Palpable tophi and more comorbidities associated with adherence to urate-lowering medical therapy in a Chinese gout cohort

ObjectiveUrate-lowering therapy (ULT) nonadherence is common and problematic in gout. Since, sociocultural factors affect adherence, we analyzed a Chinese cohort.MethodsWe studied 903 Chinese gout patients aged 46.4 ± 14.7 years (mean ± SD), uniquely extending to assay of 2-year medication possession ratio (MPR) ≥80% defined as high adherence. Multivariable logistic regression analyses evaluated factors linked with adherence and ULT target attainment.ResultsCharacterization of ULT outcomes in this cohort revealed that after 2 years ULT, MPR ≥80% patients had better target serum urate (SU) achievement (from 23.3% to 71.0%, P < 0.001), lower flare frequency and palpable tophi compared to MPR < 80%. However, only 44.7% of cohort subjects had MPR ≥80%. Male sex (OR 3.68), gout onset age >60 years (OR 3.51), disease duration >5 years (OR 1.70), more comorbidities (OR 1.74), baseline palpable tophi (OR 1.53), SU < 6 mg/dL (360 μmol/L) (OR 1.92) and more frequent follow-up visits (OR 1.98) were significantly associated with high adherence. Nevertheless, significant independent risk factors for failed SU target achievement included male sex (OR 0.36) and more comorbidities (OR 0.85).ConclusionDespite adherence to ULT linked to better outcomes for flares and tophi, the more adherent Chinese male patients and those with more comorbidities had decreased target SU attainment. Differences in adherence of Chinese gout patients compared to several primarily Western studies emphasize the importance of not stereotyping gout patients for projected nonadherence. Results underline the dual importance of identifying gout patients more likely to be ULT-adherent and leveraging adherence to drive treatment to SU target.     

A case of female premenopausal tophaceous gout requiring surgical management

We report a case of tophaceous gout in a 32-year-old woman who had suffered from anorexia nervosa since the age of 15. She had been taking a diuretic, mainly furosemide, to lose weight since she was 18. She was referred for orthopedic surgery because of a tophus at her right metatarsophalangeal joint. Because of a discharging sinus associated with the tophaceous deposits, surgery was performed. Use of the diuretic was stopped after surgery and the serum uric acid concentration returned to normal. It was thought that long-term abuse of a diuretic induced the tophaceous gout in this premenopusal woman.     

抗高尿酸血症追踪治疗对原发性痛风的影响

对已有10年以上抗高尿酸血症治疗历史的65例痛风患者进行重新评估.发现痛风石沉积的减少与血尿酸(SUA)浓度相关.降低SUA浓度有可能减少痛风石,但X线改变和SUA浓度不存在相关性.单独SUA浓度测定不能有效地监测痛风病变的进展.     

亚甲基四氢叶酸还原酶基因C677T多态性与高尿酸血症相关

采用PCR-RFLP方法检测高尿酸血症患者和正常对照者亚甲基四氢叶酸还原酶(MTHFR)基因C677T多态性,结果显示,山东沿海地区汉族人MTHFR基因C677T多态性与高尿酸血症相关,T等位基因是其危险因素,但与单纯高尿酸血症是否发展为痛风无关。     

Ischemia heart disease and greater waist circumference are risk factors of renal function deterioration in male gout patients

We examined the incidence of renal function deterioration (RFD) in a population of male gout patients and to identify associated risk factors. Subjects who had been regularly followed up for more than 2 years and had visited Chang Gung Memorial Hospital-Kaohsiung Medical Center Rheumatology Clinic between June 1, 2006 and January 31, 2007 were enrolled. Four subjects were excluded as secondary gout was suspected. Group I (Gr I) comprised subjects without RFD and group II (Gr II) comprised subjects with RFD during the follow-up period. RFD was defined as absolute increment in creatinine (Cr) levels over 0.4 mg/dl for subjects with baseline Cr levels ≤1.4 mg/dl or as more than 50% increment of baseline Cr level per 12-month interval in average for subjects with baseline Cr levels >1.4 mg/dl. Clinical parameters were analyzed to study the potential risk factors of RFD. Of 318 male gout patients, 296 (93.1%) were categorized as Gr I, and 22 (6.9%) were categorized as Gr II. The observation periods for Gr I and Gr II were 81.20 ± 53.29 and 92.41 ± 46.72 months, respectively (p = 0.338). Initial Cr levels are similar between the two groups (1.25 ± 0.51 vs 1.25 ± 0.61, p = 0.963). Multiple logistic regression analysis revealed that current age, age at disease onset, disease duration, treatment duration, body weight, height, family history of gout, tophi, urolithiasis, tobacco use, alcohol consumption, history of cerebral vascular accident, hypertension, diabetes mellitus, dyslipidemia, base-line and final Cr, blood urea nitrogen level, serum uric acid level, and body-mass index were not independent risk factors. However, history of ischemic heart disease [IHD; odds ratio (OR) 7.68, 95% confidence interval (CI) 1.99–29.70] and greater waist circumference (WC; OR 1.06, 95% CI 1.01–1.11) were two independent risk factors of RFD. Additionally, the Cox multivariable analysis disclosed that IHD (p < 0.001) and greater WC (p = 0.011) deteriorated kidney function in these patients. The incidence of RFD in male gout patients is 6.9%. History of IHD and greater WC are two independent risk factors for developing RFD.     

Annexin A1 promotes timely resolution of inflammation in murine gout

Gout is a self‐limited inflammatory disease caused by deposition of monosodium urate (MSU) crystals in the joints. Resolution of inflammation is an active process leading to restoration of tissue homeostasis. Here, we studied the role of Annexin A1 (AnxA1), a glucocorticoid‐regulated protein that has anti‐inflammatory and proresolving actions, in resolution of acute gouty inflammation. Injection of MSU crystals in the knee joint of mice induced inflammation that was associated with expression of AnxA1 during the resolving phase of inflammation. Neutralization of AnxA1 with antiserum or blockade of its receptor with BOC‐1 (nonselective) or WRW₄ (selective) prevented the spontaneous resolution of gout. There was greater neutrophil infiltration after challenge with MSU crystals in AnxA1 knockout mice (AnxA1^?/?) and delayed resolution associated to decreased neutrophil apoptosis and efferocytosis. Pretreatment of mice with AnxA1‐active N‐terminal peptide (Ac_2–26) decreased neutrophil influx, IL‐1β, and CXCL1 production in periarticular joint. Posttreatment with Ac_2–26 decreased neutrophil accumulation, IL‐1β, and hypernociception, and improved the articular histopathological score. Importantly, the therapeutic effects of Ac_2–26 were associated with increased neutrophils apoptosis and shortened resolution intervals. In conclusion, AnxA1 plays a crucial role in the context of acute gouty inflammation by promoting timely resolution of inflammation.     

双能量CT痛风石成像的研究进展

痛风是因尿酸钠盐沉积在关节、软组织、软骨和肾脏而引起组织的异物炎性反应。临床上常需综合典型的临床症状以及血、尿中尿酸盐水平的测定和常规影像检查(如X线、MRI、B超等)进行诊断,但不典型痛风的诊断仍存在困难。双能量CT通过区分尿酸盐结晶和钙质的不同衰减特性来诊断痛风,并采用特定的体积计算软件对痛风石进行准确定量。随着双能量痛风石成像的广泛应用,其在临床工作中的应用价值将不断扩展及深化,并有望成为确诊和管理痛风的重要手段。     

原发性高尿酸血症及痛风相关易患基因的研究进展

原发性高尿酸血症及痛风属于多基因遗传病,其发病及临床特征具有明显的遗传特异性:不同地域、不同种族、不同性别的人群遗传易患性显著不同,与遗传易患性密切相关的基因单核苷酸多态性位点也存在着明显的差异。约90%的原发性高尿酸血症和痛风与尿酸排泄减少相关,尿酸排泄减少与多基因遗传有关。现已通过全基因组扫描和候选基因的方法发现多个易患基因与尿酸代谢水平及原发性痛风相关,为痛风疾病的诊断、预测及治疗提供依据。     

The challenge of gout flare measurement

Gout flares are central to the patient experience of gout and are included in the Outcome Measures in Rheumatology (OMERACT) core outcome domain set for long-term gout studies. Although a valid definition for gout flare has been developed, there is no consensus around how flare outcomes are measured and reported in long-term clinical studies. Current methods of flare measurement, which are centered on measuring flares as a binary outcome (i.e., present vs absent), do not reflect the variable pattern of flares over time, nor the multidimensional patient experience of gout flares which include factors related to pain severity, functional disability, impact on family and social life, and psychological wellbeing. This review will discuss the importance and challenges of gout flare measurement.