Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rapid and effective suppression of inflammation is a primary goal in the treatment of rheumatic diseases. However, the therapeutic effect of most medications may be slow to manifest, in the order of weeks or months in the case of DMARDs. Monitoring of drug concentrations allows the possibility of appropriate dose adjustment or changes in medication to achieve more rapid or better outcomes. We review the evidence for drug concentration monitoring. Despite the theoretical utility for monitoring of MTX polyglutamate concentrations in red blood cells in patients with RA, studies have not shown a clear association between concentrations and either efficacy or toxicity and routine measurement is not yet recommended. Small studies associating disease control with concentrations of anti-TNF therapies and anti-drug antibodies suggest that routine monitoring may be useful in the future. However, the data are not yet sufficient for this recommendation. With the use of allopurinol in gout, there is a putative therapeutic range for the active metabolite oxypurinol; however, adjusting the allopurinol dose to achieve a target urate concentration is likely to be most effective, and measuring oxypurinol may be best suited to assessing drug adherence. Although measuring thiopurine metabolite concentrations with AZA therapy has been shown to be useful in IBD, studies in rheumatic diseases have so far failed to confirm a useful association between concentrations and disease control or drug toxicity. Whole blood concentrations of HCQ have been associated with disease control in SLE and future studies may be able to determine a therapeutic range.
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PMID:Therapeutic drug monitoring in rheumatic diseases: utile or futile? 2419 84

Uncontrolled gout is a painful inflammatory condition caused by excess uric acid in the blood. When standard oral medicines used to lower uric acid do not work or cannot be taken, pegloticase is the only remaining treatment option. Unfortunately, less than half of patients respond to pegloticase for an adequate amount of time because their immune system develops antibodies against the medicine, causing the medicine to be quickly removed from the body preventing a durable or prolonged response. Methotrexate has been shown to limit or prevent this immune response in patients treated with biologic therapies for autoimmune diseases. The current study found that eight of ten patients (80%) treated with both methotrexate and pegloticase responded to treatment (received 12 or more biweekly pegloticase doses and had low uric acid levels in their blood just before infusion 12). No new side effects or safety concerns were reported. In this retrospective study, methotrexate appeared to allow more patients to benefit from a full course of pegloticase therapy.
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PMID:Increased Efficacy and Tolerability of Pegloticase in Patients With Uncontrolled Gout Co-Treated With Methotrexate: A Retrospective Study. 3272 81