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Acute gout management in ckd

Philip C Robinson, Lisa K Stamp
BACKGROUND: Gout is a common problem that is increasing in prevalence in Australia. It is associated with many serious comorbidities such as hypertension, chronic kidney disease, obesity, diabetes and cardiovascular disease. Recent changes include the way that older drugs are used, as well as newer therapeutics becoming available or in development. OBJECTIVE: The objective of this article is to provide an update on the management of gout. DISCUSSION: Developments in treatment strategies for gout and newer agents to treat gout are discussed in this article...
May 2016: Australian Family Physician
Tristan Pascart, Sylvie Lancrenon, Sabine Lanz, Catherine Delva, Pascal Guggenbuhl, Charles Lambert, Jean-Pierre Aubert, Alain Saraux, Hang-Korng Ea, Frédéric Lioté
OBJECTIVES: The objective of this sub-study was to assess the use of colchicine for the treatment of gout flares in real life conditions in the GOSPEL cohort following the 2006 EULAR recommendations for gout management. METHODS: This national cross-sectional epidemiologic survey included outpatients with gout suffering from acute flare followed by randomly selected primary care physicians (n=398) and private practice rheumatologists (n=109) between October 2008 and September 2009 in France...
February 23, 2016: Joint, Bone, Spine: Revue du Rhumatisme
Samar Medani, Catherine Wall
Colchicine is an approved agent in the management and prophylaxis of gout and familial Mediterranean fever but its therapeutic value is limited by its narrow therapeutic index. Multisystem toxicity is uncommonly reported; and is often associated with renal impairment and/or specific drug interactions. We report two cases of colchicine toxicity marked by severe neuromyopathy in a diabetic with stage 4 chronic kidney disease (CKD) and a renal transplant recipient. Both patients presented with diarrhea, acute on chronic kidney injury and progressive muscle weakness while on colchicine for several weeks or longer...
August 2016: Clinical Nephrology
Pietro Cirillo, Loreto Gesualdo
In the last decades, the increase in life expectancy, changes in diet and lifestyle have resulted in raising of incidence and prevalence of gout in all countries. The phenotype of patients with gout has changed a lot over the years: more and more frequently they have several co-morbidities such as hypertension, cardiovascular disease, diabetes, obesity, chronic kidney disease (CKD) and metabolic syndrome that influence the progression and challenge the therapeutic management. The management of gout in CKD patients demands more attention and specific features in diagnosis and therapeutic approach...
2015: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Frances Rees, Michael Doherty
Gout affects 2.5% of the total UK population and is four times more common in men than women. The peak prevalence and incidence in the UK is in those aged 80-84 years. Gout is associated with comorbidities such as nephrolithiasis, chronic renal impairment, metabolic syndrome, depression and heart disease. It is also associated with increased mortality. Untreated gout can result in disabling irreversible peripheral joint damage and chronic usage-related pain. However, gout is curable. The pathogenic agents that cause gout i...
December 2014: Practitioner
George L Bakris, Paul P Doghramji, Robert T Keenan, Steven H Silber
The prevalence of gout and hyperuricemia are on the rise in the United States corresponding with an increase in risk factors for these conditions, such as obesity, metabolic syndrome, and the use of diuretics. A progressive disorder, untreated gout can be debilitating and result in tophi, chronic arthropathy, and recurrent kidney stones. Although joint aspiration is needed for a definitive diagnosis, the majority of patients are diagnosed presumptively based on medical history and presentation with characteristic signs and symptoms...
January 2014: American Journal of Medicine
David B Mount
PURPOSE OF REVIEW: Gout is a painful inflammatory arthritis associated with hyperuricemia, with a prevalence of almost 10 million in the USA. Reduced renal excretion of urate is the underlying hyperuricemic mechanism in the vast majority of gout patients; most of the genes that affect serum urate level (SUA) encode urate transporters or associated regulatory proteins. Acquired influences can also modulate SUA and renal urate excretion, sometimes precipitating acute gout. Coincidentally, the prevalence of renal comorbidities in gout - hypertension, chronic kidney disease (CKD), and nephrolithiasis - is very high...
March 2013: Current Opinion in Nephrology and Hypertension
Robert H Shmerling
Gout is an ancient disease. Despite significant advances in the understanding of its risk factors, etiology, pathogenesis, prevention, and treatment, millions of people with gout experience repeated attacks of acute arthritis and other complications. The incidence of gout is increasing, most likely reflecting increasing rates of obesity and other lifestyle factors, including diet. Comorbid conditions that often accompany gout, including chronic kidney disease and diabetes mellitus, present challenges for the management of gout...
November 28, 2012: JAMA: the Journal of the American Medical Association
Abdul A Abdellatif, Naser Elkhalili
Chronic kidney disease (CKD) is a comorbid condition that affects, based on recent estimates, between 47% and 54% of patients with gouty arthritis. However, data from randomized controlled trials in patients with gouty arthritis and CKD are limited, and current gouty arthritis treatment guidelines do not address the challenges associated with managing this patient population. Nonsteroidal anti-inflammatory drugs and colchicine are recommended first-line treatments for acute gouty arthritis attacks. However, in patients with CKD, nonsteroidal anti-inflammatory drugs are not recommended because their use can exacerbate or cause acute kidney injury...
November 2014: American Journal of Therapeutics
Frédéric Lioté, Sylvie Lancrenon, Sabine Lanz, Pascal Guggenbuhl, Charles Lambert, Alain Saraux, Pierre Chiarelli, Catherine Delva, Jean-Pierre Aubert, Hang-Korng Ea
OBJECTIVES: To assess diagnoses and management of acute and chronic gout in primary care and rheumatology settings relative to 2006 European League Against Rheumatism (EULAR) gout recommendations. Secondary objectives were to describe patient demographics, clinical features, lifestyle modifications, and short- and mid-term outcomes. METHODS: Prospective, cross-sectional, descriptive survey of patients with chronic gout, acute gout, or suspected gout, included by randomly selected general practitioners (GPs, n = 398) and rheumatologists (n = 109) between October 2008 and September 2009, in France...
October 2012: Joint, Bone, Spine: Revue du Rhumatisme
Maria Majdan, Olga Borys
Gout is a condition presenting with inflammatory arthritis caused by crystallization and phagocytosis of monosodium urate in synovial fluid. It is the most common form of arthritis in men above the age of 40 years. Four clinical stages of gout have been distinguished: asymptomatic hyperuricemia, acute gouty arthritis, intercritical gout, and chronic gout. Experimental and epidemiologic studies provide growing evidence that hyperuricemia is not only the driving force behind symptoms attributed to the deposition of monosodium urate in the musculoskeletal system but also the important etiological factor in common morbidities of modern societies such as arterial hypertension, cardiovascular disease, chronic kidney disease, and type 2 diabetes mellitus...
2010: Annales Academiae Medicae Stetinensis
Pasha Sarraf, Jonathan Kay, Anthony M Reginato
Rheumatic syndromes are cause for morbidity in patients with end-stage renal disease. Recent advances in understanding the role of tissue remodeling have provided insight into the pathogenic mechanisms responsible for some of these manifestations. Here, we survey recent and clinically relevant advances in translational research that impact our understanding of rheumatic syndromes seen in patients with significant renal disease. The management of acute and chronic crystalline arthropathies in chronic kidney disease and hemodialysis patients is discussed...
July 2008: Current Rheumatology Reports
Karl T Hoskison, Robert L Wortmann
Gout, a common inflammatory arthritis, can be diagnosed with absolute certainty. Gout results from the body's reaction to urate crystals deposited in tissues, and this pathophysiology is well understood. If used appropriately, available therapies can be entirely effective in not only treating the symptoms of gout, but also in eliminating the excess urate from the body, thereby eradicating the disease. Because of these facts, management of patients with gout should be successful. However, management of gout is particularly challenging in the elderly, even though the principles of management are the same for all age groups...
2007: Drugs & Aging
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