Chronic Gouty Arthritis Research Articles

Heart Rhythm Disturbances in Cardiac Surgery Patients with Coronary Artery Disease

The aim. To analyze arrhythmological complications in cardiac surgery patients with coronary artery disease (CAD). Materials and methods. This was a retrospective data analysis of 354 cardiac surgery patients with various forms of CAD who were operated on and discharged from the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The mean age of the patients was 61.9 ± 9.6 years. All the patients underwent laboratory examinations, electrocardiography, echocardiography, coronary angiography and cardiac surgery. The patients with uncomplicated forms of CAD (n = 194) underwent isolated surgical revascularization of the myocardium, in the case of complicated forms of CAD (n = 160), coronary bypass surgery was supplemented with valvular or ventricular correction. Results. Postoperative atrial fibrillation (AF) occurred in 40 (20.6%) patients with uncomplicated CAD and 43 patients with complicated CAD (26.8%), p = 0.1667. Among patients with complicated forms of CAD, 2 (1.25%) had paroxysms of ventricular tachycardia, which required the implantation of a cardioverter-defibrillator, also in this group of patients complete left bundle branch block occurred more often (p = 0.0020). The postoperative period in patients with impaired glucose metabolism was characterized by more frequent development of AF in patients with type 2 diabetes mellitus (33.3%, p = 0.0006), with impaired glucose tolerance (24.8%, p = 0.0156) compared to patients with normoglycemia (12.6%). Conclusions. There was no statistically significant difference in the frequency of postoperative AF in patients with various forms of CAD (p = 0.1667). In the occurrence of postoperative AF paroxysms, the negative influence of type 2 diabetes mellitus (p = 0.0006), impaired glucose tolerance (p = 0.0156), stage III-IV chronic kidney disease (p = 0.0015) and gouty arthritis (p = 0.0072) has been proven. The presence of postoperative AF was associated with acute encephalopathy (p = 0.0291) and panic attacks (p = 0.0043). The occurrence of postoperative AF increased the length of stay of cardiac surgery patients with CAD in the hospital from 8.2 ± 2.9 to 11.06 ± 6.8 days (p < 0.0001).

Assessment of the efficacy of alkaline water in conjunction with conventional medication for the treatment of chronic gouty arthritis: A randomized controlled study: Retraction.

Assessment of the efficacy of alkaline water in conjunction with conventional medication for the treatment of chronic gouty arthritis: A randomized controlled study: Retraction.

Chronic gouty arthritis and kidney damage: a clinical example

Chronic gouty arthritis and kidney damage: a clinical example

Cervical spinal gout.

An 85-year-old man was admitted to hospital with a 5-day history of fever and neck pain. He had a 12-year history of chronic kidney disease and gouty arthritis; however, the patient did not take urate lowering drugs. On admission to hospital, physical examination revealed neck pain and stiffness. He had a blood pressure of 140/102 mm Hg, pulse rate of 95 per min, respiration rate of 18 breaths per min, and body temperature of 38°C. Laboratory results revealed a white blood cell count of 11 200 cells per mm3 (reference 4 000–10 000) and C-reactive protein level of 12·26 mg/dL (reference 0·0–0·3).

Efficacy and safety of low-dose rasburicase for refractory chronic gouty arthritis

Objective: To explore the efficacy and safety of low-dose rasburicase for refractory chronic gouty arthritis. Methods: A cohort study. The clinical data of patients with refractory chronic gouty arthritis who were treated with rasburicase at Sun Yat-sen Memorial Hospital, Sun Yat-sen University between January 2021 and July 2022 were retrospectively analyzed. Refractory chronic gouty arthritis was defined as serum uric acid (sUA)>360 μmol/L and urate volume>10 cm3 under dual-energy computed tomography after tolerable maximal oral urate-lowering therapy for at least 3 months. The administration of low-dose rasburicase was applied intravenously with total dosage ranging from 4.5 to 7.5 mg each dose, at 4-week intervals for a maximum of three doses. Efficacy was evaluated by the changes of sUA level, tophus and urate volume. Results: A total of 22 patients were included for analysis, with 95.4% (21/22) male, the mean age was (44±15) years, and the median duration of gout was 11 (6-15) years. The mean sUA at baseline was (667±112) μmol/L. The levels of sUA significantly decreased after each dose of rasburicase (P<0.001), and the median reduction of sUA after each dose of rasburicase was 568 (471-635), 187 (66-335) and 123 (49-207) μmol/L, respectively. At week 12, nine patients (40.9%) exhibited sUA<360 μmol/L and tophus disappeared in one patient. The urate volume significantly decreased at week 12 when compared with that before the first dose of rasburicase in all the patients [40 (16-172) cm3 vs 17 (7-134) cm3, P<0.001], with a median reduction rate of 41.6% (22.9%-58.5%). The everall safety of rasburicase was good, and no serious adverse reactions occurred. Conclusions: Low-dose rasburicase is well-tolerated and effective for decreasing the urate burden in patients with refractory chronic gouty arthritis. Further prospective randomized controlled trials are needed to validate these findings.

Gout Remission as a Goal of Urate-Lowering Therapy: A Critical Review.

Urate-lowering therapies for the management of gout lead to a reduction in serum urate levels, monosodium urate crystal deposition, and the clinical features of gout, including painful and disabling gout flares, chronic gouty arthritis, and tophi. Thus, disease remission is a potential goal of urate-lowering therapy. In 2016, preliminary gout remission criteria were developed by a large group of rheumatologists and researchers with expertise in gout. The preliminary gout remission criteria were defined as: serum urate < 0.36 mmol/L (6 mg/dL); an absence of gout flares; an absence of tophi; pain due to gout < 2 on a 0-10 scale; and a patient global assessment < 2 on a 0-10 scale over a 12-month period. In this critical review, we describe the development of the preliminary gout remission criteria, the properties of the preliminary gout remission criteria, and clinical studies of gout remission in people taking urate-lowering therapy. We also describe a future research agenda for gout remission.

Pegloticase efficacy and safety in kidney transplant recipients; results of the phase IV, open-label PROTECT clinical trial.

Kidney transplant (KT) recipients have a high prevalence and severity of gout. Pegloticase (pegylated recombinant uricase) rapidly metabolizes serum uric acid (sUA), and its efficacy is not impacted by kidney function. This open-label, Phase 4 trial (PROTECT NCT04087720) examined safety and efficacy of pegloticase in 20 participants with KT>1 year prior to enrollment and with uncontrolled gout (sUA ≥7mg/dL, intolerance/inefficacy to urate lowering therapy, and ≥1 of the following: tophi, chronic gouty arthritis, ≥2 flares in past year) and functioning KT (estimated glomerular filtration rate [eGFR] ≥15mL/min/1.73 m2 ) on stable immunosuppression therapy. The primary endpoint was sUA response during month 6 (sUA<6mg/dL for ≥80% of time). The study enrolled 20 participants (mean±SD); age: 53.9±10.9 years, time since KT: 14.7±6.9 years, sUA: 9.4±1.5mg/dL, gout duration: 8.4±11.6 years; all on ≥2 stable doses of immunosuppression agents. Pegloticase (8mg intravenous every 2weeks) in KT recipients with uncontrolled gout showed a high response rate of 89% (16/18 responders). Two participants discontinued treatment solely due to COVID-19 concerns prior to month 6 were not included in the primary analysis. Pegloticase exposures were higher than those historically observed with pegloticase monotherapy, and no anaphylaxis or infusion reaction events occurred during the study. This improved response rate to pegloticase in the KT population reflects observations from other trials and reports on immunomodulation with pegloticase. As the KT population has a high prevalence of gout and limitations with oral urate lowering medication options, these findings suggest a potential option for uncontrolled gout therapy in KT participants.

Clinical case of severe visceral complications with atypical localization in a patient with gout

The diagnosed gout is a signal to search for unrecognized concomitant conditions and their underlying causes and mechanisms of development. Due to the fact that gout is a common metabolic disorder with symptoms of localized inflammation caused by chronic and/or episodic deposition of monosodium urate crystals (MSU) in joints and soft tissues, the understanding of the inflammation interaction in metabolic disorders has changed. In cases of severe visceral complications of gout, the most common sites of tophl are kidneys, liver, spleen, lungs, pericardium, subcutaneous tissue and other soft tissues. The aim of this study was to outline the features of severe visceral complications with atypical localization in a patient with gout (identification of MSU crystals with polarization microscopy) and to determine the role of videothoracoscopy in this case. Patient N., 55 years old, complained of moderate chest pain, shortness of breath during exercise, general weakness and occasional cough. The patient was hospitalized in a multidisciplinary clinical institution. Examinations were performed, including polarization microscopy, spiral computed tomography (polytopic foci, formations), videothoracoscopy. Endoscopic resection of SVII of the lower lobe of the left lung with a biopsy of the lungs formations and mediastinal lymph nodes was performed. Results of histologic examination: amorphous masses are presented in combination with the organized chronic giant cell granulomatous structure (tophus), which contains clusters of crystals of MSU. Cytological examination of pleural cavity fluid revealed the presence of crystals of MSU. The presence of crystals of MSU was confirmed by polarization microscopy. From the anamnesis of the disease it became known that at the age of 38 the patient consulted a rheumatologist for moderate joint syndrome. On the basis of anamnesis, laboratory and instrumental data (X-ray, ultrasound examination) the diagnosis of gout, chronic gouty arthritis was established. Urate lowering therapy was prescribed. The patient took the drugs periodically without re-consultation with the doctor. The presented case of untreated gout has led to significant structural disorders in organs such as lungs, pleura. Endoscopic resection of the lower lobe of the left lung and revision of the thoracic cavity revealed atelectasis, hemorrhage, inflammatory infiltration, fibrous changes in tissues, amorphous masses with organized chronic giant cell granulomatous structure, presented by crystals of MSU. During the surgery, a powdery substance was found on the pleura surfaces. A video thoracoscopy in this case was a means to present a visceral damage in gout. The search for diagnostic tools to diagnose a severe visceral complications with atypical localization in gout still remains unsolved. Undoubtedly, the central role in the development of gout is played by the deposition of numerous crystals of MSU. In the patient under observation, crystals of MSU were found in pleural fluid and sputum consisting of sodium urate, like the known facts of their appearance in the joint fluid and urine. Uric acid salt crystals were also detected in the areas of pulmonary fibrosis formation according to the results of radiological examination, as well as endoscopic intervention in the lower lobe of the left lung.

Lagotis brachystachya maxim attenuates chronic alcoholic liver injury combined with gouty arthritis in rats via its anti-inflammatory activity.

Lagotis brachystachya Maxim, a common herb in Tibetan medicine, is mainly used to treat pneumonia, hepatitis, yellow water disease (gouty arthritis). Since long-term heavy drinking is also a risk factor for gouty arthritis, the present study aimed to evaluate the underlying protective role and mechanism of extracts of Lagotis brachystachya (ELB) in chronic alcoholic liver injury combined with gouty arthritis. The rat chronic alcoholic liver injury combined with gouty arthritis model was established by long-term alcohol consumption and monosodium urate (MSU) injection. The therapeutical action of ELB was then evaluated by biochemical measurement, histopathological examination, ankle swelling assessment, and protein detection. According to biochemical measurements and histopathological evaluation, ELB could alleviate the symptoms of alcoholic liver injury combined with gouty arthritis. In addition, chronic alcohol consumption and MSU activated inflammatory-related signaling such as TLR4/MyD88/NF-κB, NLRP3, and JAK2/STAT3 pathways in the liver and synovial tissues, while ELB significantly inhibited the activation of the inflammatory signaling pathway. In conclusion, ELB is protective in rats with chronic alcoholic liver injury and gouty arthritis, possibly mediated by the inhibition of TLR4/MyD88/NF-κB, NLRP3, and JAK2-STAT3 signaling pathways in both the hepatic and synovial tissues.

Case report and disease’ review: tophaceous gouty arthropathy

Gout is a common inflammatory and metabolic disorder of the joints and probably other organs, especially the kidneys. It has a definitive genetic and environmental background, making it mainly a disease of middle-aged and elderly males, infrequently inflicting postmenopausal and elderly women who usually have arterial hypertension, renal impairment, and usually on diuretics. Excessive tissue urate turnover and persistent hyperuricemia is the hallmark of the disease. A typical algorithm is characterized by acute attack of the monoarticular joint, the metatarsophalangeal joint of the big toe often is involved (podagra), but tarsal joints, ankles, and knees might also be affected. Chronic asymmetric polyarticular arthritis that might be confused with classical Rheumatoid Arthritis might be encountered in some patients and in recurrent and relapsing diseases. In this setting, many organs and tissues are affected by the deposition of monosodium urate (MSU) crystals other than synovium, bursae, tendons, and periarticular tissues. The risk of involvement of renal interstitium or uric acid nephrolithiasis has a particular interest in the course of the disease. By the inflammation and collection of MSU crystals in form of tophi that might involve many tissues and occasionally the pinna of the ears, this kind of tophaceous gout is rarely observed nowadays, especially in our community (Middle East region). The patient who is presented here has exhibited acute attack on the top of chronic tophaceous gouty arthritis. The recent epidemiologic reports revealed that gout has given different results. This wide variation is attributed to the population studied and methods employed, but overall, for the prevalence of &lt;1% to 6.8% and an incidence of 0.58-2.89 per 1,000 person per year. The most noticeable risks for gout are obesity and associated metabolic syndrome (insulin resistance, hypertension, dyslipidaemia), dietary factors, high fructose-containing diet, high purine diet (red meat, internal organ’s meat ,seafood) high consumption of alcohol, and exclusively beer ( as in our patient’s case ), a wide variety of disorders that are characterized by high urate turnover like myeloproliferative disorders, neoplasms, psoriasis, haemolytic anaemias, medications , to under-secretion of urate like renal insufficiency.

Acute gout – A harbinger for more serious outcome

Gout is a crystal-induced arthropathy which can start as an acute arthritis and over a few years become chronic and cause systemic complications. Acute gout can manifest as an emergency and cause misery. It is considered as one of the risk factors for hypertension, metabolic syndrome, and cardiovascular disease and when becomes chronic, may end in nephropathy. It may be primary or secondary. Recognition of gout is a simple exercise most of the times but may manifest with atypical features. This discussion is primarily on acute gout, hence its progression to chronic gouty arthritis and its attending complications has a passing mention.

Uric Acid Levels in Menopausal Women

Based on data from Riskesdas 2013, in line with increasing age the prevalence of joint disease has increased. The trigger is abnormal metabolic processes in the body and 10% of cases occur in postmenopausal women because the production of the hormone estrogen is disrupted. If treatment is not carried out, it will result in chronic gouty arthritis, resulting in paralysis. The purpose of this study was to determine the description of uric acid levels in postmenopausal women in Berahan Kulon Village, Wedung District, Demak Regency. The research method used is an observational study with a cross sectional approach. Of the 20 research subjects, 1 research subject had low uric acid levels, 9 research subjects had normal uric acid levels, and 10 research subjects had high uric acid levels. High uric acid levels were dominated by the age group 51-55 years, menopause duration 6-10 years and 10 years, no history of heredity, and consumption of foods high in uric acid 3-5 times/week and 5 times/week. The conclusion of this study is that 5% of postmenopausal women have low uric acid levels, 45% have normal uric acid levels, and 50% have high uric acid levels.

«Вегетативный паспорт» и реабилитационный диагноз в артрологической практике

Проблема постановки так называемого реабилитационного диагноза (РД) на основе Международной классификации функционирования, ограничений жизнедеятельности и здоровья остается малоизвестной стороной деятельности врачей и психологов. В настоящее время не существует единых подходов к постановке РД специалистами разного профиля, абсолютно не разработаны общие принципы РД для артрологической группы больных, удовлетворяющие врачей-реабилитологов и врачей-ревматологов, хотя именно заболевания суставов могут быть некой моделью для решения обсуждаемой проблемы. Это стало целью и задачами настоящего исследования. Материал и методы. Выдвинутая научная концепция базировалась на анализе результатов обследования и эффективности последующей реабилитации 643 больных с разными по патогенезу заболеваниями суставов: 249 человек с ревматоидным артритом, 89 — с хронической формой подагрического артрита, 305 — с остеоартритом. Результаты. Необходимость РД, который вытекает из клинического и функционального диагнозов, признается во всем мире, но пока он мало известен отечественным реабилитологам и не используется в практике ревматологами, а ведь именно РД является неким ключом успешных мероприятий по восстановительному лечению больных, страдающих заболеваниями суставов. В основу разработанной классификации РД был положен принцип распределения больных по типам вегетативной нервной системы (ваготоники, симпатотоники и эйтоники), от которых сильно зависит эффективность реабилитационных мероприятий, с определением так называемого «вегетативного паспорта». Если среди здоровых пациентов, таких же по полу и возрасту, распределение по частоте ваготоников, симпатотоников и эйтоников было 1 : 3 : 5, то среди больных РА существенно превалировали лица с доминированием симпатической активности (симпатикотоники), а среди других групп пациентов с хронической патологией суставов — парасимпатической (парасимпатикотоники). У ваготоников основным медиатором является ацетилхолин, а у симпатотоников — норадреналин. Заключение. Предложенный РД для ревматоидного, подагрического артрита и остеоартрита на основе «вегетативного паспорта», степени нарушений функций опорно-двигательного аппарата, параметров измененного гомеостаза и форм соматогении найдет свое применение в работе реабилитологов и ревматологов, а на предложенных принципах дальнейшая разработка и внедрение РД, опосредованного через типы вегетативной ­нервной системы, займут достойное место в практике специалистов другого профиля.

Differential Diagnosis of Acute and Chronic Gouty Arthritis by Multijoint Ultrasound

To investigate whether multi-joint ultrasound (US) findings in patients with gouty arthritis could be used to distinguish between acute and chronic stages, we performed a retrospective study with 129 enrolled patients from the Rheumatology Department of the First Affiliated Hospital of Chengdu Medical College from September 1, 2018 to June 12, 2019. Patients with acute or non-acute gout were categorized using clinical data, and US imaging findings of the knees, ankles and first metatarsophalangeal joints were analyzed and compared between groups. Notably, we found that the most prevalent sign detected by US was the hyperechoic spot in the synovium, followed by arthrosynovitis, aggregates, double contour signs and tophi; meanwhile, bone erosions were the least common. Additionally, synovitis was more frequently detected in the acute joints of gouty arthritis (49%) compared with the non-acute joints (35%), whereas grade 1 or 2 blood flow classifications (97%), tophi and bone lesions were more often seen in the latter. Overall, our data suggest that multi-joint US scanning might be used to evaluate disease severity and discriminate between stages of gouty arthritis.

Establishment of a clinical diagnostic model for gouty arthritis based on the serum biochemical profile: A case-control study.

The disease progression of gouty arthritis (GA) is relatively clear, with the 4 stages of hyperuricemia (HUA), acute gouty arthritis (AGA), gouty arthritis during the intermittent period (GIP), and chronic gouty arthritis (CGA). This paper attempts to construct a clinical diagnostic model based on blood routine test data, in order to avoid the need for bursa fluid examination and other tedious steps, and at the same time to predict the development direction of GA.Serum samples from 579 subjects were collected within 3 years in this study and were divided into a training set (n = 379) and validation set (n = 200). After a series of multivariate statistical analyses, the serum biochemical profile was obtained, which could effectively distinguish different stages of GA. A clinical diagnosis model based on the biochemical index of the training set was established to maximize the probability of the stage as a diagnosis, and the serum biochemical data from 200 patients were used for validation.The total area under the curve (AUC) of the clinical diagnostic model was 0.9534, and the AUCs of the 5 models were 0.9814 (Control), 0.9288 (HUA), 0.9752 (AGA), 0.9056 (GIP), and 0.9759 (CGA). The kappa coefficient of the clinical diagnostic model was 0.80.This clinical diagnostic model could be applied clinically and in research to improve the accuracy of the identification of the different stages of GA. Meanwhile, the serum biochemical profile revealed by this study could be used to assist the clinical diagnosis and prediction of GA.

ASSESSMENT OF URODYNAMICS AND CONCENTRATION FUNCTION OF PARENCHYMA IN PATIENTS WITH ARTERIAL HYPERTENSION AND GOUT

Objective: To assess the urodynamics and concentration function of the parenchyma in patients with arterial hypertension and gout. Design and method: We examined 87 patients with arterial hypertension and gout. 83% were men (mean age 55.4 ± 12.3 years). Grade 1 of arterial hypertension was detected in 43.7%, grade 2 - in 36.9%, grade 3 - in 19.3%. All the patients had chronic gouty arthritis, 30% of the patients had tophi. Markers for kidney damage, urine sediment, GFR calculation were evaluated in all the patients. All the patients were given a systemic examination of their nephro-urological condition based on complex renal scintigraphy (SENS-CRS) with the in-depth differential analysis of the impaired renal parenchyma function, upper and lower urinary tract (fig.1). Results: According to the standard method of GFR calculation using the CKD-EPI formula, we found that 10 patients (11.3%) had no CKD symptoms; stage I-II CKD was observed in 56 patients (64.5%), stage III-IV in 21 patients (24.2%). 16 patients with arterial hypertension and serum creatinin level &gt;125 μmol/l were allocated to a subgroup of patients in the category of increased risk of developing high stages of CKD. According to the CKD-EPI formula, those 16 patients had CKD stage I-II and one patient had stage III CKD with a high risk of transition it to stage IV. The reliable difference (p &lt; 0.05) was established only by the D (%) indicator that is by the radiopharmaceutical removal rate from the renal parenchyma when we compared the analyses of complex renal scintigraphy data in the 16 specified patients and in the remaining 71 patients with arterial hypertension (tab.1). Conclusions: Patients with arterial hypertension from the time of gout diagnosis must be included in the nephro-urological control system. It is important to control the risk factors related to the probability of CKD progression. The renocortical parameter D (%) used in the SENS-CRS technology is a prognostically important preclinical marker of intrarenal congestion when the latent development of serious morphological and functional disorders in the renal parenchyma occurs that leads to the CKD development or aggravation of the existing CKD stage.

Differentiation of Crystals Associated With Arthropathies by Spectral Photon-Counting Radiography: A Proof-of-Concept Study.

The aims of this study were to test whether spectral photon-counting radiography (SPCR) is able to identify and distinguish different crystals associated with arthropathies in vitro and to validate findings in a gouty human third toe ex vivo. Industry-standard calibration rods of calcium pyrophosphate, calcium hydroxyapatite (HA), and monosodium urate (MSU) were scanned with SPCR in an experimental setup. Each material was available at 3 different concentrations, and a dedicated photon-counting detector was used for SPCR, whereas validation scans were obtained on a clinical dual-energy computed tomography (DECT) scanner. Regions of interest were placed on SPCR images and consecutive DECT images to measure x-ray attenuation characteristics, including effective atomic numbers (Zeff). Statistical tests were performed for differentiation of Zeff between concentrations, materials, and imaging modalities. In addition, a third toe from a patient with chronic gouty arthritis was scanned with SPCR and DECT for differentiation of MSU from HA. In both SPCR and DECT, significant differences in attenuation and Zeff values were found for different concentrations among (P < 0.001) and between different materials (P < 0.001). Overall, quantitative measurements of Zeff did not differ significantly between SPCR- and DECT-derived measurements (P = 0.054-0.412). In the human cadaver toe, gouty bone erosions were visible on standard grayscale radiographic images; however, spectral image decomposition revealed the nature and extent of MSU deposits and was able to separate it from bone HA by Zeff. Identification and differentiation of different crystals related to arthropathies are possible with SPCR at comparable diagnostic accuracy to DECT. Further research is needed to assess diagnostic accuracy and clinical usability in vivo.

Increased Efficacy and Tolerability of Pegloticase in Patients With Uncontrolled Gout Co-Treated With Methotrexate: A Retrospective Study.

IntroductionGout is a painful inflammatory condition caused by chronically elevated serum uric acid levels (sUA). When standard urate-lowering therapies fail/are not tolerated, uncontrolled gout (elevated sUA, subcutaneous tophi, chronic gouty arthritis, frequent flares) can occur. Pegloticase, a recombinant uricase, converts uric acid to allantoin, a readily excreted molecule. Responder rate in trials was 42%, limited by anti-drug antibody (ADA) development. Immunomodulators attenuate ADA formation and case reports suggest immunomodulation increases pegloticase responder rates. The current study retrospectively examined responder rate in patients undergoing methotrexate/pegloticase co-therapy.MethodsPatients who underwent methotrexate/pegloticase co-treatment at a single rheumatology practice were included. Demographics, clinical, treatment, and safety parameters were collected. The primary outcome was the proportion of responders (≥ 12 biweekly pegloticase infusions, sUA < 6 mg/dl just prior to infusion 12).ResultsTen patients (nine men, 52.3 ± 13.5 years) with uncontrolled tophaceous gout (erosive damage, ulcerative tophi, frequent flares, gout-related hospitalizations) were included. Patients had failed allopurinol (100–300 mg) or febuxostat (40 mg) therapy (doses not increased because of intolerance, kidney concerns, noncompliance, or rapid tophi resolution requirement). Baseline sUA was 9.42 ± 2.05 mg/dl. Along with standard pre-infusion prophylaxis, nine patients received subcutaneous methotrexate (25 mg/week) initiated 14–35 days before pegloticase and one patient received oral methotrexate (12.5 mg/week) initiated 14 days after pegloticase. Eight patients (80%) were responders, receiving 15.5 ± 3.8 infusions (range, 12–21) over 31.8 ± 9.5 weeks. One patient had efficacy loss with mild infusion reaction during infusion 4 and one patient was lost to follow-up after infusion 5. One patient reported one gout flare. No new safety concerns emerged.ConclusionsMethotrexate/pegloticase co-therapy resulted in a higher responder rate than the established 42% with pegloticase alone. Therefore, methotrexate/pegloticase co-therapy may safely allow more patients to benefit from a full treatment course, likely through ADA attenuation.

Impact of the Synbiotics and Urate-Lowering Therapy on Gut Microbiota and Cytokine Profile in Patients with Chronic Gouty Arthritis.

The main goal of our study is the impact evaluation of complex urate-lowering therapy with the synbiotic addition on fecal microbiota and cytokine profile in patients with primary gout. During our study, 130 men (mean age 55.5 ± 9.4 years) with gout (duration 7.7 ± 7.1 years) were examined. All patients were divided into two treatment groups. The main group (n = 68) was taking allopurinol at 300 mg per day dose and additionally a synbiotic. The comparison group (n = 62) received allopurinol monotherapy without synbiotic intake. The therapy duration was 3 months. Evaluation of therapy efficiency was marked by blood uric acid changes, cytokine levels, CRP and fecal microbiota condition. After treatment, stabilization of the gut microbiota parameters was observed, which was leading to normalization uricemia levels (40.3% vs. 21%, p <0.01) in the main group patients. Addition of synbiotic to allopurinol leads to a blood uric acid lowering (18.7% vs. 13.3%, p <0.01), CRP reduction (75% vs. 26.3%, p <0.01) as well as decrease of cytokines level: IL-1β, IL-6, IL-8, IL-10 and TNFα (all p <0.001). After a 3-month gout treatment, a group of patients who received complex therapy with synbiotic inclusion showed signs of disease remission characterized by inflammation activity reducing, fecal microbiota condition normalization and a more pronounced decrease in laboratory markers comparing to control group.

Gout, Hyperuricaemia and Crystal-Associated Disease Network (G-CAN) consensus statement regarding labels and definitions of disease states of gout

ObjectiveThere is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease...