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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gout is a common form of arthritis. It is associated with a number of comorbidities, including hypertension, cardiovascular disease, renal impairment, diabetes, obesity, hyperlipidaemia and frequently in a combination known as the metabolic syndrome. These comorbidities and their treatment may have an effect on the development of gout and on the choice of therapeutic agent. Treatment of acute gout with short-term corticosteroids may be a safer option than either NSAIDs or colchicine in patients with significant renal and/or cardiac impairment. Sustained reduction of serum urate <0.36 mmol/l is required for long-term management of gout. The optimal dosing regimen for patients with renal impairment is the subject of on-going investigation. There is less experience with newer urate-lowering therapies. This review will consider the relationship between comorbidities and gout with a particular focus on the treatment of gout and the potential interactions between drugs used for gout and those for comorbid conditions.
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PMID:Gout and its comorbidities: implications for therapy. 2294 27

Hyperuricemia is commonly associated with traditional risk factors such as dysglicemia, dyslipidemia, central obesity and abnormal blood pressure, i.e. the metabolic syndrome. Concordantly, recent studies have revived the controversy over the role of circulating uric acid, hyperuricemia, and gout as an independent prognostic factor for cardiovascular morbidity and mortality. In this regard, different studies also evaluated the possible role of xanthine inhibitors in inducing blood pressure reduction, increment in flow-mediated dilation, and improved cardiovascular prognosis in various patient settings. The vast majority of these studies have been conducted with either allopurinol or its active metabolite oxypurinol, i.e. two purine-like non-selective inhibitors of xanthine oxidase. More recently, the role of uric acid as a risk factor for cardiovascular disease and the possible protective role exerted by reduction of hyperuricemia to normal level have been evaluated by the use of febuxostat, a selective, non purine-like xanthine oxidase inhibitor. In this review, we will report current evidence on hyperuricemia in cardiovascular disease. The value of uric acid as a biomarker and as a potential therapeutic target for tailored old and novel "cardiometabolic" treatments will be also discussed.
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PMID:Chronic hyperuricemia, uric acid deposit and cardiovascular risk. 2317 92

Diet plays a significant role in the development of gout and hyperuricemia. Gout and hyperuricemia have likewise been associated with the development of cardiovascular disease and metabolic syndrome. Epidemiological studies have shown that certain foods influence levels of serum uric acid and the risk for development of gout.This article reviews the influence of dietary factors on serum uric acid levels and risk of gout, as well as the role of urate transporters in the development of hyperuricemia and gout.Various epidemiological studies have shown the effects of certain foods on the risk of developing gout and hyperuricemia. Low-fat dairy products, purine-rich vegetables, whole grains, nuts and legumes, and less sugary fruits, coffee and vitamin C supplements decrease the risk, whereas intake of red meat, fructose-containing beverages and alcohol increase the risk of gout. There is also an increased although basic understanding of the effects of vitamin C, alcohol and fructose on urate transporters. Certain foods can lead to a decreased or increased risk of development of gout and hyperuricemia. Advances have established the interplay of certain foods on urate transporters and renal handling of urate. More studies, especially prospective ones, are needed to increase our understanding of the roles of foods and urate transporters and other molecular mechanisms on the risk of developing gout and hyperuricemia.
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PMID:The interplay between diet, urate transporters and the risk for gout and hyperuricemia: current and future directions. 2325 31

Gout affects more than 1% of adults in the world, and this is the most common form of inflammatory arthritis in men. Accumulating data support an increase in the prevalence of gout that is potentially attributable to recent shifts in diet and lifestyle, improved medical care, and increased longevity. There are both nonmodifiable and modifiable risk factors for hyperuricemia and gout. Nonmodifiable risk factors include age and sex. Gout prevalence increases in direct association with age; the increased longevity of populations in industrialized nations may contribute to a higher prevalence of gout through the disorder's association with age-related diseases such as metabolic syndrome and hypertension, and treatments for these diseases such as thiazide diuretics for hypertension. Although gout is considered to be primarily a male disease, there is a more equal sex distribution among elderly patients. Modifiable risk factors for gout include obesity, the use of certain medications, high purine intake, and consumption of purine-rich alcoholic beverages. The increasing prevalence of gout worldwide indicates that there is an urgent need for improved efforts to identify patients with hyperuricemia early in the disease process, before the clinical manifestations of gout become apparent.
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PMID:[Gout and hyperuricemia today: prevalence, risk factors, features in the elderly]. 2328 37

Gout is the most common inflammatory arthropathy and occurs in the setting of elevated serum urate levels. Gout is also known to be associated with multiple comorbidities including cardiovascular disease and the metabolic syndrome. Recent advances in research have increased our understanding and improved our knowledge of the pathophysiology of gout. Genome-wide association studies have permitted the identification of several new and common genetic factors that contribute to hyperuricemia and gout. Most of these are involved with the renal urate transport system (the uric acid transportasome), generally considered the most influential regulator of serum urate homeostasis. Thus far, SCL22A12, SCL2A9, and GLUT9 have been found to have the greatest variation and most influence on serum urate levels. However, genetics are only a part of the explanation in the development of hyperuricemia and gout. As results have been mixed, the role of known urate influential genes in gout's associated comorbidities remains unclear. Regardless, GWAS findings have expanded our understanding of the pathophysiology of hyperuricemia and gout, and will likely play a role in the development of future therapies and treatment of this ancient disease.
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PMID:Genetics of hyperuricemia and gout: implications for the present and future. 2330 80

Sugar intake in the United States has increased by >40 fold since the American Revolution. The health concerns that have been raised about the amounts of sugar that are in the current diet, primarily as beverages, are the subject of this review. Just less than 50% of the added sugars (sugar and high-fructose corn syrup) are found in soft drinks and fruit drinks. The intake of soft drinks has increased 5-fold between 1950 and 2000. Most meta-analyses have shown that the risk of obesity, diabetes, cardiovascular disease, and metabolic syndrome are related to consumption of beverages sweetened with sugar or high-fructose corn syrup. Calorically sweetened beverage intake has also been related to the risk of nonalcoholic fatty liver disease, and, in men, gout. Calorically sweetened beverages contribute to obesity through their caloric load, and the intake of beverages does not produce a corresponding reduction in the intake of other food, suggesting that beverage calories are "add-on" calories. The increase in plasma triglyceride concentrations by sugar-sweetened beverages can be attributed to fructose rather than glucose in sugar. Several randomized trials of sugar-containing soft drinks versus low-calorie or calorie-free beverages show that either sugar, 50% of which is fructose, or fructose alone increases triglycerides, body weight, visceral adipose tissue, muscle fat, and liver fat. Fructose is metabolized primarily in the liver. When it is taken up by the liver, ATP decreases rapidly as the phosphate is transferred to fructose in a form that makes it easy to convert to lipid precursors. Fructose intake enhances lipogenesis and the production of uric acid. By worsening blood lipids, contributing to obesity, diabetes, fatty liver, and gout, fructose in the amounts currently consumed is hazardous to the health of some people.
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PMID:Energy and fructose from beverages sweetened with sugar or high-fructose corn syrup pose a health risk for some people. 2349 38

Chronic asymptomatic hyperuratemia (HUA), gout paroxysm in patients with chronic hyperuratemia (HU) and normouricemic attacks of gouty arthritis are well known, but poorly understood. A review of the current literature with attempt of its explanation is presented. The natural course of gout is associated with joint structure changes that may be evaluated by different imaging techniques; comparative advantages and shortcomings of each technique are presented. For almost over 50 years the market has not offered new drugs for the control of HU and gout, while management of such patients was a rather neglected field. Over the last five years an unpredictable number of prospective clinical studies have been conducted involving the investigation of the efficacy and safety of new drugs to control HU (febuxostat, pegloticase). The return of pharmaceutical industry into the world of gout has considerably changed the picture. New recommendations have been presented on appropriate colchicine dose regime for acute gouty flares. Emerging therapies, including pegloticase, uricosuric agent RDEA596 and the interleukin-1 inhibitors have shown promises in early and late phase clinical trials. Each of them deserves to be considered for implementation and feasibility in clinical practice as well as outcome measures for clinical trials. Another purpose of this review was to summarize new knowledge on approved drugs to treat hyperuricemia, or the clinical manifestations of gout. Results of several clinical trials provide new data on the efficacy and safety of the approved urate lowering drugs (allopurinol and febuxostat). Lifestyle and dietary recommendations for gout patients should take into consideration overall health benefits and risks, since gout is often associated with metabolic syndrome and an increased future risk of cardiovascular disease and mortality. This review also summarizes the recent data about lifestyle factors that influence serum uric acid levels and the gout risk, and attempts to provide holistic recommendations, considering both their impact on gout as well as on other health implications.
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PMID:[Novelties in gout]. 2353 21

Gout is the most prevalent form of inflammatory arthropathy, and affecting more than 2% of the population in industrialized countries. The development and expression of gout depends on three key steps:chronic hyperuricemia, the growth ofmonosodium urate crystals and interaction between this cristals and inflammatory system. Prevalence and incidence of gout have risen in recent decades. Numerous risk factors for the development of gout have been established, including hyperuricaemia, genetic factors, dietary factors, alcohol consumption, metabolic syndrome, hypertension, obesity, diuretic use and chronic renal disease.
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PMID:[Epidemiology and risk factors for gout]. 2374 62

Gout is a recurrent inflammation of one or more joints that occurs because of disposal monosodium urate crystals in joints and other structures in soft tissues. Gout is a common metabolic disorder characterized by chronic hyperuricemia, serum urate levels > or = 360 mmol/1 (> 6.8 mg/ dl), which exceeds the physiological threshold of saturation. Well known complications of gout are tophi, deforming arthropathy, urolithiasis, chronic urate nephropathy, acute uric nephropathy (usually secondary due to chemotherapy), avascular necrosis of the femoral head. The risk of developing gout is directly linked to the development of hyperuricemia. Numerous evidence-based clinical and epidemiological study of urinary acid as an independent risk factor for developing hypertension, cardiovascular disease, chronic kidney disease, stroke and metabolic syndrome revalued the role of uric acid in human health and disease. In gout, as in other rheumatic disease, extraarticular manifestations are of utmost importance for morbidity and mortality.
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PMID:[Gout as a systemic disease: systemic manifestations and comorbidities of hyperuricaemia]. 2374 68

Excessive fructose intake from high-fructose corn syrup (HFCS) and sucrose has been implicated as a driving force behind the increasing prevalence of obesity and its downstream cardiometabolic complications including hypertension, gout, dyslidpidemia, metabolic syndrome, diabetes, and non-alcoholic fatty liver disease (NAFLD). Most of the evidence to support these relationships draws heavily on ecological studies, animal models, and select human trials of fructose overfeeding. There are a number of biological mechanisms derived from animal models to explain these relationships, including increases in de novo lipogenesis and uric acid-mediated hypertension. Differences between animal and human physiology, along with the supraphysiologic level at which fructose is fed in these models, limit their translation to humans. Although higher level evidence from large prospective cohorts studies has shown significant positive associations comparing the highest with the lowest levels of intake of sugar-sweetened beverages (SSBs), these associations do not hold true at moderate levels of intake or when modeling total sugars and are subject to collinearity effects from related dietary and lifestyle factors. The highest level of evidence from controlled feeding trials has shown a lack of cardiometabolic harm of fructose and SSBs under energy-matched conditions at moderate levels of intake. It is only when fructose-containing sugars or SSBs are consumed at high doses or supplement diets with excess energy that a consistent signal for harm is seen. The available evidence suggests that confounding by excess energy is an important consideration in assessing the role of fructose-containing sugars and SSBs in the epidemics of hypertension and other cardiometabolic diseases.
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PMID:Fructose-containing sugars, blood pressure, and cardiometabolic risk: a critical review. 2379 49


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