Hyperuricaemia, gout and cardiovascular risk after liver transplantation
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Gout is a chronic disease in which excessively high levels of serum urate (hyperuricemia) result in tissue depositions of sodium urate crystals and intermittent inflammatory attacks. Patients who have gout frequently experience a range of comorbidities, which complicates management and affects long-term prognosis. We review some of the more important of these comorbidities and consider the extent to which gout or hyperuricemia may be either a consequence or a cause of these related conditions. In addition, we briefly consider several neurological conditions in which the presence of gout or a high serum urate level may be associated with less disease, rather than more.
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Gout is a common type of arthritis. It is a painful and potentially debilitating condition that develops from deposits of uric acid crystals in the joints. 1,2 The accumulation of crystals causes attacks of painful inflammation in and around the joints. 3 Not everyone with high blood uric acid levels (called hyperuricaemia) develops gout. Up to two-thirds of individuals with hyperuricaemia never develop symptoms. It is unclear why some people with hyperuricaemia develop gout while others do not, but the symptoms of gout result from the body’s reaction to deposits of uric acid crystals in the joints. 1
Gouty arthritis
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Gout is a painful, inflammatory disease that affects more men than women. The incidence of gout has increased substantially over the past few decades, as evidenced by information from the Rochester project. Some of the risk factors for the development of gout include: increased ethanol intake, high dietary purine consumption, obesity and the use of certain drugs, such as diuretics. Another important risk factor for the development of gout is hyperuricaemia.
Hyperuricaemia results from an imbalance between the rate of production and excretion of uric acid in the body. An excess of uric acid thus builds up in the body, supersaturating body fluids and leading to the formation of monosodium urate crystals. These crystals accumulate in tissue and around joints, leading to an acute gout attack.
Gout can be divided into four phases, namely symptomatic hyperuricaemia, acute gout attacks or recurrent gout, intercritical gout and chronic tophaceous gout. Various treatment options are available for gout, and the treatment for each gout patient is determined by the stage of the disease. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, corticotropin and colchicine are used for the treatment of acute gout attacks. Allopurinol and probenecid are used for long-term hypouricaemic therapy, while NSAIDs and colchicine are prescribed for the prophylaxis of future gout attacks.
All of these treatments have side effects, ranging from mild to life-threatening in nature. There is a need for novel gout therapies that have fewer side effects but are still as effective.
Allopurinol
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Benzbromarone
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Objective/methods: The Longitudinal Health Insurance Database (LHID) 2010 was used to identify gout cases and their number of gout flares.Results: Out of 21,376 gout patients, a total of 3561 (16.7%) had frequent gout flares (≥3 gout flares/year). Average all-cause healthcare utilization (35.9 visits vs. 30.7 visits; p < .001) and gout-related utilization (22.7 visits vs. 15.6 visits; p < .001) were higher in frequent gout flare patients than in those with infrequent gout flares. The median gout-related cost (USD $369 vs. $285; p < .001), but not all-cause costs (p = .25), were higher in frequent gout flare patients compared to the infrequent group. Over 55.8% of the flares were treated with colchicine + NSAIDs.Conclusions: In conclusion, patients with frequent gout flares had higher healthcare utilization and gout-related healthcare costs. Colchicine + NSAIDs are commonly used therapy for gout flare.
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Gout, a common and complex form of inflammatory arthritis, is characterized by abnormally elevated levels of uric acid in the blood. The most current estimate from the Centers for Disease Control and Prevention shows an increase from 52.5 million to 54.4 million people in the U.S. have arthritis or one of the rheumatic diseases. There are over 100 rheumatic diseases and conditions. In the U.S., the most common types of arthritis or rheumatic diseases are osteoarthritis, gout, fibromyalgia, and rheumatoid arthritis, in that order according to prevalence. This article focuses on gout. Gout can be effectively treated and managed with a combination of medication (manufactured and/or compounded) and self-management strategies. Part 1 of this 2-part article provided the definition of gout and a brief history of gout. Part 2 continues the discussion of gout and includes examples of compounded formulations used in the treatment of gout.
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Although our understanding of hyperuricemia and gout has changed little over the past several years, questions remain in defining the many metabolic abnormalities that can result in these problems. In the past year, several papers have further addressed heritable mechanisms for the development of hyperuricemia, as well as environmental factors that contribute to its onset in adulthood. Consequences of hyperuricemia other than clinical gout have received further attention. Although typical gout is easily recognized and treated, several recent papers have addressed atypical presentations of gout, as well as other causes of podagra that might have been attributed previously to gout. The treatment of patients whose disease is uncomplicated by other conditions remains straightforward. However, the presentation of gout in patients with multiple comorbidities not only increases recognition of the toxicity of nonsteroidal anti-inflammatory drugs and colchicine, but often requires innovative approaches to its treatment.
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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. Using the case of Mr R, a 57-year-old man with a history of podagra, hyperuricemia, and mild renal insufficiency, the diagnosis and treatment of gout are discussed. For those with moderate to severe gout, urate-lowering treatment can eliminate acute attacks of arthritis and prevent complications. In the near future, it is likely that new risk factors for gout will be identified and new ways of preventing and managing this common disease will become available.
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Gout is a painful, inflammatory disease that affects more men than women. The incidence of gout has increased substantially over the past few decades, as evidenced by information from the Rochester project. Some of the risk factors for the development of gout include: increased ethanol intake, high dietary purine consumption, obesity and the use of certain drugs, such as diuretics. Another important risk factor for the development of gout is hyperuricaemia.Hyperuricaemia results from an imbalance between the rate of production and excretion of uric acid in the body. An excess of uric acid thus builds up in the body, supersaturating body fluids and leading to the formation of monosodium urate crystals. These crystals accumulate in tissue and around joints, leading to an acute gout attack.Gout can be divided into four phases, namely asymptomatic hyperuricaemia, acute gout attacks or recurrent gout, intercritical gout and chronic tophaceous gout. Various treatment options are available for gout, and the treatment for each gout patient is determined by the stage of the disease. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, corticotropin and colchicine are used for the treatment of acute gout attacks. Allopurinol and probenecid are used for long-term hypouricaemic therapy, while NSAIDs and colchicine are prescribed for the prophylaxis of future gout attacks.All of these treatments have side effects, ranging from mild to life-threatening in nature. There is a need for novel gout therapies that have fewer side effects but are still as effective.
Allopurinol
Probenecid
Colchicine
Benzbromarone
Febuxostat
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Objectives
To evaluate the clinical features and risk factors for gout attack during the postsurgical period in patients with gout.Methods
Seventy patients who had histories of gout and had been consulted to rheumatologic clinic before surgery under general anaesthesia at a single tertiary hospital were included. Clinical characteristics of patients who developed postsurgical gout attack were compared with patients who did not developed gout attack.Results
Among 70 patients, 31 (44.3%) patients developed gout attack during postsurgical period. Mean time of gout attack after surgery was 3.7±4.9 days. Most of attacks involved lower extremity joints (83.9%) and tended to monoarticular involvement (61.3%). Knee joint (26%) and foot except 1st metatarsophalangeal (MTP) joint (26%) were more frequently involved than 1st MTP joint (13%). Uric acid levels before surgery (OR 1.46, 95% CI 1.13–1.88, p=0.004) and amount of uric acid changes between before and after surgery (OR 1.62, 95% CI 1.21–2.18, p=0.001) were risk factors for postsurgical gout attack. Taking medications for gout including uric acid lowering agents and/or colchicine reduced the risk of postsurgical gout attack (OR 0.11, 95% CI 0.04–0.32, p<0.001). Operation time, amount of blood loss during surgery, amount of fluid administration during surgery, and surgery site were not significantly associated with postsurgical gout attack.Conclusions
Adequate uric acid control and taking medications for gout could prevent the postsurgical gout attack.Disclosure of Interest
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