ARTICLE DESCRIPTION: 

Himanshu Sharma, Dr. Milind Pande, Prof. K. K. Jha, Hyperuricemia: a risk factor beyond gout, ASIO Journal of Pharmaceutical & Herbal Medicines Research (ASIO-JPHMR), 2020, 6(1), 42-49.

Affiliation: Teerthanker Mahaveer College of Pharmacy, Teerthanker Mahaveer University, Moradabad, India.

DOI :10.2016-19146535/ ; DOI Link :: http://doi-ds.org/doilink/06.2020-25164442/

ABSTRACT:

Gout is the most common inflammatory type of arthritis in men affecting 1-2% of adults in Western countries, with male to female ratio of 3.6:1, but rare in pre-menopausal women and its incidence and prevalence increases with age. It is characterized by chronic hyperuricaemia which is defined as serum urate levels above 6.8 mg/dl (≥ 400µmol/L), the level above which the physiological saturation threshold is exceeded. Risk factors for gout include high dietary purine consumption, e.g. various types of meat, seafood and certain vegetables, ethanol intake, obesity and the use of diuretics and low dose aspirin. Symptoms of an acute gout attack include pain, inflammation and erythema of the afflicted joint. The above-mentioned inflammation is caused by the release of various cytokines, including interleukin-1β (IL-1β). IL-1β is an inflammatory cytokine that is associated with the leukocytosis and fever that often accompany acute gouty attacks. All patients with gout should be screened for renal dysfunction and metabolic bone syndrome. An acute attack of gout is very painful and should be treated with either joint aspiration with intra-articular glucocorticoid injection, low dose oral colchicine, oral glucocorticoid, NSAIDs or Cox 2 inhibitors depending on the patient’s co-morbidities. On introducing the urate lowering therapy, prophylaxis therapy should be considered to prevent any precipitation of acute attack of gout. The starting of low dose of allopurinol or benzbromarone with slow titration may obviate the use of prophylaxis therapy. Lifestyle modification is important and should be considered in particular to tackle factors related to metabolic bone syndrome.

KEYWORDS: Gout, Hyperuricemia, NSAIDS

1. Geronikolou SA. Treatment of gout in a recently published 9th century manuscript of Rhazes. Vesalius. 2014 winter; 20(2):95-8. PMID: 25739155
2. Lawrence RC, Felson DT, Helmick CG, et al. National arthritis data workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008;58:2635
3. Nuki G, Simkin P. A concise history of gout and hyperuricaemia and their treatment. Arthritis Res Ther 2006; 8:S1.
4. Mandell BF. Clinical manifestations of hyperuricaemia and gout. Cleve Clin J Med 2008; 75(Suppl 5):S5- S8.
5. Hak AE, Choi HK. Lifestyle and gout. Curr Opin Rheumatol 2008;20:179-86
6. Bieber JD, Terkeltaub RA. Gout: on the brink of novel therapeutic options for an ancient disease. Arthritis Rheum 2004; 50: 2400-14.
7. Falasca GF. Metabolic diseases: Gout. Clin Dermatol 2006; 24:498–508.
8. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 2004 March 11; 350(11):1093–103.
9. Sherman MR, Saifer MGP, Perez-Ruiz F. PEG-uricase in the management of treatment- resistant gout and hyperuricemia. Adv Drug Deliv Rev 2008;60:59–68
10. Darmawan J, Lutalo SK. Gout and hyperuricaemia. Bailliére’s Clin Rheumatol 1995 February;9(1):83–94.
11. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011;63(10):3136-3141.
12. MacFarlane LA, Kim SC. Gout: a review of nonmodifiable and modifiable risk factors. Rheum Dis Clin North Am. 2014;40(4):581-604.
13. Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum. 2011 Oct; 63(10):3136- 41. PMID: 21800283
14. Annemans L, Spaepen E, Gaskin M, et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis. 2008 Jul; 67(7):960-6. PMID: 17981913
15. De Miguel E, Puig JG, Castillo C, et al. Diagnosis of gout in patients with asymptomatic hyperuricaemia: A pilot ultrasound study. Ann Rheum Dis. 2012 January; 71(1):157-8. PMID: 2011671627 MEDLINE PMID 21953340.
16. Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: a systematic review of the literature. Curr Opin Rheumatol. 2011 Mar; 23(2):192-202. PMID: 21285714.
17. Cheng T, Lai H, Chiu C, Chen Y. A single-blind, randomized, controlled trial to assess the efficacy and tolerability of rofecoxib, diclofenac sodium, and meloxicam in patients with acute gouty arthritis. Clin Ther 2004; 26(3):399–406.
18. Ren K, Torres R. Role of interleukin-1β during pain and inflammation. Brain Res Rev 2009; 60(1):57–              64.
19. Hoffman HM, Yasothan U, Kirkpatrick P. Fresh from the pipeline: Rilonacept. Nat Rev Drug Discov 2008 May; 7:385–6.
20. Chen LX, Schumacher HR. Gout: Can we create and evidence-based systematic approach to diagnosis and management? Best Pract Res Clin Rheumatol 2006; 20(4):673–84.
21. Richardson RMA. Treatment of asymptomatic hyperuricemia: When do you have a good reason to provide therapy? Can Fam Physician 1991 February; 37:459–63.
22. Fujimori S. Establishment of therapeutic goal and plan of gout and asymptomatic hyperuricemia. Nippon Rinsho 2008 Apr; 66(4):729–35.
23. Del Favero A. Anti-inflammatory and antipyretic analgesics and drugs used in gout. In: Aronson JK, editor. Side effects of drugs. Elsevier; 2008; 125–36.
24. Malik A, Schumacher HR, Dinnella JE, Clayburne GM. Clinical diagnostic criteria for gout: comparison with the golden standard of synovial fluid crystal analysis. J Clin Rheumatol 2009; 15(1):22-4.
25. Janssen HJ, Fransen J, van de Lisdonk EH, van Riel PL, Janssen M. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch Intern Med 2010; 170(13):1120-6.
26. Glazebrook KN, Guimaraes LS, Murthy NS, et al. Identification of intraarticular and periarticular uric acid crystals with dualenergy CT: initial evaluation. Radiology 2011 Nov; 261(20):516-24.
27. De Miguel E, Puig JG, Castillo C, et al. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis 2012; 71(1):157-8.
28. Pineda C, Amezcua-Guerra LM, Solano C, et al. Arthritis Res Ther 2011 Jan;13(1):R4
29. Doghramji PP, Wortmann RL. Hyperuricemia and gout: new concepts in diagnosis and management. Postgrad Med. 2012 Nov; 124(6):98-109. PMID: 23322143.
30. Perez-Ruiz F, Hernandez-Baldizon S, Herrero-Beites AM, et al. Risk factors associated with renal lithiasis during uricosuric treatment of hyperuricemia in patients with gout. Arthritis Care Res (Hoboken). 2010 Sep;62(9):1299-305. PMID: 20506124.
31. Thompson GR, Duff IF, Robinson WD, et al. Long term uricosuric therapy in gout. Arthritis Rheum. 1962 Aug; 5:384-96. PMID: 13920871.
32. Anderson A, Singh Jasvinder A. Pegloticase for chronic gout. Cochrane Database Syst Rev: John Wiley & Sons, Ltd; 2010.
33. Tayar Jean H, Lopez-Olivo Maria A, Suarez-Almazor Maria E. Febuxostat for treating chronic gout. Cochrane Database Syst Rev: John Wiley & Sons, Ltd; 2012.
34. Gaffo AL, Saag KG. Management of hyperuricemia and gout in CKD. Am J Kidney Dis 2008;52(5):994–1009
35. Terkeltaub RA. Clinical practice: gout. N Engl J Med 2003; 349:1647-55.
36. Lomen PL, Turner LF, Lamborn KR, et al. Flurbiprofen in the treatment of acute gout. A comparison with indomethacin. Am J Med 1986; 80(3A):134-9.
37. Shrestha M, Morgan DL, Moreden JM, et al. Randomized double-blind comparison of the analgesic efficacy of intramuscular ketorolac and oral indomethacin in the treatment of acute gouty arthritis. Ann Emerg Med 1995; 26(6):682-6.
38. Douglas G, Thompson M. A comparison of phenylbutazone and flufenamic acid in the treatment of acute gout. Ann Phys Med 1970; 10(6):275-80.
39. Shipley         Mike,Trends         in            Urology and         Men’s Health, May/ June 2011 (www.trendsinurology.com).
40. Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective - A review. J Adv Res. 2017; 8(5):495-511.
41. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017; 76(1):29-42.
42. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012; 64(10):1431-1446.
43. Becker MA, Schumacher HR Jr., Wortmann RL, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005; 353(23): 2450-2461.
44. Schumacher HR, Jr., Becker MA, Wortmann RL, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28- week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum. 2008; 59(11):1540-1548.
45. Becker MA, Schumacher HR Jr., Wortmann RL, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005; 353(23): 2450-2461. 19.
46. Schumacher HR, Jr., Becker MA, Wortmann RL, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum. 2008; 59(11):1540-1548.
47. Vázquez-Mellado J, Morales EM, Pacheco-Tena C, Burgos-Vargas R. Relation between adverse events associated with allopurinol and renal function in patients with gout. Ann Rheum Dis. 2001;60(10):981-983
48. Becker MA, Schumacher HR Jr, Wortmann RL, et al. Febuxostat compared with allopurinol in patients with hyperuricaemia and gout. N Engl J Med 2005; 353: 2450-61.
49. Schumacher HR Jr, Becker MA, Wortmann RL, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricaemia and gout: a 28- week, phase III, randomised, double-blind, parallel-group trial. Arthritis Rheum 2008;59:1540-8
50. Uloric [package insert]. Deerfield, IL: Takeda Pharmaceuticals America; 2018. 50. Pineda C, Amezcua-Guerra LM, Solano C, et al. Arthritis Res Ther 2011 Jan; 13(1):R4.
51. Terkeltaub RA. Colchicine update: 2008. Semin Arthritis Rheum 2008; 38: 411-9 52.Krystexxa [package insert]. Lake Forest, IL: Horizon Pharma USA; 2016
52. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017; 76(1):29-42.
53. Keenan RT. Limitations of the current standards of care for treating gout and crystal deposition in the primary care setting: a review. Clin Ther. 2017; 39(2):430-441.
54. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012; 64(10):1431-1446.