Acute Gout Attack Research Articles

Spontaneous resolution of acute gout: mechanisms and therapeutic targets

Gout is a common inflammatory arthritis that has been increasing in both prevalence and incidence. Consequently, management of refractory and chronic gout has been gaining attention. Onset of gout is...

Realities of modern urate-reducing therapy for gout

Introduction. In the treatment of a patient with gout, it is important to achieve the target level of uric acid (UA) < 360 μmol/l, which reduces the frequency of acute attacks of arthritis and improves the prognosis of comorbid diseases. Relief of acute gouty arthritis causes much less difficulty compared with the appointment of urate-l owering therapy (UST). The reasons for not achieving the target level of MC can be both objective and subjective.Aim. To analyze the objective and subjective components of the activity and effectiveness of UST in real outpatient practice.Material and methods. A cross- sectional study of 117 randomly selected outpatient records of patients diagnosed with gout. Mean age 58.6 ± 13.1, mean UA level 423.7 ± 122.4 μmol/L. Additionally, an anonymous survey of doctors and patients with gout was conducted on the issues of UST.Results. Patients with gout in the analyzed group were characterized by a high degree of polymorbidity: women and men, respectively, had arterial hypertension in 100 and 79%, type 2 diabetes mellitus in 39 and 23%, osteoarthritis in 73 and 57%. With inevitable polypharmacy, UST was prescribed in 37.6% of patients. Achievement of target levels of UA was registered in 23.8% of men and 39.4% of women. Failure to achieve the target sUA was associated with diuretics, elevated creatinine, and body mass index. Physicians were more than 70% active in prescribing UST, but knowledge of a single target UA level was demonstrated by 6 to 13%, depending on work experience, with an excessive assumption of UST use during an acute gout attack (19 to 36.5%). Conclusion. All components of the diagnostic and therapeutic process of curing a gouty patient need to be improved.

Antiphagocytic Properties of Polygallic Acid with Implications in Gouty Inflammation.

Polygallic acid (PGAL) has been used in vitro to protect synoviocytes from monosodium urate (MSU) crystals due to its anti-inflammatory properties. However, MSU crystals can also activate other cells of the synovial fluid (SF). We studied the impact of PGAL on the phagocytosis of MSU crystals, inflammation, and oxidative stress using an in vitro model with SF leukocytes and THP-1 monocyte cells. SF leukocytes were stimulated with PGAL and MSU crystals, proinflammatory cytokines and phagocytosis were assessed. In THP-1 cells, the effect of PGAL on the phagocytosis of MSU crystals and the levels of IL-1β, IL-6, TNF-α, and reactive oxygen species (ROS) was evaluated. PGAL was added to THP-1 cultures 24 h before MSU crystal addition as a pre-treatment, and IL-1β was measured. One-way ANOVA with Tukey's post hoc testwas performed, and a P value < 0.05 was considered statistically significant. PGAL (100 µg/mL) decreased phagocytosis in SF leukocytes by 14% compared to cells exposed to crystals without PGAL. In THP-1 cells, 100 and 200 µg/mL PGAL reduced phagocytosis by 17% and 15%, respectively. In SF cells, there was a tendency to decrease IL-1β and IL-6. In THP-1 cells, decreases in IL-1β and TNF-α, as well as a slight decrease in ROS, were identified. PGAL pre-treatment resulted in a reduction of IL-1β. PGAL inhibits MSU phagocytosis by exerting an anti-inflammatory effect on cells exposed to crystals. The use of PGAL before an acute attack of gout suggests an important protective factor to control the inflammation.

Penapisan Hiperuresemia dan Obesitas Pada Remaja di Jakarta Barat

Hyperuricemia is a pathophysiological condition associated with chronic inflammatory diseases such as rheumatoid arthritis, diabetes, and cardiovascular and kidney disease. Hyperuricemia is related to changes in lifestyle. Elevated serum uric acid levels can be a marker for the metabolic syndrome that commonly occurs in adults. Obesity is a complex condition involving biological, developmental, environmental, behavioral and genetic factors. The most common cause of obesity during adolescence is an imbalance in energy balance; i.e. excess caloric intake without appropriate caloric expenditure. Tomang sub-district is a sub-district under the Faculty of Medicine, Tarumanagara University. More than 25% of adults in the Tomang sub-district have hyperuricemia and 60% of the community are obese. So far it is not known how much the prevalence of hyperuricemia and obesity in adolescents in the Tomang Village. The promotion of healthy lifestyles and the prevention of disease are the fundamental principles behind public health and the promotion of public health. Measuring uric acid levels can prevent acute attacks of gout. The purpose of this service is to get an overview of the uric acid levels and obesity of the youth group in Tomang Village, West Jakarta

Development of a novel anti-inflammatory recombinant uricase with extended half-life for gout therapy

Gout is a form of inflammatory arthritis that results from elevated serum uric acid levels and the deposition of urate crystals in multiple joints. The inflammatory response during an acute gout attack is mediated by the activation of the NLRP3 inflammasome, leading to the release of IL-1β and inducing a localized tissue inflammatory response. Urate lowering therapies such as Pegloticase effectively reduce serum uric acid levels but are generally associated with an increase in acute gout flares. In this study, we developed a long-acting anti-inflammatory recombinant uricase by sequential fusing interleukin-1 receptor antagonist (IL-1Ra) and albumin-binding domain (ABD) with the N-terminal end of Arthrobacter globiformis uricase (AgUox). The recombinant uricase has longer in vivo half-life, and significantly alleviates monosodium urate (MSU) crystals induced inflammation in mouse model compared with the wild-type AgUox. This long-acting anti-inflammatory recombinant uricase has the potential to be developed as an effective urate lowering therapy with better safety profiles.

Intestinal uric acid excretion contributes to serum uric acid decrease during acute gout attack.

Spontaneous serum uric acid (SUA) decrease has been found in many patients during acute gout attacks, but its mechanism remains unclear. The spontaneous regulation of SUA during a gout attack and its possible causes were evaluated in patients with gout. The mechanism of the spontaneous SUA decrease was further studied in Caco2 cells and a monosodium urate (MSU)-induced gout model of wild-type mice and ABCG2-/- mice. The urate transport function of intestinal epithelial cells was detected by transwell culture of Caco2 cells. Expression of ATP-binding cassette super-family G member 2 (ABCG2), IL-1β and phosphoinositide 3-kinase (PI3K)/Akt was analysed using real-time PCR, western blotting, or immunofluorescence assays. SUA decreased during acute gout attacks in both the gout patients and MSU-induced gouty mice. Increased serum CRP and IL-1β levels were correlated with the SUA decrease. Intestinal uric acid excretion and expression of ABCG2 were upregulated in the mice during acute gout attacks. In the ABCG2-/- mice, intestinal uric acid excretion significantly decreased during gout attacks. In an in vitro study of a transwell culture, ABCG2 and its upstream PI3K/Akt pathway were significantly upregulated in intestinal epithelial cells. However, ABCG2 expression and its associated intestinal uric acid transport were inhibited when PI3K/Akt was blocked by a PI3K inhibitor, LY294002. Increased intestinal urate excretion resulted in spontaneous SUA downregulation during acute gout attacks. Inflammation-induced PI3K/Akt activation and ABCG2 expression in epithelial cells might contribute to the upregulation of intestinal uric acid excretion.

Similarities and differences between gouty arthritis and rheumatoid arthritis—an interesting case with a short look into the literature

Gout often presents as acute arthritis but may also present with chronic joint inflammation. For the diagnosis of an acute gout attack with its typical symptoms, the differentiation towards a bacterial joint infection is critical and mandatory. The detection of intracellular uric acid crystals in the synovial fluid of affected joints is important for the initial diagnosis of gout. In the case of a chronic course with polyarticular joint involvement, the differentiation from other inflammatory rheumatic diseases such as rheumatoid arthritis (RA) can be challenging. The case presented here is of interest because the patient initially had characteristic clinical symptoms of tophaceous gout including a typical medical history—even though rheumatoid factor and anti-citrullinated protein antibodies (anti-CCP) were positive. The course of the disease and the critical evaluation of all findings also, and most interestingly, including histological results finally suggested a main diagnosis of RA.

Acute gout attacks during the perioperative period and risk factors of recurrence after orthopedic surgery among untreated gout patients

BackgroundThis study aimed to explore the clinical characteristics of perioperative acute gout attacks in patients with varying uric acid levels undergoing orthopedic surgery, identify the risk factors for gout recurrence within the first postoperative year, and provide a disease prevention and diagnostic reference.MethodsThis hospital-based retrospective study was conducted between January 2018 and December 2020. According to the blood uric acid levels at admission, the patients were grouped into either the normal uric acid level group or the hyperuricemia group. Patient comorbidities, serum uric acid levels, inflammatory indicators, follow-up recurrence rates, and other indicators were compared.ResultThe uric acid decline ratio and the inflammatory indexes (white blood cell count and C-reactive protein level) at the time of the attack were significantly higher in the normal uric acid level group than in the hyperuricemia group (P < 0.05). Patients in the hyperuricemia group with diabetes and tophi and those administered diuretics were more prone to acute gout attacks than those in the normal uric acid level group (P < 0.05). In the normal uric acid level group, 22 patients (84.6%) exhibited single joint involvement, whereas only 18 patients (47.4%) in the hyperuricemia group demonstrated single joint involvement (P < 0.05). After 1 year of follow-up, the gout recurrence rate in the hyperuricemia group was 44.7%, which was significantly higher that the recurrence rate in the normoglycemic group (11.5%; P < 0.05). Presenting tophi in perioperative orthopedic surgery patients was found to be an independent risk factor for gout recurrence within 1 year (RR = 4.80; P = 0.029).ConclusionThe recurrence rate of gout in patients with hyperuricemia during perioperative period increased 1 year after operation. Therefore, it is crucial to monitor the uric acid level to prevent acute gout attacks during the perioperative period and recurrence during the 1-year follow-up period. Moreover, the risk of an acute gout recurrence 1 year after operation increased in patients who presented tophi; therefore, it is necessary to maintain appropriate blood uric acid level during perioperative period among patients undergoing orthopedic surgery.

Factors and Treatment of Acute Gout Attack Induced by Upper Gastrointestinal Bleeding

Factors and Treatment of Acute Gout Attack Induced by Upper Gastrointestinal Bleeding

Angiotensin type 2 receptor antagonism as a new target to manage gout.

There is a growing search for therapeutic targets in the treatment of gout. The present study aimed to evaluate the analgesic and anti-inflammatory potential of angiotensin type 2 receptor (AT2R) antagonism in an acute gout attack mouse model. Male wild-type (WT) C57BL/6 mice either with the AT2R antagonist, PD123319 (10pmol/joint), or with vehicle injections, or AT2R KO mice, received intra-articular (IA) injection of monosodium urate (MSU) crystals (100µg/joint), that induce the acute gout attack, and were tested for mechanical allodynia, thermal hyperalgesia, spontaneous nociception and ankle edema development at several times after the injections. To test an involvement of AT2R in joint pain, mice received an IA administration of angiotensin II (0.05-5nmol/joint) with or without PD123319, and were also evaluated for pain and edema development. Ankle joint tissue samples from mice undergoing the above treatments were assessed for myeloperoxidase activity, IL-1β release, mRNA expression analyses and nitrite/nitrate levels, 4h after injections. AT2R antagonism has robust antinociceptive effects on mechanical allodynia (44% reduction) and spontaneous nociception (56%), as well as anti-inflammatory effects preventing edema formation (45%), reducing myeloperoxidase activity (54%) and IL-1β levels (32%). Additionally, Agtr2tm1a mutant mice have largely reduced painful signs of gout. Angiotensin II administration causes pain and inflammation, which was prevented by AT2R antagonism, as observed in mechanical allodynia 4h (100%), spontaneous nociception (46%), cold nociceptive response (54%), edema formation (83%), myeloperoxidase activity (48%), and IL-1β levels (89%). PD123319 treatment also reduces NO concentrations (74%) and AT2R mRNA levels in comparison with MSU untreated mice. Our findings show that AT2R activation contributes to acute pain in experimental mouse models of gout. Therefore, the antagonism of AT2R may be a potential therapeutic option to manage gout arthritis.

Pharmacological treatment of acute Gout attacks

Gout is an inflammatory condition of the joints caused by deposition of crystallized monosodium urate (MSU) in the joint which leads to Arthritis. there are many debates about the suitable pharmacological therapy for the acute inflammatory gout attacks. The Pharmacological treatment included colchicine, non steroidal anti- inflammatory (NASIDS) and corticosteroid injection. The aim of this study is to review the evidences which studied the effect of Colchicine, NASID and corticosteroid injections and discuss their effectiveness in treating the acute flares of Gout. After evaluation the validity of the latest best evidences presented in the database by using the AMSTAR tool. There was no best drug and no optimal dose identified in treating acute Gout attacks. Doctors should be careful in selecting the treatment considering the side effect of each medication and deal with each patient individually to provide the best health care.

Clinical Effect of the Guizhi Shaoyao Zhimu Decoction in the Treatment of Hyperuricemia.

Traditional Chinese Medicine (TCM) is a medical system with a distinctive theoretical framework and extensive experience in identification and treatment acquired by the Chinese people in long-term medical practice and life practice. It is a complete, integrated, and complex knowledge system in epistemology. This study is aimed at exploring the clinical effectiveness of TCM called the Guizhi Shaoyao Zhimu Decoction in the treatment of hyperuricemia. A total of 100 patients with hyperuricemia at the Medical College of the Second Clinical College, Shandong, China, from January 2019 to January 2022 are selected as the research subjects and divided into group A and group B according to the random table method, with 50 cases in each group. Group A is treated with oral allopurinol tablets, 100 mg, 2 times a day, and group B is treated with the modified Guizhi Shaoyao Zhimu Decoction based on group A. For observation, serum uric acid (SUA) levels, urinary uric acid (UUA) levels, levels of serum inflammatory response factors (IL-6, CRP, and TNF-α), vascular endothelial function indexes (serum malondialdehyde (MDA) content, nitric oxide (NO) content), an acute attack of gout, and the incidence of adverse reactions are measured. Results show that after 2 w and 4 w of treatment, the levels of blood uric acid in each group gradually decreased compared with those before treatment, and group B is lower than group A (P < 0.05). After treatment, the vascular endothelial function indexes and inflammatory factor levels in each group are significantly improved compared with those before treatment, and the indexes in group B are better than those in group A. There is no significant difference in the incidence of related adverse reactions and acute attack of gout (P > 0.05). This shows that the TCM Guizhi Shaoyao Zhimu Decoction has a significant curative effect in the treatment of patients with hyperuricemia, which is worthy of clinical reference application.

Stephalagine, an aporphinic alkaloid with therapeutic effects in acute gout arthritis in mice

Ethnopharmacological relevanceGout is an inflammatory disease characterized by the accumulation of monosodium urate crystals (MSU) in the joints, leading to severe pain and inflammation. Stephalagine is a Brazilian Savanna aporphine alkaloid isolated from Annona crassiflora Mart. Fruit peel, that has been popularly used to treat rheumatism and have been described with antinociceptive properties. However, no studies evaluated the possible therapeutic properties of stephalagine in arthritic pain. Aim of the studyTo evaluate the possible antinociceptive and anti-inflammatory effects of stephalagine in an acute gout attack in mice. Materials and methodsAdult male wild type C57BL/6/J/UFU mice (20–25 g) were used (process number 018/17). The treated group received stephalagine (1 mg/kg, by gavage) and the vehicle group received saline (10 mL/kg, by gavage), both 1 h before the MSU crystals (100 μg/ankle joint) administration. All groups were analyzed for mechanical allodynia, thermal hyperalgesia, overt pain-like behaviors, and edema development at 2, 4, 6 and 24 h after injections. Synovial fluid and the ankle articulation from the injected joint were collected 4 h after administrations for myeloperoxidase enzyme activity, IL-1β measurement, and histological analysis. ResultsStephalagine had a significant antinociceptive effect on mechanical allodynia, when compared to vehicle group at 2–24 h after intra-articular injection of MSU and 2 h for spontaneous and cold thermal sensitivity. Stephalagine was also able to significantly reduce the articular edema (45 ± 1%), the activity of the myeloperoxidase enzyme (37 ± 6%), and IL-1β levels (43 ± 3%). The histological analysis confirms that stephalagine dramatically reduced the number of infiltrating inflammatory cells (75 ± 6%) in MSU injected animals. Also, stephalagine treatment did not alter the uric acid levels, xanthine oxidase activity, AST and ALT activities, urea and creatinine levels, neither cause any macroscopic changes in the mice’s weight, deformations, changes in the coat, or feces. ConclusionStephalagine may be an alternative for the management of gout, once it was able to induce antinociceptive and anti-inflammatory effects without causing adverse effects on the evaluated parameters.

Treatment of refractory acute gout by invigorating spleen, raising Yang, dehumidifying, and dredging collaterals: A metabolomics study

ObjectiveThis study aimed to use proton nuclear magnetic resonance technology to analyze the metabolic pathways of invigorating the spleen and promoting Yang dehumidification and dredging collaterals (Cassia twig Peony Anemarrhenae and Rise Yang Dehumidification Decoction) in treating the acute attack of refractory gout and to find the target of traditional Chinese medicine (TCM). MethodForty patients with acute refractory gout of spleen deficiency and dampness-heat type were recruited and randomly divided into TCM group and the Western medicine group, with 20 patients in each group. Serum samples were collected before and after 10 days of treatment for comparative analysis, and the metabolic pathways were identified. Combined with the results of TCM syndrome score, inflammatory indexes (C reactive protein, erythrocyte sedimentation rate), and creatinine, adiponectin, and cytokine (interleukin-6, tumor necrosis factor-α) levels before and after treatment, the mechanism of TCM action was analyzed. ResultsCassia twig Peony Anemarrhenae and Rise Yang Dehumidification Decoction were found to be better than Western medicine in alleviating joint swelling and pain, localized as well as systemic fever, and bitter and dry mouth. Furthermore, inflammatory indicators, cytokines, creatinine, and adiponectin levels were better in the TCM group than in the Western medicine group. In terms of metabolic pathways, the treatment of an acute attack of refractory gout with our TCM compounds resulted in better improvements in branched-chain amino acid (BCAA) metabolism, glycine, serine, and threonine metabolism, tyrosine metabolism, taurine, and low taurine metabolism, glycolysis/sugar dysplasia, synthesis and degradation of ketone body, D-glutamine metabolism, citric acid cycle (TCA cycle), glyceride metabolic pathways, etc., than the use of Western medicine. ConclusionTCM compounds may improve the metabolic network of refractory acute gout by stimulating the above metabolic pathways to inhibit the inflammatory response, relieve joint pain, and augment glucose metabolism, energy metabolism, and lipid metabolism. These compounds are hence worthy of promotion.

Reduction in Gout Attacks Post Sleeve Gastrectomy in Al-Ahsa Hospital, KSA

Objective: The objective of this study was to assess the improvements in patients following sleeve gastrecto-my as measured by a subsequent reduction in the incidence of gout attacks. Methods: This retrospective study was conducted at the Bariatric Surgery Department, Al-Moosa Hospital, Al Mubarraz, Saudi Arabia, in 2018. Data for this study were extracted from the records of 3247 patients who had undergone sleeve gastrectomy. The data were analyzed using SPSS version 20. Result: The study included 36 patients who fulfilled the study’s inclusion criteria, with mean age of 39.6 ± 11.6 years, and 26 (72.2%) of them were male. A significant reduction (p = 0.002) in weight was observed in both male and female patients after sleeve gastrectomy; similarly, a significant reduction (p = 0.003) in uric acid levels was also found in both genders. Post-surgery acute gout attack was observed in five (45.5%) cases in the 1 month following surgery and in only one (9.1%) case after 9 months. Various factors were analyzed for their association with postoperative acute gout attack, but only higher baseline body mass index showed a sig-nificant association (p = 0.001). Conclusion: The outcome of the study is that sleeve gastronomy significantly reduces gout attacks in obese patients. Along with this conclusion, it was also observed that age, gender, preoperative uric acid levels, and a higher body mass index are risk factors associated with the incidence of gout attacks. Keywords: sleeve gastrectomy; acute gout attack; uric acid

Identification of Inflammation-Related Biomarker Pro-ADM for Male Patients With Gout by Comprehensive Analysis.

ObjectiveGout is a local inflammatory disease caused by the deposition of monosodium urate (MSU) crystals in joints or adjacent tissues. When some gout occurs without hyperuricemia, or its clinical symptoms and signs are not typical, the diagnosis of gout will be delayed, so there is an urgent need to find a new biomarker to predict and diagnose of gout flare. Our research attempts to find the key genes and potential molecular mechanisms of gout through bioinformatics analysis, and collected general data and blood biochemical samples of patients with gout and healthy, then analyzed and compared the expression of factors regulated by key genes.MethodGSE160170 were downloaded from GEO database for analysis. The data were normalized to identify the differentially expressed genes (DEGs), then GO and KEGG enrichment analysis were applied. Protein-protein interaction (PPI) networks and hub genes between DEGs were identified. Then collect general information and blood samples from male patients with acute gout, hyperuricemia and healthy. ELISA method was used to detect pro-ADM levels of different groups, and the data was input into SPSS statistical software for analysis.ResultWe identified 266 DEGs (179 up-regulated and 87 down-regulated) between gout patients and healthy controls. GO analysis results show that DEGs are mostly enriched in inflammatory response, growth factor activity, cytokine activity, chemokine activity, S100 protein binding and CXCR chemokine receptor binding. KEGG pathway analysis showed that DEGs are mainly related to Chemokine signaling pathway and Cytokine-cytokine receptor interaction. ADM, CXCR1, CXCR6, CXCL3, CCL3, CCL18, CCL3L3, CCL4L1, CD69, CD83, AREG, EREG, B7RP1, HBEGF, NAMPT and S100B are the most important hub genes in the PPI network. We found that the expression of pro-ADM in the gout group and hyperuricemia group was higher than that in the healthy group, and the difference was statistically significant.ConclusionIn this study, a series of bioinformatics analyses were performed on DEGs to identify key genes and pathways related to gout. Through clinical verification, we found that pro-ADM can be used as an inflammation-related biomarker for acute attacks of gout, providing new ideas for the diagnosis and treatment of gout.

Effect of Clinical Typing on Serum Urate Targets of Benzbromarone in Chinese Gout Patients: A Prospective Cohort Study.

IntroductionAchieving a goal of serum urate levels in patients with gout is an important way to prevent gout and its complications while it remains difficult with a low targeting rate worldwidely. Currently, hyperuricemia classification has not been widely applied to the management of gout owing to insufficient clinical evidences. This study aimed to evaluate the effectiveness of achieving target urate based on hyperuricemia classification in Chinese patients with gout.MethodsIn this prospective study, patients with gout receiving urate lowering therapy with benzbromarone were assigned to two groups, a renal underexcretion and an unclassified type. The primary endpoint was the proportion of patients achieving the serum urate target (<360 μmol/L) during the 12-week study. The frequency of acute gout attacks as well as physical and chemical indicators were secondary endpoints.ResultsTarget serum urate level was achieved in 60.5% of underexcretors compared with 39.0% of patients of the unclassified type at week 12 (P = 0.002). Blood glucose and cholesterol levels were lower in the underexcretor group compared with the unclassified type group at the end of the trial, without significant different frequencies in gout flare during the study. In subgroup analysis, stratified by body mass index and estimated glomerular filtration rate, the proportion of patients with serum urate <360 μmol/L was greater in the underexcretion compared with the unclassified type group.ConclusionsThe increased achievement of target serum urate in the underexcretion group supports the use of a clinical hyperuricemia typing treatment strategy for gout.

Madelung Disease-a Challenge in Clinical Practice

Multiple Symmetric Lipomatosis (MSL) or Madelung’s disease is a rare disorder of the lipid metabolism characterized by symmetric growth of sometimes massive unencapsulated fatty deposits (lipomas) in anatomical regions ranging from typical sites such as neck, occipital area, upper arms, face, abdomen and back to the more unusual involvement of the scrotum and the tongue. In this article we present the diagnostic and therapeutic challenges in a patient developing an acute oligoarticular attack of gout generating important functional incapacity, alcoholic liver disease potentially evolving to liver cirrhosis, heart and kidney failure, bilateral parotid gland region swelling and Madelung disease. The recognition and screening for potential complications related to the Madelung disease is of great practical importance because treatment priorities should be stratified accordingly.

A pharmacokinetic and pharmacodynamic evaluation of colchicine sustained-release pellets for preventing gout

Gout is a common metabolic disease caused by the chronic deposition of monosodium urate (MSU) crystals in joints and tissues. Low-dose of colchicine (COL) has become the first-line drug for clinical prevention of acute gout attacks. However, their high cytotoxicity leads to a narrow therapeutic index and frequent toxic reactions. This study developed colchicine sustained-release pellets (COL-SRPs) using fluidized-bed technology to overcome the shortcomings of fluctuation in blood concentration and other side effects of commercial rapid release COL preparations. The COL-SRPs showed a smooth surface and spherical shape under a scanning electron microscope (SEM). The in vitro release curves of the COL-SRPs under different pH dissolution medium were not significantly different (similarity factors 2 ˃ 50). The release of COL from pellets may be a diffuse action. Pharmacokinetic studies demonstrated that the mean residence time (MRT) and tmax of the COL-SRPs group were significantly higher than those in the commercial colchicine tablets (COL-Ts) group. Pharmacodynamic studies comprehensively evaluated serum inflammatory factor indicators (IL-1β and TNF-α), liver and kidney function indexes (ALT, AST and CRE), as well as ankle joint histopathology, further suggesting that the COL-SRPs exhibited a more optimal preventive potential against acute gout attack. The COL-SRPs prepared in this study provide a powerful alternative to commercial COL-Ts by overcoming their shortcomings and having great industrial production potential.

Colchicine Intoxication In A Patient With Unilateral Renal Agenesis

Colchicine is an alkaloid used in the treatment of acute gout attacks, Familial Mediterranean Fever, Behçet's Disease and inflammatory bowel diseases. Depending on the dose taken, the clinic occurs in various ways. Gastrointestinal manifestations are common in colchicine intoxication, but multi-organ failure is a more rare and more serious problem. As the blood level of colchicine is determined by the kidney and the liver, toxicity may progress more rapidly in dysfunction of these organs. In this case report, we aimed to remind that colchicine intoxications may be more mortal in patients with renal insufficiency.