-and-incident-renal-failure
#13
Jasvinder A Singh, Shaohua Yu
OBJECTIVE: To assess the effect of allopurinol dose/duration on the risk of renal failure in the elderly with allopurinol use. METHODS: We used the 5% random Medicare claims data from 2006 to 2012. Multivariable-adjusted Cox regression analyses assessed the association of allopurinol dose/duration with subsequent risk of developing incident renal failure or end-stage renal disease (ESRD) (no prior diagnosis in last 183 days) in allopurinol users, controlling for age, sex, race and Charlson-Romano comorbidity index...
June 13, 2016: Annals of the Rheumatic Diseases
https://www.readbyqxmd.com/read/27257659/predictors-of-ckd-and-rate-of-decline-in-egfr-in-the-elderly-a-case-cohort-study
#14
Umbar Ghaffar, Najindra Maharjan, Page C Moore
We wanted to examine the predictors of annual estimated glomerular filtration rate (eGFR) decline during a five-year follow-up in elderly individuals with pre-existing chronic kidney disease (CKD) stage 3 or greater (defined as baseline eGFR of less than 60 ml/min per 1.73 m2 or a urinary albumin-to-creatinine ratio > 30 mg/g), and to examine the difference in risk factors when compared to a co-hort without CKD. Our research team identified 599 patients who were 65 years of age or older with and without CKD stage 3 or greater at baseline...
April 2016: Nephrology News & Issues
https://www.readbyqxmd.com/read/27185589/relevant-aspects-of-imaging-in-the-diagnosis-and-management-of-gout
#15
Eloy De Avila Fernandes, Samuel Brighenti Bergamaschi, Tatiane Cantarelli Rodrigues, Gustavo Coelho Dias, Ralff Malmann, Germano Martins Ramos, Soraya Silveira Monteiro
Gout is an inflammatory arthritis characterized by the deposition of monosodium urate crystals (MSU) in the synovial membrane, articular cartilage and periarticular tissues leading to inflammation. Men are more commonly affected, mainly after the 5th decade of life. Its incidence has been growing with the population ageing. In the majority of the cases, the diagnosis is made by clinical criteria and synovial fluid analysis, in search for MSU crystals. Nonetheless, gout may sometimes have atypical presentations, complicating the diagnosis...
April 30, 2016: Revista Brasileira de Reumatologia
https://www.readbyqxmd.com/read/27125882/dual-energy-computed-tomography-a-novel-technique-for-diagnosis-of-gout
#16
Zohra Ahmad, Arun Kumar Gupta, Raju Sharma, Ashu Seith Bhalla, Uma Kumar, V Sreenivas
AIM: To evaluate the sensitivity and specificity of dual energy computed tomography (DECT) for diagnosing gout compared with a composite gold standard (CGS) comprising joint aspiration and/or American College of Rheumatology clinico-radiographic criteria. METHODS: Ninety patients of suspected gout underwent radiography and DECT of bilateral feet and knees. Radiographs and non-contrast CT (NCCT) were assessed for morphological characteristics, following which DECT was used to identify urate deposits...
September 2016: International Journal of Rheumatic Diseases
https://www.readbyqxmd.com/read/27069192/prevention-and-management-of-complications-during-robotic-assisted-laparoscopic-radical-prostatectomy-following-comprehensive-planning-a-large-series-involving-a-single-surgeon
#17
Yen-Chuan Ou, Chun-Kuang Yang, Kuangh-Si Chang, John Wang, Siu-Wan Hung, Min-Che Tung, Ashutosh K Tewari, Vipul R Patel
AIM: To report a series of 1,000 patients treated by a single surgeon using robotic-assisted laparoscopic radical prostatectomy (RALP) and to show how to prevent and manage complications of the procedure. PATIENTS AND METHODS: Complication rates were prospectively assessed in a series of 1,000 consecutive patients who underwent RALP (group I, cases 1-200; IIa, 201-400; IIb, 401-600; IIIa, 601-800; and IIIb, 801-1000). Preoperative evaluation focused on patients' history of gout, use of drugs that can influence clotting time, and cardiopulmonary problems...
April 2016: Anticancer Research
https://www.readbyqxmd.com/read/27033862/general-practitioners-perspectives-on-the-management-of-gout-a-qualitative-study
#18
Andrew Jeyaruban, Muriel Soden, Sarah Larkins
BACKGROUND: Many quantitative studies globally have identified suboptimal management of gout. PURPOSE: To explore management of gout from the perspective of general practitioners (GPs), while identifying the barriers and possible strategies for improvement. STUDY DESIGN: This descriptive qualitative study used semistructured interviews with 14 purposely selected GPs from four separate general practices in Townsville. The questions focused on management strategies, practicalities in managing gout, barriers and possible strategies to improve management...
October 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27023686/cost-comparison-of-urate-lowering-therapies-in-patients-with-gout-and-moderate-to-severe-chronic-kidney-disease
#19
Ghaith Mitri, Eric T Wittbrodt, Robin S Turpin, Beni A Tidwell, Kathy L Schulman
BACKGROUND: Patients with chronic kidney disease (CKD) are at increased risk for developing gout and having refractory disease. Gout flare prevention relies heavily on urate-lowering therapies such as allopurinol and febuxostat, but clinical decision making in patients with moderate-to-severe CKD is complicated by significant comorbidity and the scarcity of real-world cost-effectiveness studies. OBJECTIVE: To compare total and disease-specific health care expenditures by line of therapy in allopurinol and febuxostat initiators after diagnosis with gout and moderate-to-severe CKD...
April 2016: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/26962732/case-records-of-the-massachusetts-general-hospital-case-7-2016-an-80-year-old-man-with-weight-loss-abdominal-pain-diarrhea-and-an-ileocecal-mass
#20
Vijay Yajnik, Shaunagh McDermott, Hamed Khalili, Jamie M Everett
Presentation of Case. Dr. Amulya Nagarur (Medicine): An 80-year-old man with end-stage renal disease, type 2 diabetes mellitus, peripheral arterial disease, hypertension, coronary arteriosclerosis, congestive heart failure, abdominal aortic aneurysm, hyperlipidemia, and gout was admitted to this..
March 10, 2016: New England Journal of Medicine
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