Use of metformin (siofor) in patients with gout and insulin resistance (pilot 6-month results)

AIM: To evaluate metformin efficacy and safety in patients with gout and insulin resistance (IR). MATERIAL AND METHODS: The trial included 26 patients with gout (criteria of the American collage of rheumatologists) and IR (index HOMA). The inclusion criteria were the following: absence of antigout therapy, normal hepatic and renal function, rejection of alcohol. The drug dose was 1500 mg/day. The study was made of anthropometric and clinical characteristics, 24-h blood pressure monitoring, blood tests for uric acid, glucose, insulin, urea, creatinin, alaninaminotransferase, aspartataminotransferase, lipid spectrum at the first and further visits. RESULTS: A 6-month metformin therapy significantly changed the levels of glucose, insulin, HDLP and LDLP cholesterol, uric acid, HOMA index. Normouricemia was achieved in 11 patients, a significant lowering of uric acid--in 12 patients. The number of affected joints in 23 patients reduced from 4 (1-5) to 1 (0-2), p < 0.01. Seven patients with achieved normouricemia had no arthritis attacks. In 3 of 10 patients with chronic arthritis joint inflammation persisted. Six patients had dyspepsia during the first week of therapy, 1 patient discontinued the drug because of persistent diarrhea. CONCLUSION: Metformin therapy is safe. It reduces IR. The principal result of the study was lowering of uric acid and attenuation of the articular syndrome.     

2013年风湿免疫病学主要临床进展

风湿免疫病学科是内科领域最年轻的学科,但也是发展速度最快的学科之一.每年都有多种疾病治疗指南得到更新.2013年,类风湿关节炎(RA)新的治疗指南仍将传统合成改变病情抗风湿药物(csDMARDs)作为一线治疗方案,不再推荐生物制剂作为一线治疗,而是作为csDMARDs治疗反应不佳的RA患者的二线选择.应用生物制剂治疗前后均应高度重视结核病筛查与预防性治疗.关节超声、磁共振成像检查有助于诊断不典型RA、预测进展型未分化炎症性关节炎、了解疾病活动度、评估预后和治疗反应等.侵蚀性关节炎有了明确定义.部分系统性红斑狼疮(SLE)患者有望接受少或无激素治疗,生物制剂在SLE中的应用也初显端倪.尽管SLE患者预后显著改善,但心血管疾病、抑郁症、骨质疏松和骨折等合并症患病率显著增高.放射学阴性中轴型脊柱关节炎(SpA)概念的提出和系统性硬化病(SSc)分类标准的更新,显著提高了SpA和SSc的早期诊断率."达标治疗"方案成为高尿酸血症和痛风的目标治疗策略,特别是反复发作的痛风患者血尿酸水平应长期控制在300 μmol/L以下.     

痛风性关节炎的临床及关节镜诊治特点

目的探讨膝、踝关节痛风性关节炎临床及关节镜诊治特点。方法回顾分析21例(22个关节)痛风性关节炎临床发病特点、关节镜下表现及治疗效果。结果21例中7例(33.33%)有第一跖趾关节肿痛史,13例(61.90%)有血尿酸值升高,关节液检查15例(71.43%)尿酸值增高,13例(61.90%)可见尿酸盐结晶。21例病检均为痛风性关节炎,关节镜下特征性表现为关节内各组织结构表面可见点片状或团块状反光的结晶物沉积,滑膜呈急性炎症表现。镜下通过搔刮、打磨、旋切、冲洗等处理,所有病例肿痛症状均迅速缓解,术后随访6个月～7年,原手术关节因软骨严重剥脱呈骨性关节炎而肿痛复发2例,另关节再发1例。结论大关节痛风尽管有些患者症状不典型,但结合病史、症状及化验仍有一定规律可循,结合关节镜可达到早期诊治的目的。     

Severity of a female gout course

AIM: Comparison of a gout course in males and females. MATERIAL AND METHODS: The trial enrolled 34 patients (17 females and 17 males). The patients were matched by age and the disease duration. Severity of a gout course was assessed by the disease history, articular syndrome, concomitant diseases, blood biochemistry. Statistical processing was made with a computer program "Statistica 6.0". RESULTS: Events predisposing to purin metabolism disturbances and, therefore, to development of gout occur more frequently in females than in males. For the most part this concerns arterial hypertension and intake of diuretics. Women often have endocrine pathology (artificial menopause, dysmenorrhea, euthyroid goiter). In women gout runs a more severe course manifesting in early chronization, polyarticularity, lingering arthritis, rapid formation of tophuses. Both groups demonstrated marked polymorbidity with accumulation of the diseases related to atherosclerosis. Distinct group differences by content of uric acid seem to arise from early onset of chronic renal failure in women. CONCLUSION: In the absence of sex- and age-related differences, a more severe course of gout is observed in women. This may be due to hyperuricemia and a trend to the disease chronization, high prevalence of arterial hypertension and renal failure.     

Nimesil treatment of gouty arthritis

AIM: To evaluate efficacy and safety of nimesil, a selective inhibitor of cyclooxigenase-2, in gouty arthritis (GA). MATERIAL AND METHODS: Nimesil was given to 20 male patients with GA (mean age 53.8 years, mean duration of the disease 8.1 years) in a dose 100 mg twice a day for 14 or 21 days depending on positive clinical changes (13 and 6 patients, respectively). The articular swelling index, supraarticular skin hyperemia, the articular index, pain in rest and movement were estimated on the treatment day 1, 5, 14 and 21. Arterial pressure was controlled in all the patients. ESR, uric acid, seromucoid, ALT, AST, gamma-GTP, glucose levels were measured before and after the treatment. RESULTS: Nimesil relieved pain and inflammation (ESR and seromucoid level lowered significantly). Effects on the other estimates were not registered. One patient developed generalized urticaria on the treatment day 5. The drug was discontinued in him. CONCLUSION: Nimesil can be used as monotherapy of an acute attack of gout. In a dose 200 mg/day nimesil provides an effective and fast treatment of gout, is well tolerated and safe.     

双能量CT对急性痛风结晶的评估及相关因素分析

目的:采用单源双能量CT(dual energy CT,DECT)处理技术测定痛风性关节炎患者急性发作时的尿酸盐结晶沉积量多少,评估其临床诊断价值,探讨尿酸盐结晶及相关影响因素.方法:选取2018年1月—2020年12月在高新区人民医院因急性痛风性关节炎住院的116例拟诊患者的病例资料并进行分析.所有患者均接受关节DE...     

Gout: an update

Arthritis caused by gout (i.e., gouty arthritis) accounts for millions of outpatient visits annually, and the prevalence is increasing. Gout is caused by monosodium urate crystal deposition in tissues leading to arthritis, soft tissue masses (i.e., tophi), nephrolithiasis, and urate nephropathy. The biologic precursor to gout is elevated serum uric acid levels (i.e., hyperuricemia). Asymptomatic hyperuricemia is common and usually does not progress to clinical gout. Acute gout most often presents as attacks of pain, erythema, and swelling of one or a few joints in the lower extremities. The diagnosis is confirmed if monosodium urate crystals are present in synovial fluid. First-line therapy for acute gout is nonsteroidal anti-inflammatory drugs or corticosteroids, depending on comorbidities; colchicine is second-line therapy. After the first gout attack, modifiable risk factors (e.g., high-purine diet, alcohol use, obesity, diuretic therapy) should be addressed. Urate-lowering therapy for gout is initiated after multiple attacks or after the development of tophi or urate nephrolithiasis. Allopurinol is the most common therapy for chronic gout. Uricosuric agents are alternative therapies in patients with preserved renal function and no history of nephrolithiasis. During urate-lowering therapy, the dose should be titrated upward until the serum uric acid level is less than 6 mg per dL (355 micromol per L). When initiating urate-lowering therapy, concurrent prophylactic therapy with low-dose colchicine for three to six months may reduce flare-ups.     

Insulin resistance syndrome in patients with gout and its influence on formation of clinical characteristics of the disease

AIM: To evaluate the occurrence of immunoresistance (IR) syndrome in gout and its correlation with a gout course. MATERIAL AND METHODS: Anthropometric parameters, blood lipid spectrum, levels of glucose, uric acid (UA), immunoreactive insulin, HOMA index were studied in 55 male patients with gout (mean age 50.1 +/- 7.9 years, mean duration of the disease 7.5 +/- 7.2 years). Statistic processing was made with computer program Statistica 6.0. RESULTS: IR was revealed in 49% patients. Immunoresistant patients had visceral obesity, arterial hypertension, abnormal lipid profile, high UA concentrations, longer disease, chronic articular syndrome, high occurrence of diabetes mellitus and vascular events significantly more frequently. CONCLUSION: IR in gout patients is the risk factor of cardiovascular diseases; combination of IR and hyperinsulinemia is characterized by marked hyperuricemia and a trend to chronic course of the articular syndrome. Longer duration of gout, especially treated inadequately, raises the risk of IR. IR deteriorates prognosis in relation to cardiovascular diseases, diabetes mellitus type 2, course of gout itself.     

Gout: current views. Stage oriented treatment

Gout is a common disease arising due to abnormal purin metabolism and excessive accumulation of uric acid in the blood (hyperuricemia) and manifesting with attacks of acute gouty arthritis. In long duration of gout uric acids accumulate in the bones and periarticular tissues as tophuses. Repeat attacks lead to development of chronic gouty arthritis. Purins restriction diet is an important component of gout treatment. Treatment of acute arthritis should be started early, in initial pains before the development of the attacks. Gouty arthritis in the presence of continuous hyperuricemia, tophyses and urolithiasis is treated with allopurinol. Its intake should be long and controlled by the blood level of uric acid. Balneotherapy is recommended for patients with chronic gouty arthritis associated with cardiovascular diseases, urolithiasis.     

结肠途径灌洗机配合中药在重症肝炎合并自发性腹膜炎中的应用

目的：观察结肠途径灌洗机配合中药灌肠治疗重症肝炎合并自发性腹膜炎的临床疗效。方法：114例重症肝炎患者分为观察组64例和对照组50例，均采用常规综合治疗，观察组配合结肠途径灌洗机联合中药灌肠治疗。治疗前后检测血清肝功能、血氨等生化指标，并观察腹痛、腹胀、腹水等临床症状的改善情况。结果：治疗12周后观察组患者肝功能的恢复程度和血氨等指标下降幅度均好于对照组，且临床症状改善较对照组显著（P〈0．05）；治疗中无明显副作用。结论：结肠途径灌洗机配合中药灌肠治疗重症肝炎合并自发性腹膜炎安全，且能明显提高临床疗效。     

不同剂量依托考昔治疗急性痛风性关节炎的效果及安全性

目的：探讨不同剂量依托考昔治疗急性痛风性关节炎的疗效及安全性。方法：急性痛风性关节炎患者84例,随机分为依托考昔60mg组（29例）,90mg组（30例）,120mg组（25例）。采用视觉模拟评分（VAS）评价各组患者治疗前及用药后4h、2、3、5、7d的疼痛程度,检测各组患者用药前及用药7d后的白细胞、CRP、血清肌酐、血尿酸、ALT、平均动脉压的变化,同时观察各组不良反应的发生情况。结果：各组治疗后VAS评分比治疗前明显降低（P〈0．01）,用药后4h及2d,60mg组的VAS评分明显高于90mg组和120mg组,而90mg组高于120mg组（P〈0．01）,用药后5、7d各组的VAS评分比较差异无统计学意义（P〉0．05）。治疗后7d各组的白细胞计数、CRP较治疗前明显下降（P〈0．01）,120mg组平均动脉压较治疗前明显升高,而治疗前后血清肌酐、ALT及血尿酸比较差异无统计学意义（P〉0．05）。120mg组恶心、呕吐、胸闷的发生率高于其他两组（P〈0．01或0．05）,各组腹痛、腹泻、踝关节水肿的发生率比较差异无统计学意义（P〉0．05）。结论：依托考昔90mg／d可迅速缓解急性痛风性关节炎患者的疼痛症状,且具有良好的安全性。     

Proteomic analysis of Down's syndrome patients with gout

BACKGROUND: In this study, the expression of hypoxanthine-guanine phosphoribosyl transferase (HPRT) in Down's syndrome patients with gout (DS/G) was determined, and possible underlying mechanisms of gout were characterized using proteomic tools. METHODS: Serum was obtained from DS/G, healthy controls and gout patients (without DS), recruited from the rheumatology clinic. Baseline enzyme assays were recorded and RT-PCR used to identify HPRT gene expression. 2-D electrophoresis and mass spectrometry were utilized to determine a plausible explanation concerning the mechanisms leading to increased uric acid levels in DS patients. RESULTS: Two DS patients were diagnosed with gouty arthritis. Their HPRT enzyme activity was slightly lower than that of normal controls. HPRT expression was also slightly decreased in DS/G patients compared with controls. Serum protein profiles of these two DS/G patients revealed that haptoglobin alpha chain and apolipoprotein A1 (ApoA1) were both significantly down-regulated. Protein expression was validated by immunoblot. CONCLUSION: Our results revealed that low levels of haptoglobin in the two DS/G patients were related to renal dysfunction may have affected uric acid excretion and caused gout. However, decreased ApoA1 revealed a positive correlation between defective lipid metabolism and gouty arthritis in DS/G patients.     

海南汉族人群痛风患者血脂情况及健康教育管理策略

目的对海南汉族人群痛风患者血脂情况进行调查,探讨采取相应健康教育管理策略实施情况。方法 2016年1-5月对海南省三家医院(海南医学院附属医院、海南省人民医院、海口市人民医院)的体检中心痛风汉族患者300例(观察组)进行问卷调查,与同期正常的体检者300例(对照组)进行比较,并对痛风患者进行多样化、个性化的健康教育,比较患者与健康人群血脂水平(TC、TG、LDL-C、HDL-C)情况,随访3个月后,健康教育管理干预前后干预患者依从性得分情况,痛风知识掌握率、血尿酸值情况及痛风复发率情况。结果观察组患者TC、LDL-C、TG浓度高于对照组,HDL-C水平低于对照组(P0.05);经过健康教育管理1个月后,痛风患者依从性得分显著高于干预前;痛风知识知晓率显著高于干预前,血尿酸值水平及痛风复发率低于干预前(P0.05)。结论海南汉族痛风患者血脂发生显著变化,健康教育管理后,患者依从性提高,病情缓解,培养患者自我管理能力。     

冠状动脉慢血流现象与血液生化指标的相关性分析

目的:探讨冠状动脉慢血流现象(coronary slow flow phenomenon,CSFP)与血尿酸(UA)、同型半胱氨酸(Hcy)、红细胞压积(Hct)及红细胞分布宽度(RDW)的相关性。方法:对因胸闷、胸痛症状行冠状动脉造影术(coronary angiography,CAG)住院患者的病例资料进行回顾性分析,选择其中CAG显示心外膜冠状动脉无明显狭窄但存在CSFP的121例患者作为CSFP组(SCF组),另将CAG证实心外膜冠状动脉完全正常且血流正常的606例患者设为正常血流组(NCF组)。比较两组患者UA、Hcy、Hct及RDW的差异,并分析CSFP与上述指标、UA与其他生化指标间的相关性。结果:SCF组UA、Hcy、Hct水平均较NCF组升高(P0.001);两组RDW水平差异无统计学意义。条件Logistic回归分析发现,UA、Hcy、Hct均为CSFP的危险因素;Spearman相关及偏相关性分析示UA与Hcy正相关(P0.001)。结论:UA、Hcy、Hct是CSFP发生的危险因素,UA与Hcy可能协同促进CSFP的发生发展。     

99Tc-亚甲基二膦酸盐对类风湿性关节炎患者关节肿痛症状的改善效应

背景对类风湿关节炎(rheumatoid arthritis,RA)患者关节肿痛的治疗一直是风湿病研究领域的重点问题,临床上迫待需要一种疗效和安全性好的治疗药物.99Tc-亚甲基二膦酸盐一经用于风湿病治疗,其疗效和安全性即得到普遍关注.设计以患者为研究对象的前后对照研究.目的99Tc-亚甲基二膦酸盐改善RA患者关节功能障碍的特征.单位一所大学医院风湿免疫科病房.对象四川大学华西医院风湿科2000-03/2002-03收治的活动期RA住院患者67例,均符合美国风湿病协会1987年制订的RA诊断标准.年龄29～71岁,病程9～78月,其中男11例,女56例.全部病例均排除严重心、肝、肾等功能不全者,活动性胃肠病变者,血液及内分泌系统疾病者,过敏体质,以及孕期或哺乳期妇女.方法67例RA患者经99Tc-亚甲基二膦酸盐治疗,对其治疗前后关节肿胀指数,关节压痛指数,握力,晨僵时间,休息痛和血沉,C反应蛋白等临床指标进行比较.疗程结束后进行综合评定,按症状和体征改善程度30％以上且ESR和CRP有所下降记为有效.同时观察记录副反应出现情况,对资料进行统计分析.结果67例经99Tc-亚甲基二膦酸盐治疗后,RA病情明显改善,治疗前后关节肿胀指数,关节压痛指数,晨僵时间,休息痛和血沉,C反应蛋白等各项临床指标改善均有显著性意义(P＜0.05).该药物临床总有效率81%,副反应发生率小且轻微.结论99Tc-亚甲基二膦酸盐可以改善RA患者的关节功能障碍,且安全性较好.     

低嘌呤糖尿病饮食的疗效观察

目的：观察低嘌呤糖尿病饮食对痛风合并2型糖尿病病人的疗效。方法：将57例痛风合并2型糖尿病病人分为两组,在控制总热量的基础上,治疗组限制饮食中的嘌呤含量,饮食中每日嘌呤摄入量< 150mg,对照组不限制饮食中的嘌呤含量,每日嘌呤摄入量>300mg。结果：治疗第8天与治疗前比较空腹血糖、餐后2小时血糖、血尿酸均下降,但治疗组的血尿酸下降比对照组有显著性差异(P<0.01)。结论：饮食与痛风合并2型糖尿病关系密切;合理的低嘌呤糖尿病饮食有助于患者控制血糖、血尿酸,对治疗痛风合并2型糖尿病病人是有利的。     

How to Recognize and Treat Gout

The two unequivocal diagnostic criteria for gout are urate crystals in synovial fluid during an acute attack and subcutaneous or bony tophi. A serum uric acid level higher than 7.0 mg per 100 ml during acute joint pain also suggests gout. Colchicine is still a good agent for acute attacks, but phenylbutazone, indomethacin and ACTH also have a place. Probenecid alone or with colchicine is effective for long-term therapy.     

Assessment and management of gouty arthritis

Gout is a metabolic disorder of purine metabolism that leads to elevated serum concentrations of uric acid. When this happens, urate crystals may precipitate and accumulate in the joints and bursae. Gout is characterized by recurrent, painful attacks of arthritis, which is the major clinical complication of the disease. Early diagnosis and treatment of gout are important to prevent complications, and with early, sustained therapy, most patients can live without functional disability. If gout becomes chronic, individuals may experience severe limitations of activity. This article discusses the clinical manifestations, diagnosis and treatment of acute and chronic gout.     

老年高尿酸血症肾损害19例临床分析

本文介绍了1990～1993年我院住院的19例老年高尿酸肾病患者.除血尿酸升高外,全部患者伴有不同程度的高血压和肾损害.往往伴有关节痛和肾结石.老年患者常因饮酒过量、高嘌呤饮食、受凉、劳累诱发.以下几点有助于诊断:①本病老年患者并不少见;②肾功能减退进展缓慢,早期以肾小管功能损害为主;③血尿酸升高与肌酐不成比例,血尿酸/血肌酐可>2.5;④痛风肾病有典型临床表现,而原发肾小球疾病即使尿酸很高也很少发生关节炎等改变;⑤肾活检可助鉴别.     

The effectiveness and safety of nimesulide (nimesile) in patients with gouty arthritis

Patients with gout are at a high risk for drug-induced complications associated with the use of nonsteroidal anti-inflammatory drugs due to the baseline renal and hepatic abnormalities, metabolic disturbances, and concomitant diseases, such as arterial hypertension or type 2 diabetes mellitus. In this connection, it is expedient to use safer selective cycloxygenase-2 (COG-2) inhibitors. However, there are only single reports dealing with studies of the effectiveness and safety of selective COG-2 inhibitors in gout. The study was undertaken to evaluate the effectiveness and safety of the selective COG-2 inhibitor nimesulide (nimesile) in acute gouty arthritis (GA). Twenty male patients (whose mean age was 51.1 +/- 8.4 years) with PA were examined. Seven patients were found to have monoarthritis of 1 metatarsophalangeal joint, oligoarthritis was present in 9 patients and 4 patients had polyarthritis. The history of arthritis was as long as 6 days in 16 patients and 21-30 days in 4. Nimesulide was given in a dose of 200 mg/day for at least 14 days. The time course of changes in the objective and subjective symptoms of arthritis was studied. The tolerability of the drug was evaluated by its effect on renal (the levels of creatinine and urea, creatinine clearance) and hepatic (alanine transferase (ALT), aspartate transferase (AST), gamma-glutamyltranspeptidase (gamma-GTP)) functions, and blood pressure (BP) [24-hour BP monitoring (24-h BPM) before and after treatment. There were clear positive changes in the major parameters of arthritis: the swelling index was 4.5 +/- 2.7 and 0.5 +/- 0.5 scores before and after treatment, respectively; hyperemia, 3.5 +/- 2.5 and 0.1 +/- 0. 1 scores; articular index, 3.6 +/- 2.0 and 0.7 +/- 0.6 scores; pain (visual analogue scale) when resting, 53.8 +/- 17.6 and 4.7 +/- 4.6 scores, and that when moving, 68.3 +/- 16.0 and 9.0 +/- 8.8 mm, respectively. Negative changes in the levels of creatinine and uric acid and a reduction in creatinine clearance were not observed. There were no increases in the levels of ACT, ALT, gamma-GTP. 24-h BPM did not reveal any significant changes in the mean 24-hour, mean diurnal and nocturnal variables of BP. The 24-hour BP profile became better in some patients. Thus, nimesulide is an effective and safe drug for the treatment of PA.